While many people associate breast cancer with a noticeable lump, the earliest signs are often much more subtle. In fact, many early symptoms are missed by patients and even providers without specialized training in breast imaging. Learning to recognize these subtle signs is key to catching breast cancer early, when treatment is most effective. In this post, Dr. Tchaiko Parris, MD, PhD, Medical Director of Mammography & Breast Cancer Prevention at ImageONE shares insights on the less obvious ways breast cancer can present, and how mammography technologists and radiologists can work together to detect subtle but important changes.
Not All Breast Lumps Are the Same
A new breast lump is the most common symptom of breast cancer. But not all lumps feel or look the same.
"Most cancerous lumps are hard, irregular, and painless," explains Dr. Parris. "By contrast, benign lumps tend to be round, soft, and sometimes tender. But these patterns are not always reliable."
Some lumps are deep within the tissue and not noticeable during a self exam. Others may be missed if a patient skips their annual mammogram. This is why both regular screening and clear communication are essential.
Early Signs of Breast Cancer That Are Easy to Miss
Breast cancer symptoms are not always obvious. Some subtle signs to watch for include:
- Swelling in part of the breast, even without a lump
- Shrinking or asymmetry between the breasts
- Dimpling, puckering, or thickened skin
- Discoloration or "orange peel" skin texture
- Nipple pain, inversion, or retraction
- Redness or irritation around the nipple or areola
- Nipple discharge (especially if clear or bloody)
- Swollen lymph nodes near the collarbone or under the arm
"These changes are easy to overlook," says Dr. Parris. "But even slight distortion or texture changes can be meaningful in breast imaging."
How Mammography Technologists Help Spot Subtle Signs
Technologists are often the first point of contact for patients. They may hear about concerns the radiologist does not. A thoughtful intake process, along with attention to what the patient is experiencing, can help identify areas that need further review.
TomoSPOT® skin markers are designed to mark specific areas on the breast, such as moles, scars, or palpable concerns. One unique offering is the square-shaped TomoSPOT, which is specifically intended for nonpalpable findings like focal pain, skin dimpling, swelling, orange peel texture, or other subtle but potentially significant surface changes.
By placing a visible marker over these nonpalpable findings, technologists provide radiologists with critical context that bridges the gap between patient symptoms and image interpretation. It reinforces that even minor, hard-to-define changes are being properly evaluated.
"Marking what the patient feels on their body builds trust," says Dr. Parris. "It also improves accuracy and helps us connect what we see on the image with what the patient is experiencing."
Why Annual Mammograms Are So Important
Even the most subtle signs of breast cancer can become easier to detect when radiologists have previous images to compare. A small shift in density, a change in symmetry, or the development of architectural distortion may not be apparent on a single image but becomes clear when compared over time.
Keeping up with your regular mammogram schedule is one of the best ways to support early detection.
Every Small Detail Matters in Breast Cancer Detection
Breast cancer doesn’t always present as a lump. A minor skin change, unusual sensation, or nipple irregularity could be an early warning sign. The key to early diagnosis is paying attention, listening carefully, and using every available tool to ensure nothing is missed.
Tools like TomoSPOTs give technologists and radiologists the visual clarity they need to take patient-reported symptoms seriously and act on them with confidence. When subtle signs are taken seriously, it can make the difference between catching breast cancer early or catching it too late.
Megan Sargalski
Marketing Communications Specialist
