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The image illustrates lesser-known signs of breast cancer that should be checked out ASAP.

January 13, 2017

What can you learn from a carton of lemons? A lot, it turns out. A viral photo of the citrus fruit is helping to spread the word that lumps aren't the only breast cancer symptom women need to know about.

Earlier this week, breast cancer survivor Erin Smith Chieze posted the image on her Facebook page, in response to all the heart emojis that were popping up in her feed. The emojis are part of a social media trend meant to raise awareness about breast cancer. But Chieze wanted to share something that might actually help someone with the disease.

She chose a graphic that uses a dozen lemons to illustrate 12 different symptoms that shouldn't be ignored, including lesser-known signs of cancer, such as dimpling and a retracted nipple. In the caption, Chieze explained that the graphic is very similar to one that saved her life.

"Someone once posted a picture on Facebook of what breast cancer can look like. Not feel, but look like," she wrote. Then, in December of 2015, Chieze noticed an indentation on her breast that resembled what she had seen in that image. She checked for a lump, and felt nothing; but went to get checked out by a doctor. Five days later, Chieze was diagnosed with cancer. The next month, she learned she had stage 4. "I knew all about self exams, but a picture of what to look for keyed me into knowing I had a terminal disease," she wrote in her post, which has since been shared more than 33,000 times.

In the past few days, I have received quite a few private messages about a "game" going around where you post a heart,...

Posted by Erin Smith Chieze on Tuesday, January 10, 2017

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The graphic is part of a grassroots campaign called #KnowYourLemons, launched by the charity Worldwide Breast Cancer. And according to Marisa C. Weiss, MD, director of breast radiation oncology at the Lankenau Medical Center in Wynnewood, Pennsylvania, it accurately represents a "range of presentations for breast cancer."

You should alert your doctor if you notice any of the symptoms shown, says Dr. Weiss, who is also the chief medical officer and founder of Breastcancer.org. Those changes include a new shape or size on one side; sores; redness or heat; unusual or new nipple discharge; a nipple that indents or seems to turn inward; an indentation in the skin; dimpling anywhere on your breast; a change in skin texture; a growing vein; and of course, a thick mass, a bump, or a hard, hidden lump.

But it's important to remember that many tumors cannot be felt or seen, Dr. Weiss adds. "Most breast cancers are detected through mammography with a range of findings," she explained in an email, such as an area of "architectural distortion," or a cluster of tiny calcifications. "Many of these mammo findings are not in fact palpable or visible from the outside. That is, most of them are not represented by the lemons."

So in addition to checking your breasts for any changes on a regular basis, be sure to talk to you doc about when and how often you should get a mammogram as well.