Stage 1 breast cancer is the earliest stage of breast cancer, when the tumor is small and has not spread beyond the breast. The main symptoms of stage 1 breast cancer include changes or abnormalities in the breast that are usually first detected by a woman herself or by a healthcare provider during a clinical breast exam. Some of the most common symptoms and signs are:
- A painless, hard lump in the breast or underarm area
- Thickening or swelling of part of the breast
- Irritation or dimpling of breast skin
- Redness or flaky skin in the nipple area or the breast
- Pulling in of the nipple or pain in the nipple area
- Nipple discharge other than breast milk, including blood
These changes are most often found during self-exams or mammograms before women experience any symptoms. Approximately 60-70% of stage 1 breast cancers are detected through screening mammograms before the cancer can be felt, highlighting the importance of regular mammogram screenings. Some early-stage breast cancers may not have any signs or symptoms at all. As tumors grow in size and invade deeper breast tissue in later stages, additional symptoms like breast pain and skin changes become more apparent.
Lump in the Breast
A lump in the breast is often the first noticeable symptom of early-stage breast cancer. The lump is usually hard, irregularly shaped, and painless, though some may be tender to the touch. Lumps are most frequently found in the upper, outer quadrant of the breast, but can occur anywhere. Breast self-exams and professional clinical breast exams are the most effective ways to detect abnormal lumps. Any new lumps warrant further diagnostic evaluation, though most breast lumps are noncancerous (benign). Still, it is essential that all women have any unusual breast lumps examined by their doctor right away.
Characteristics of Cancerous Lumps
Lumps in stage 1 breast cancers typically exhibit some or all of these characteristics:
- Hard, firm to the touch
- Usually painless
- Immovable – does not shift when pushed
- Irregular edges or shape
- Fixed deep in breast tissue
Benign breast lumps tend to be soft, rounded, movable, and sometimes painful. But there is no sure way to know if a lump is cancerous from feel alone. Imaging tests and breast biopsies are needed to determine if a breast lump is malignant or benign. Any suspicious or unexplained lump should be investigated.
Changes in Breast Size or Shape
Swelling, thickening, or distortion of the breast shape can indicate stage 1 breast cancer. Early cancers may manifest as:
- Noticeable increase in breast size and/or fullness
- Swelling in a specific part of the breast
- Puckering, dimpling, or indentation of the breast skin resembling an orange peel
- New asymmetry between the two breasts
- One breast feeling heavier or fuller than the other
- Nipple inversion or spontaneous discharge from the nipple
These changes are often subtle in stage 1 and may not be accompanied by pain or discomfort. Many times, changes in breast contour are only detected through a clinical exam. Women should know how their breasts normally look and feel and report any differences or changes to their doctor right away.
Skin Changes
Some early skin changes can indicate breast cancer:
- Thickening or pitting similar to an orange peel (peau d’orange)
- Unexplained redness, rash, or swelling
- Warmth, burning, or itching of the breast
- Changes in nipple shape or position
- Nipple retraction – nipple pulled into the breast
- Scaly, flaky skin around nipple or areola
These skin changes are due to cancer cells blocking and invading the lymph vessels in the skin overlying the breast. Inflammatory breast cancer specifically may cause diffuse skin inflammation and a swollen, red appearance. Any abnormal skin textures or colors on the breast should be evaluated promptly.
Nipple Discharge
A spontaneous nipple discharge is another common symptom of early breast cancer. Types of worrisome discharge include:
- Occurs without squeezing the nipple
- Present in only one breast
- Bloody, brown, or clear fluid discharge
- Sticky, thick discharge
Healthy breast secretions can be milky or clear. But new onset of unilateral nipple discharge in any form warrants further evaluation, especially if no nipple discharge was present before. Doctors may analyze the discharge under a microscope to help determine if cancer cells are present.
Breast Pain
Breast pain is not a cardinal symptom of early breast cancer. In stage 1, painless lumps are more common. As the cancer grows, some women may notice heaviness, discomfort, or pain in the affected breast or armpit region. Pain or tenderness is still more likely to be from a benign breast condition like a cyst or fibroadenoma. Sharp breast pains that persist warrant medical attention. Be sure to tell the doctor about any breast pain, even if you believe it to be hormonal.
When to See a Doctor
Women should report any of the following breast changes immediately to their healthcare provider:
- New lumps, swelling, or thickening in breast or underarm
- Nipple changes – inversion, rash, discharge, retraction
- Changes in breast size or shape
- Unexplained persistent breast pain
- Redness, scaliness, or warmth of breast skin
- Recently noticed asymmetry of breasts
Early detection is key with breast cancer. Even if symptoms are mild or insignificant, it’s important to have them examined promptly. Your doctor will perform a clinical breast exam and may order breast imaging tests like a diagnostic mammogram, ultrasound, or MRI scan to evaluate any abnormalities. If results are suspicious for cancer, a biopsy of the breast lump or abnormal tissue will be done to confirm a cancer diagnosis. Don’t delay on getting any breast changes checked out.
Risk Factors
There are certain risk factors that increase a woman’s chances of developing breast cancer:
- Older age – risk rises as women age, most cases over age 50
- Genetic mutations (BRCA1/BRCA2)
- Family history of breast cancer
- Personal history of breast cancer or certain benign breast conditions
- Early menstrual periods (before age 12)
- Late menopause (after age 55)
- Never being pregnant
- Recent use of oral contraceptives
- Post-menopausal hormone therapy
- Radiation treatment to chest or face before age 30
- High breast tissue density on a mammogram
- Obesity, especially after menopause
- Alcohol consumption
- Sedentary lifestyle
But even without any risk factors, it is still important for women to have regular breast cancer screening. All women over age 40 should get annual mammograms to detect any cancer in its earliest stages. Clinical breast exams every 1-3 years are also recommended, starting in the 20s. Women at higher risk may require supplemental screening with MRI. Finding and treating any breast cancer early provides the best prognosis.
Diagnostic Evaluation
If you have any potential symptoms of breast cancer, further testing will be necessary. Here are some common diagnostic tests used to evaluate breast abnormalities:
- Clinical breast exam – Physical palpation exam performed by healthcare provider
- Diagnostic mammography – More detailed, targeted views of the breast compared to screening mammograms
- Breast ultrasound – Uses soundwaves to examine breast lumps or abnormalities
- Breast MRI – Magnetic imaging test that can help characterize indeterminate findings
- Biopsy – Removal of suspicious breast tissue for analysis; required for definitive diagnosis
Based on results of this workup, your doctor will be able to determine if breast cancer is present and at what stage. Pathology reporting from a biopsy can confirm a stage 1 diagnosis when cancer cells are found confined to the breast with no lymph node involvement or distant spread.
Breast Cancer Staging
Breast cancer is categorized into five main stages based on tumor size, lymph node status, and metastasis. Stage 1 is the earliest stage:
Stage 0 – Non-invasive breast cancer or carcinoma in situ confined to milk ducts.
Stage 1 – Tumor 2 cm or less in size with no lymph node involvement or distant spread.
Stage 2 – Tumor 2-5 cm with spread to underarm lymph nodes on same side.
Stage 3 – Larger tumor or any size with cancer found in several lymph nodes.
Stage 4 – Advanced cancer that has metastasized to other organs like lungs, liver, bones, or brain.
Treatment is tailored to the individual’s cancer stage. The majority of stage 1 breast cancers have an excellent prognosis with 5-year survival over 90% with appropriate treatment.
Treatment
Common treatments utilized for stage 1 invasive breast cancers include:
- Lumpectomy – Removal of tumor and small margin of surrounding tissue
- Mastectomy – Removal of entire breast containing cancer
- Radiation – External beam radiation to kill any remaining cancer cells
- Hormone therapy – Anti-estrogen medicines for ER+ cancers
- Chemotherapy – Used sometimes if tumor > 5 mm or high grade
- Targeted therapy – Herceptin for HER2+ breast cancers
Depending on the tumor characteristics and patient preferences, a combination of surgery, radiation, and systemic therapy is used. Treatment side effects are usually minimal with early stage disease. The five-year survival rate for properly treated stage 1 breast cancer is close to 100%.
Outlook and Survival Rates
Stage 1 breast cancers have an excellent prognosis when treated appropriately. Overall 5-year survival rates by subtype for stage 1 breast cancer are:
- Stage 1A – 100%
- Stage 1B – 93%
- Stage 1C – 92%
Survival is slightly lower for cancers that are higher grade, larger size, or have spread to a few lymph nodes. But generally stage 1 breast cancers have a favorable outcome with conventional treatments like surgery, radiation, chemotherapy, and targeted drugs.
Regular follow up is important after completing treatment to monitor for potential recurrence. But the probability of cure is quite high for most women with an early stage 1 diagnosis before the cancer advances further. Catching breast cancer early and starting treatment without delay provides the best chances for long-term remission and survival.
Conclusion
Stage 1 breast cancer is highly curable, especially when diagnosed early. Some typical symptoms include a new lump or mass in the breast, changes to breast size or shape, nipple abnormalities, skin changes, or spontaneous nipple discharge. But early cancers can also be asymptomatic and only detected via screening mammograms. Regardless of symptoms, diagnostic workup with imaging and biopsy is essential to confirm a stage 1 diagnosis. Most women go on to have excellent outcomes with current treatments like surgery, radiation therapy, chemotherapy, hormone therapy, and targeted drugs. Starting treatment promptly at this earliest stage gives a favorable prognosis. Women should know what is normal for their breasts and report any concerning changes to their doctor as soon as possible. Increased awareness, early detection, and timely treatment provide the best odds of survival.