HEALTH
We’ re all taught to check for lumps, and that’ s important – but it’ s not the whole story.
“ Although breast cancer presents as a lump in most patients, about 17 % of all breast cancers did not present with a palpable lump,” says Dr Cornél Steyn of Mediclinic Kloof in Pretoria. Instead, they show up as skin or nipple changes, or pain that might easily be shrugged off as hormones, a rash, or“ just my bra”.
Because we are so focused on finding a physical lump, we may miss the other ways breast cancer can present. Knowing the full picture means you can get checked sooner. Early detection saves lives and there is up to a 95 % chance of successful treatment of breast cancer at an early stage.
According to Dr Steyn, signs that could point to breast cancer even when there is no lump include:
• Changes in breast size or shape: Look for a new change in asymmetry, particularly if one breast gets larger than the other.
• Puckering: This may appear as an indentation in one breast when raising your arms to form a“ Y”.
• Skin changes: Dimpling may occur when a malignant growth pulls the skin inwards. Redness can be associated with inflammatory breast cancer, while thickening or orange-peel appearance, known as peau d’ orange, should also be investigated.
• Nipple changes: These include a newly inverted nipple, redness, or flaky skin, and bloody or unusual charge.
• A non-healing ulcer or wound on the breast or nipple.
• A breast abscess when you are not breastfeeding: Although rare, breast cancer can sometimes resemble an abscess. A doctor may recommend further investigation, including imaging or a biopsy.
WHY DON’ T YOU ALWAYS GET A LUMP? Some breast cancers are detected before a lump develops.“ Early breast cancer can present as ductal carcinoma in situ( DCIS, very early breast cancer), which oftentimes do not present with a mass but rather present with mammogram signs such as calcifications in the breast,” says Dr Steyn.
There are also certain types of breast cancer that are more likely to be diagnosed without a lump.“ In some cases, patients could have Paget’ s disease of the nipple, which is also a carcinoma in situ of the breast,” she explains. This can also present without a lump, but it would involve changes such as a flaky, red, itchy nipple, and nonhealing, bleeding lesions on the nipple.
Then there is inflammatory breast carcinoma.“ It presents with an array of symptoms, such as a diffusely red, tender breast. The breast usually feels warmer and heavier than the other breast, and there is this‘ orange-peel’ skin associated with this breast cancer,” says Dr Steyn.
Some changes can be less obvious on darker skin tones. Dense breast tissue can also make mammograms more difficult to interpret, which is why feeling and looking matters.
HOW TO CHECK PROPERLY“ Knowing your breasts is of the utmost importance,” says Dr Steyn. You don’ t need a complicated technique, but you do need to know your“ normal”.
Once a month, ideally just after your period if you menstruate, follow these steps:
• Look: Stand in front of a mirror with your arms by your side, then hands on your hips, and finally raise your arms overhead. Look for changes in skin texture, overall shape, nipple direction, swelling, or visible veins.
• Feel: In the shower or while lying down, use the flat pads of three fingers. Cover the whole breast from your collarbone to your bra line, and from your armpit to your breastbone. Don’ t forget the armpit and collarbone areas.
“ Seek advice if you pick up any changes, like those we’ ve mentioned,” she adds.“ Having regular clinical breast exams with your GP and going for routine mammograms and breast examinations, as per your local guidelines, is very important in detecting breast cancer early.”
Most breast concerns turn out to be benign. Getting checked isn’ t inviting bad news; it means you’ re giving yourself options, peace of mind, and the best chance of early treatment.“ The take-home message here,” concludes Dr Steyn,“ is to know your breasts and seek help if you notice any changes.” IB
OCTOBER 2026 / INBOUND SA 51