Warning Signs of Breast Cancer Beyond the Lump: What Should Send You to the Doctor

Breast cancer is the most common type of cancer in women in Romania. The disease can develop without symptoms, and the risk increases with age. Changes in the breasts are an important signal, but do not automatically indicate the presence of cancer.

Who is at greater risk

Breast cancer can occur at any age, including in women with no known risk factors. According to the World Health Organisation, factors that influence risk include: female sex (99% of cases occur in women), a family history of breast cancer, certain genetic mutations, obesity, alcohol and tobacco consumption, previous exposure to radiation, age at first menstruation, and age at first pregnancy.

However, approximately 80% of cases occur in women with no specific risk factors beyond sex and age. Most diagnoses are made after the age of 50, and more than half of cases in the European Union are recorded in women between the ages of 45 and 69.

Statistical data

According to the WHO, in 2024 approximately 2.4 million women worldwide were diagnosed with breast cancer, and 694,000 died from the disease. This type of cancer was the most common in women in 164 of the 186 countries analysed.

The International Agency for Research on Cancer (IARC) estimates that 1 in 20 women worldwide will be diagnosed with breast cancer during their lifetime. If current trends continue, by 2050 there could be 3.2 million new cases and 1.1 million deaths annually.

At European Union level, the European Cancer Information System (ECIS) estimated approximately 360,000 new cases in women for 2024, representing 29% of all cancers diagnosed in women. Breast cancer ranks fourth among causes of cancer death in the EU, accounting for 7.3% of all cancer deaths across both sexes.

In Romania, GLOBOCAN 2024 (IARC) estimates indicate 12,308 new cases and 3,599 deaths, with breast cancer representing 27% of cancers diagnosed in women.

The WHO and the European Union recommend organised screening by mammography for women aged between 50 and 69, the age range in which incidence is highest, with screening recommended once every two years.

Romania is implementing the DARIA project (Active Detection, Responsibility, Information and Access), through which women aged 50–69 who meet the vulnerability criteria will have free access to mammography. The aim is for at least 119,000 women to benefit from this examination by 2029.

Despite these measures, the European Cancer Screening Policy Index 2026 report places Romania last in Europe, with an overall score of 11%. The participation rate in breast cancer screening is just 9%, according to survey data cited in the report.

Symptoms requiring urgent investigation

Screening is intended for women without symptoms, as a tumour can develop without any visible signs. Once symptoms appear, seeing a doctor becomes urgent.

The most common symptom is the appearance of a new lump or mass in the breast, although most lumps are not cancerous. According to the American Cancer Society, a fixed, hard, painless mass with irregular edges is more likely to be cancerous, but cancer can also present as a soft, round, tender, or painful mass.

Other possible signs mentioned by the same source include:

• swelling of all or part of the breast, even without a palpable lump;
• dimpling of the skin on the breast, sometimes with an orange-peel appearance;
• red, dry, flaking, or thickened skin on the nipple or breast;
• pain in the breasts or nipples;
• nipple retraction (turning inward);
• nipple discharge other than breast milk;
• swollen lymph nodes under the arm or near the collarbone, which may appear as a sign of the disease spreading even before the original tumour can be felt.

Changes that are not necessarily cancer

Breast changes can also have benign (non-cancerous) causes, including lumps, pain, or nipple discharge. Medical investigations are necessary to distinguish a serious condition from one that is more straightforward to treat.

Hormonal changes can affect the breasts throughout life. Before the menopause, breast size and shape may change during the menstrual cycle, and pregnancy can also produce changes. The use of hormonal medications, such as contraceptives or hormone replacement therapy, can likewise affect breast tissue.

Most breast pain is not caused by cancer, with the most common cause being linked to hormonal fluctuations. Tenderness and pain can arise due to pregnancy, breastfeeding, ill-fitting bras, injuries or trauma, breast infections (mastitis), or other benign conditions.

Specialists recommend that patients keep track of when pain occurs, in order to identify any pattern (cyclical or non-cyclical) that may help the medical team establish the cause.

Although pain is not usually a sign of most breast cancers, there are situations in which a tumour manifests as pain around a mass, in another area of the breast, or in the armpit. In such cases, the pain is generally accompanied by other symptoms and is constant, lasting more than a few weeks, described as a sensation of tightness, burning, tingling, or stabbing in a specific area.

The American Cancer Society also mentions a rare type known as inflammatory breast cancer, which frequently causes pain, swelling, and rapidly developing firmness, as well as skin changes that cause the skin to become red and take on an orange-peel appearance.

Recommendations for women

It is important for women to know their own risk of breast cancer, including whether they have a family history of the disease — in which case investigations may be recommended at shorter intervals or started earlier in life.

Regular screening remains essential: women between the ages of 50 and 69 are advised to have a mammogram every two years, even in the absence of any warning signs.

Women are also advised to be familiar with their own bodies and the normal appearance of their breasts, so that they can quickly notice any changes and bring them to the attention of a doctor.