- Amanda Lenahan, 50, from Watlington, watched a doctor speak on TV
- He advised getting creased or dimpled breast skin checked
- Amanda went to her GP and was diagnosed with breast cancer
- Other symptoms include a nipple that has become inverted
Amanda was diagnosed with breast cancer
Drying her hair in front of the mirror one morning Amanda Lenahan noticed strange creases, around a millimetre deep, in the skin underneath her left breast.
‘It was as if an area of skin the size of a 50 pence piece had been caught up and snagged,’ says Amanda, 50, a mother-of-two from Watlington, Oxfordshire.
‘I put it down to recently losing two stone, going down to 8 ½ st after dieting,’ recalls Amanda, now three years later.
At 5 ft 5 in, she’d had gone from a 36 DD to a 34 B. One thing she wasn’t worried about was cancer – ‘there is none in my family and I felt my breasts for lumps once a month’.
But coincidentally, as Amanda dried her hair, she was watching breakfast television where a doctor was discussing breast cancer.
He spoke about taking notice of skin changes, including creasing or puckering, where the skin is dented or dimpled.
‘I looked in the mirror again and saw my breasts didn’t match,’ recalls Amanda, who has 11-year-old twins Chloe and Luca with her husband Des, 54, a sales and marketing director.
‘My right breast was smooth while my left one was puckered. I couldn’t feel any lumps, but the changes may have been there for months – I couldn’t remember when I’d last looked at my breasts properly.’
That day she went to see her GP. Skin puckering around the breast can be caused by cancer pulling the skin inwards, so it is a symptom that should be taken seriously.
However, when Amanda’s doctor examined her, she couldn’t feel any lumps and she, too, put it down to the weight loss.
‘I was 47 at the time and the GP said I’d have to wait until I was 50 to have a mammogram on the NHS,’ says Amanda, who works as a part-time carer.
‘But I needed reassurance. I knew a family history puts you at higher risk so, although I felt awful lying, I pretended my mum and granny had breast cancer. There was obviously no mention of that in my notes, but she took me more seriously and referred me for tests.’
Two weeks later, a specialist at the John Radcliffe Hospital, Oxford, examined her breasts but didn’t seem concerned. A biopsy came back clear; however, the specialist also arranged for a mammogram a few days later.
The day after the mammogram Amanda got a call telling her to go to the Churchill Hospital in Oxford. ‘My legs went because I know it’s a cancer hospital,’ says Amanda. ‘I went into a trance.’
Amanda (pictured when younger) went to her GP after watching a doctor on TV describing tell tale signs
Des went with her and after an ultrasound scan, Amanda was given the devastating news. She had two lumps in her left breast – one under her nipple and one under the breast – and they were cancerous.
‘I asked the radiologist if I would die. She said I wouldn’t, but I’d need to see a consultant urgently.
‘I left in tears. I could barely look at the kids. They were eight so I didn’t want to worry them by saying I was ill, but I tortured myself thinking that I wouldn’t see them grow up.’
About 50,000 cases of breast cancer are diagnosed every year and 32 per cent are found through routine mammograms, offered every three years to women aged 50 to 70.
Ninety per cent of the remaining cases go to their GP with a lump, while the other 10 per cent – around 3,400 women – have other symptoms, such as skin changes. Yet although many women routinely look for lumps, too few are aware of the need to check for visible changes.
Tell-tale signs to look out for
Puckering or dimpling of the skin
A nipple that has become inverted or changed its position or shape
A rash on or around the nipple
A lump or thickening in your breast that feels different from the rest of the breast tissue
Discharge from the nipples
A swelling under your armpit or around your collarbone (where lymph nodes are)
‘Most people think about lumps but skin changes – which affect up to 5 per cent of patients – can also be a symptom, even without a noticeable lump,’ says Simon Smith, a consultant oncoplastic breast surgeon at the Chelmsford Breast Unit and Springfield Hospital in Essex.
‘Women might not take skin changes as seriously as lumps and delay seeing a GP. The changes can include skin puckering, which looks like a small dent in the skin. Women often notice this in a mirror when they lift their arms, but often can’t feel a lump.
‘In these cases, the women may have a tumour inside the breast, which causes the ligaments (fibrous tissue) in the breast to shorten. This shortening pulls the tissue and skin inwards, which results in a puckered appearance, known as tethering.’
Skin puckering can be a first sign of breast cancer in women – it’s only later that they will find a lump, adds Lester Barr, a consultant surgeon specialising in breast cancer at the Christie Hospital in Manchester.
Male patients are usually diagnosed after finding a lump because there isn’t much skin in the breast to pucker. It’s important to note that puckered skin may not always be cancer – as breasts are made partly of fat, if a woman has lost a significant amount of weight, it may leave her with saggy skin on her breasts, which may look like puckering.
Days after her diagnosis, Amanda’s consultant advised a mastectomy
Another sign to watch for is the skin looking like ‘orange peel’, which may indicate inflammatory breast cancer, adds Mr Barr, who is chair of Genesis Breast Cancer Prevention in Manchester.
This is a more aggressive, though rarer, cancer. Here, the cancer cells grow along tiny channels called the lymph vessels – these become blocked, causing the breast to become inflamed and swollen and a large area of skin to develop little dimples.
Other less common symptoms of breast cancer include bleeding from the nipple – it could suggest that cancer cells are lining the ducts behind the nipple, says Mr Barr.
Developing an inverted nipple – i.e. not being born with one – which can’t be drawn out, may suggest a lump behind the nipple is pulling it in.
A swelling in the lymph glands under the arms can be a warning sign, too. These glands are part of the immune system as they defend the body against infection.
‘In some women, the cancer may have spread to the lymph glands under the arms, because they are the nearest to the breast,’ says Mr Barr. ‘Sometimes a lump under the arm is more noticeable than in the breast.’
Paget’s disease of the nipple mimics eczema, causing an itchy red rash on the nipple. This is usually a sign that breast cancer is in tissue behind the nipple. It affects up to 2 per cent of breast cancer patients.
Days after her diagnosis, Amanda’s consultant advised a mastectomy. Her tumours were grade III, meaning the breast cancer has extended beyond the immediate region of the tumour.
‘I hated the thought of a mastectomy,’ says Amanda. ‘I felt young and wanted to be able to wear a bikini. I asked for a lumpectomy (where only the lumps are removed).
‘My consultant agreed, but warned if she didn’t get a clear margin of cancer-free tissue, I’d need a mastectomy. I told the children I had a lump which needed removing, and I might need medicine to make me better.’
In April, Amanda’s 17 mm and 13 mm tumours were removed. Seven lymph nodes from under her arms were also removed – the cancer had spread to one of them.
‘I felt groggy and sore afterwards but relieved,’ says Amanda.
Luckily, she didn’t need a mastectomy, as the lumps were removed with a clear margin, but she did need chemotherapy and radiotherapy. The radiotherapy – which she started in January 2012 – had an unexpected effect, drawing her nipple inwards.
Radiotherapy interferes with blood supply to the breast, which affects existing scar tissue within the breast that has formed after surgery. This makes scarring worse, causing the scar to contract and shorten more than normal, pulling the breast inwards.
‘I always have an ultrasound at my check-ups to make sure my nipple is only inverted because of the radiotherapy,’ says Amanda.
Scans have since shown the cancer has been cleared.
However, Amanda is now taking the drug Tamoxifen, which blocks oestrogen from reaching cancer cells – her cancer was found to be fuelled by the hormone – and has annual check-ups.
Following her experience she is keen to help other women spot the danger signs early.
‘Don’t just feel your breasts – lift them up, separate them and look all around them,’ advises Amanda. ‘If there’s anything unusual or they don’t match, see your doctor.
‘We expect lumps to be like gobstoppers, but sometimes they can’t be seen or felt and there will be other symptoms that could be spotted much earlier.’
I never knew an inverted nipple was so dangerous
Ali Schofield is a 31-year-old writer who lives in Steeton, West Yorkshire. She writes:
Ali’s nipple had inverted and felt quite hard
Putting on my yoga bra before a class late last year, I realised my right nipple had inverted and felt quite hard. I had read that changes in the breast could be a sign of cancer, but was shocked when my GP referred me for a scan.
The hospital consultant reassured me that usually an inverted nipple was nothing to worry about. I was then 30, with no history of breast cancer in my family.
I had an ultrasound scan and the radiologist said he could see no cause for concern. What a relief! My nipple stayed inverted and hard but I paid little attention to it. I started trying for a baby with my boyfriend Tim, and we looked for a new home in the next county.
Before the house move, I thought I’d visit my GP to check it again.
Nearly a year later, I returned to hospital for another ultrasound but I still couldn’t feel a lump.
This consultant told me there definitely was a lump. I had a biopsy, and the results confirmed it – I had invasive breast cancer.
That was three months ago, and I am having a course of chemotherapy. Luckily, a biopsy of tissue under my arm revealed the cancer has not spread beyond the breast.
The treatment is hard. I’ve lost all my hair and, after the chemotherapy, I feel tired and achy.
I am also having hormone injections of leuprorelin acetate. These induce a false, reversible menopause, in the hope that my ovaries might not be damaged by chemotherapy. Early next year, I will have a mastectomy and possibly radiotherapy. I’m determined to stay positive.
My worry is that not enough people are aware that an inverted nipple can be a sign of breast cancer – patients and GPs alike.