Like many people, Lisa Harvey was used to the occasional twinge in her back.
But three years ago, she experienced pain which was so intense that, at times, it took her breath away.
“It came on gradually, starting as a nagging pain just below my right shoulder blade, but soon built up into a constant throbbing sensation - as if someone had pressed a hot needle into my back,” says the deputy registrar of marriages and deaths, from Cardiff, Wales.
“I would sit at my desk feeling as if I was about to cry.
“I thought I must have somehow pulled a muscle and I wanted to get as much heat into it as possible. I’d go home and push a hot water bottle into my back until my skin was red raw.”
Occasionally, the excruciating spasms would radiate into her breast and armpit, even as far as her elbow.
“But I assumed it was all a knock-on effect of a pulled muscle in my back. I thought perhaps I’d picked something up the wrong way.”
After several weeks of agony, the mother-of-two described the symptom to her GP and asked for some naproxen; she had found this powerful anti-inflammatory effective when she suffered whiplash in a car accident a few years earlier.
But this time the drug only made a slight difference. And it wasn’t until three months after the symptom appeared that she discovered what was really wrong: she had breast cancer.
Although a lump in the breast is the most obvious and best-known symptom of breast cancer, one in six women with this disease has symptoms other than a lump, according to a study of more than 2000 women published in May in the journal Cancer Epidemiology.
These can include a swollen arm, breathlessness, weight loss or, as in Harvey’s case, back pain.
But because of a lack of awareness about such symptoms, these women are more likely to wait three months or more before seeing their GP than those who find a lump, the University College London (UCL) researchers said.
Indeed, the possibility of cancer only occurred to Harvey - and her GP - when she finally found a lump herself three months later in April 2014.
“I hadn’t contemplated checking my breasts when my back was hurting,” says Harvey, 46, who is married to Tim, 51, a sales director. “But I’d forgotten to pack the shower puff I wash with, so I had to use my hands.”
That’s how she came to find a pea-sized lump, on the underside of her right breast.
She went back to her doctor after her holiday and was immediately referred for tests that confirmed the cancer diagnosis.
Thankfully, although the tumour was aggressive, it was still confined to the breast. One in eight women is diagnosed with breast cancer during their life, and the symptom of back pain is typically associated with cancer that has spread to the bones.
“Bones are the most common site of secondary breast cancer, and it tends to affect large bones such as the spine, ribs and shoulder blades,” says Emma Pennery, clinical director of the charity Breast Cancer Care. A swollen arm, breathlessness and weight loss - some of the symptoms flagged up in the recent UCL study - also tend to be associated with breast cancer that’s spread (to the lymph nodes in the arm or lungs, for example).
However, there are a number of reasons why back pain may occur with cancer confined to the breast, too.
“Sometimes the specific location of the cancer can trigger a symptom, such as pain for example, by pushing on a nerve,” says Pennery. “There’s also a recognised syndrome called referred pain, where pain is felt in a part of the body other than its source.
“We don’t know exactly why this happens, but because cancer attaches to tissue and can pull down on it, and can intrude on blood vessels and nerves that can sometimes lead to pain elsewhere in the body.”
General ill health, too, can be a trigger for back pain, explains Dr Martin Johnson, clinical lead for chronic pain for the Royal College of General Practitioners.
“If someone isn’t feeling well, they become less mobile and start to slouch, causing back pain - your muscles get stiffer and can start to spasm.”
It’s also possible that someone may have back pain and then find a breast lump, but the two events are not entirely connected.
One difficulty is that back pain “is one of the vaguest symptoms known to man”, says Johnson. “Nearly everyone gets it at some point in their life and the vast majority of it is muscular.”
For this reason, Breast Cancer Care does not list it as a key symptom of the disease. “As there are so many things that can cause back pain, from the very banal to the more serious, it could be misleading - you don’t want everyone with back pain to assume they have breast cancer,” says Pennery.
“That said, it’s important that if someone has a symptom that’s not going away and is difficult to explain - that is, there’s no obvious cause, such as having spent three hours digging in your allotment - then see your GP.”
Other red flags that indicate there may be a more serious cause include pain that wakes you at night, or gets worse despite taking painkillers.
Unfortunately, there is a lack of awareness surrounding the less well-known symptoms - on the part of patients, but also potentially among GPs, says Dr Anne Rigg, a consultant medical oncologist at Guy’s and St Thomas’ NHS Hospital Trust in London.
As for patients, she adds: “There is no doubt that when there is a lump, almost everyone knows that it might be cancer and they go and see a doctor quickly. When it’s a lesser-known symptom, people tend to see a doctor much later.”
By the time Harvey received her diagnosis, she had prepared herself for the fact it might be cancer. “When I broke it to my husband he looked as though he’d been punched in the face.”
She had surgery, radiotherapy, chemotherapy, and was given tamoxifen, a hormone therapy drug. Harvey says: “The worst thing was that the treatment put me into an early menopause - I’d have hot flushes and joint pain as a result.
“The back pain subsided when I had surgery, and as far as I’m aware I’m free from cancer now. However, one thing I do now is shout about the fact that upper back pain can be a symptom of breast cancer - it never crossed my mind I might have cancer until I found that lump.”
While back pain may be an unusual symptom, there are other more common signs many women may not realise can also indicate breast cancer because they assume the only indication is a lump.
These include change in the size or shape of the breast, a change in skin texture such as puckering or dimpling, any redness or rash on the skin or an inverted or altered nipple.
Discharge from the nipple, swelling around the armpit or collarbone, constant pain in the breast or armpit, are also possible symptoms. - Daily Mail