Although almost 65% of women over 40 have had a mammogram in the last two years, according to the CDC, cancer isn’t always caught by screening tests.
Moreover, when women do suspect something, fear sometimes prevents them from seeing a doctor right away, says Beth Y. Karlan, MD, director of the Women’s Cancer Research Program at Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute in Los Angeles. Or women minimize or misinterpret symptoms that could indicate cancer.
“They say, ‘Oh, this bloating is nothing. It can wait,’” says Karlan. “There’s this idea that if you look into it, if you acknowledge the symptoms, then something is going to change in your life, and you don’t want it to change.
“But warning signs do not mean cancer,” she adds. “Even if you have all of them. There are many other benign diagnoses or physiological changes that can also cause warning signs.” For instance, you can have bloating, low back pain, and pelvic pressure and just have fibroids, says Karlan.
But if your symptoms are “persistent and progressive,” she says, “meaning you wake up every morning and feel something and it has you worried — even for two weeks in a row — it really is worth calling your physician and having it checked out.”
Regular checkups and screenings such as Pap smears and mammograms, as well as knowing your own body, are all crucial for good health, Karlan adds.
Which changes are worth bringing to your doctor’s attention? We’ve asked experts about the signs and symptoms you most want to keep on your radar screen.
1. Breast Changes
“If you feel a lump, you shouldn’t ignore it, even if your mammogram is normal,” says Carolyn Runowicz, MD, a breast cancer survivor and professor of obstetrics and gynecology at Florida International University’s Herbert Wertheim College of Medicine and past president of the American Cancer Society. If your nipple develops scaliness or flaking, that could indicate Paget’s disease of the nipple, which is associated with an underlying cancer in about 95% of cases. Any milky or bloody nipple discharge should also be checked out.
Dimpling of the skin over the breast, particularly if it looks like the skin on an orange, “is something to be worried about,” says Karlan. Such dimpling is most often associated with inflammatory breast cancer, a rare, usually aggressive cancer characterized also by swollen, hot, red breasts.
Expect your doctor to do a breast exam and medical history, followed by a mammogram or sonogram and perhaps a biopsy, depending on the results of both tests.
2. Irregular Bleeding
Once you hit menopause (defined as 12 months without a period), any postmenopausal bleeding is a warning sign, says Runowicz. “Any bleeding, staining, little drops on your underwear, or big clots are abnormal and should be immediately investigated,” she says. Such bleeding could indicate something as benign as an endometrial polyp or something more serious like endometrial or cervical cancer.
Bleeding that is uncharacteristic for you — spotting outside of your normal menstrual cycle or heavier periods — should be looked into, says Karlan. Around menopause, abnormal bleeding is often attributed to hormonal shifts, though more serious problems could be the cause, which is why all abnormal vaginal bleeding should be evaluated. Expect to receive a transvaginal sonogram and perhaps a biopsy.
3. Rectal Bleeding
Colon cancer is the third most common cancer in women. One of the hallmarks is rectal bleeding, which many people attribute to hemorrhoids, the most common cause. “But it’s not always that,” says Karlan. Red or dark blood in your stool warrants a visit to your doctor, she says.
Your doctor will likely do a rectal exam and order a colonoscopy if you’re 50 or older and perhaps even if you’re younger.
4. Discharge
A foul or smelly vaginal discharge could be a sign of cervical cancer, says Runowicz. The discharge may contain blood and may occur between periods or after menopause. It’s best not to self-treat a discharge with over-the-counter medications, she advises.
An exam is necessary to determine if the discharge is due to an infection or something more serious.
5. Bloating
“Ovarian cancer is the No. 1 killer of all the reproductive-organ cancers,” says Karlan. “For years it’s been known by the misnomer of the silent killer, and we really need to put that aside. Ovarian cancer clearly has symptoms.” The four most frequent are bloating; feeling that you’re getting full earlier than you typically would when eating; changing bowel or bladder habits, such as urinating more frequently; and low back or pelvic pain.
It’s not unusual to have one or two of these symptoms occasionally, particularly after a big meal. But pay attention if you have two or more symptoms occurring daily for more than two weeks. “If they’re persistent and progressive,” says Karlan, “call your physician.”
Expect a pelvic exam, transvaginal sonogram, and perhaps a CA-125 blood test to check for cancerous cells.
6. Unexplained Weight Gain or Loss
“If you suddenly put on 5 pounds, I wouldn’t worry,” says Runowicz. But gaining excess weight month to month — especially if you usually maintain a normal weight and watch what you eat — can be due to an accumulation of fluid in the belly related to ovarian cancer and warrants seeing your doctor, she says.
Unexplained weight loss of 10 pounds or more “may be the first sign of cancer,” according to the American Cancer Society, and is most often associated with pancreatic, stomach, esophagus, or lung cancer.
But weight loss in women is often caused by a hyperactive thyroid, says Runowicz. Expect your doctor to order a thyroid test first to check for this common disease.
7. Persistent Cough
Any persistent cough — one that lasts more than two or three weeks and is not due to an allergy or upper respiratory infection or one that produces blood in the sputum — needs to be checked by your doctor. If your cough may be caused by smoking or being exposed to second-hand smoke, get it checked out. “Smoking is the number one cancer killer of women,” says Karlan. Yet you don’t have to be a smoker to be at risk; the majority of lung cancers that occur in nonsmokers also occur in women. Expect your doctor to order a chest X-ray and perhaps a CT scan.
8. Change in Lymph Nodes
“If you feel hard lymph nodes in your neck or under your arm, you should be seen by a doctor,” advises Runowicz. Swollen, firm lymph nodes are often the result of an infection. However, lymphoma or lung, breast, head, or neck cancer that has spread can also show up as an enlarged lymph node. Expect a physical exam and possibly a biopsy.
9. Fatigue
Although fatigue can be hard to quantify, the American Cancer Society defines it as “extreme tiredness that does not get better with rest.” If you’re persistently fatigued, see your doctor. Leukemia, colon, or stomach cancer — which can cause blood loss — can result in fatigue.
“Fatigue can be a serious problem and it’s easy to ignore,” says Runowicz, who notes your doctor will most likely do a physical exam and order blood tests to evaluate your thyroid and rule out a thyroid condition.
10. Skin Changes
Keep an eye on any changes you notice on your skin all over your body, and call your doctor right away if anything concerns you.
Sores in the mouth that don’t heal — especially if you smoke or drink alcohol — may be a sign of oral cancer and should be examined by your physician.
In particular, note any sores or irritated skin in the vaginal area. “A nonhealing vulvar lesion could be a sign of vulvar cancer,” says Runowicz. Changes in moles or pigmented lesions on the vulva can also signify cancer. “Vulvar melanoma can frequently be overlooked and can have a very aggressive course,” says Karlan. A simple biopsy can be done in your doctor’s office if necessary.
The Bottom Line
Watch for all of these symptoms, but remember: While it’s important to be on the alert for physical changes, “We don’t want to [cause] too much alarm,” says Karlan.
“Don’t be afraid,” she says. If you notice something different about your body, get it checked out. Most likely it’s not cancer, but if it is, she says, “cancer is treatable, often it’s curable, and clearly having a diagnosis earlier will allow you to have the most benefit possible from current health care advances and to live as full a life as prior to a diagnosis.”
Caryl Engstrom agrees. “It’s all about early diagnosis. At the stage I was diagnosed, it was completely treatable,” she says. Getting confirmation she had breast cancer was “the worst part.” The treatment — a mastectomy, chemotherapy, and radiation — “wasn’t that difficult,” she adds. “I found it all very manageable.”
Today, two years after being diagnosed and treated, Engstrom is in remission, despite having what turned out to be a very fast-growing cancer — and, more important, despite recent screenings that revealed nothing amiss. For her, picking up the phone right away was the best thing she could do for her health — and her life.
