Six subtle warning signs that could point to breast cancer.

Most women are aware that if they discover a lump in their breast, they should have it checked out by a doctor – immediately. Most also are (hopefully) having regular breast examinations and being vigilant about checking their own breasts in the shower.

What a lot of us don’t know, however, is that even though the discovery of a lump is usually the most obvious and classic sign, breast cancer can present itself in a number of other, often very subtle, ways.

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Which is exactly how Lisa Royle of Manchester, England, recently discovered a malignant breast cancer. She post a selfie on Facebook that went viral to highlight her only symptom. A symptom that was so subtle, she almost missed it.

Her only warning was this:

A slight puckering (sometimes describes as dimpling) of the skin, underneath the breast. "This is all that I found," she wrote before she underwent a mastectomy. "Very subtle dimples underneath that could easily be missed" Royle urged other women on Facebook to "Please take time to look at your boobs, it could save [your] life."

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A survey of women in the UK shows that fewer than half of women over 70 could name a single symptom of breast cancer other than a lump, highlighting the lack of knowledge that exists in this area.

So what is it we should be on the lookout for? Whilst the following six warning signs aren't a definitive list, they are some of the lesser known symptoms of breast cancer that we should be watching out for:

1. Itchy breasts

This symptom, mostly associated with inflammatory breast cancer, is often not noticed. So many women with breast cancer spend months visiting the dermatologist, only to be sent home with creams and medications for a rash. If it is extremely itchy and it makes you feel like scratching, constantly, continue to ask questions until you get answers.

2. Upper back, shoulder and neck pain

Sometimes, breast cancer can be felt in the back or shoulders rather than the chest or breasts. The pain can easily be confused with sore muscles. The difference is the pain doesn’t go away with stretching or changing position. Bone pain is a deep ache or throbbing, and the first place breast cancer usually spreads is to the spine or ribs, becoming secondary spine cancer. If back pain doesn’t go away with rest, stretching or physical therapy, see a doctor.

3. Changes in breast shape, size or appearance

Your partner might notice this change even before you do. Or it might become obvious to you when you put your bra on and look in the mirror. Tissue growth might push out the shape or size of the breast without causing an obvious lump. Be particularly alert if you’ve been told you have dense breast tissue. Study the shape and size of your breasts in a mirror. If there’s a difference in size or shape you haven’t ever noticed, approach your doctor.

4. A change in nipple appearance or sensitivity

One of the most common locations for a breast tumour is just beneath the nipple, which can alter the look and feel of the nipple. You may notice that one of your nipples sticks up less than it used to, or it might have become inverted, flattened or indented. Remember this is about a CHANGE, so if you've always had inverted nipples, this isn't cause for concern.

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There can also be a decrease in nipple sensitivity, which can come to you or your partner’s attention during sex.

Finally, unless you are breastfeeding, if you discover discharge coming from your nipples, you need to have it investigated. The skin of the nipple can also become crusty, scaly or inflamed. Many breast cancers start in the milk ducts just under and around the nipple, affecting the nipple’s appearance or causing pain or discharge. Because some women have naturally inverted nipples or have discharge during and post-pregnancy, a doctor won’t necessarily notice this symptom. Pay close attention to any changes in the nipples and discuss them with your doctor.

5. Swelling or lump in your armpit

Any pain in the armpit is a sign to check the area carefully with your fingers. A lump under the armpit is hard and doesn’t move when you touch it. It will feel like a sore or tender spot under the arm. You may not necessarily feel a lump. In some women, the swelling is more prominent under the arm or under the collarbone. The lymph nodes in your armpit are where breast cancer spreads first, by way of lymphatic fluid that drains from the breast. Basically, if a lump or tender spot in the underarm area persists for a week with no apparent cause, see your doctor.

 6. Skin dimpling or puckering

The American Cancer Society warns that skin dimpling on the breast can be a sign of cancer, though many women may be unaware of its significance. As Lisa Royle mentioned when posting her selfie on Facebook, recognising this abnormality saved her life.

It's important to remember the different potential signs of breast cancer are important, having one or more of these symptoms does not automatically mean you have cancer. But a doctor visit to determine the cause is still necessary.

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Breast cancer remains the most common cancer (aside from some skin cancer) in women, so it is important to be on the lookout for any changes in our bodies, even when they aren't obviously in the breast.

You know your body best so if something doesn't feel quite right, PLEASE get it checked it out. Women with a family history of breast cancer or others at higher risk may need more frequent screening starting at a younger age, and should be vigilant about checking any physical changes.

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Remember, the earlier you find it, the better chance you have of fighting it.

See how you can check your breasts for lumps here:

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