A Ugandan oncologist has urged women to seek medical assessment for changes in their breasts even when they experience no pain or notice no lump, warning that misconceptions about breast cancer can delay diagnosis.
Dr Aleesha Adatia, a medical oncologist and palliative care specialist who heads the oncology department at C-Care International Hospital Kampala, said awareness efforts should cover less familiar signs of the disease, including changes in breast skin, nipple appearance, discharge and shape.
Breast cancer was Uganda’s second most commonly diagnosed cancer among women in 2022, with an estimated 2,999 new cases, according to the International Agency for Research on Cancer’s GLOBOCAN database. Cervical cancer ranked first, with 6,938 cases.
The figures highlight the burden of cancer among women in Uganda and the importance of recognising symptoms and obtaining timely medical assessment.
Symptoms can occur without pain
Adatia said some women dismiss breast lumps that do not hurt, assuming they are harmless cysts, swollen glands or changes associated with hormonal fluctuations.
However, the absence of pain does not rule out cancer. The World Health Organization lists a breast lump or thickening, often without pain, among the possible symptoms of the disease.
Other changes that warrant medical assessment include unexplained redness, scaling or dimpling of the breast skin, a nipple that turns inward, abnormal nipple discharge and changes in breast size, shape or symmetry.
Discharge that occurs without squeezing the nipple, particularly if it contains blood or comes from one breast, should also be evaluated.
Not every breast change indicates cancer. Cysts, hormonal changes and other non-cancerous conditions can cause lumps or changes in breast tissue. Medical assessment is needed to establish the cause.
The WHO says early diagnosis involves recognising possible symptoms, seeking medical advice and obtaining timely evaluation and referral for treatment where necessary.
Family history does not tell the whole story
Adatia also cautioned against assessing breast cancer risk solely through a woman’s family history.
Inherited genetic changes, including harmful variants in the BRCA1 and BRCA2 genes, can increase the risk of breast cancer. These variants can be inherited from either parent, meaning a history of cancer on the father’s side of the family is also relevant.
However, the absence of a known family history does not mean a woman cannot develop the disease.
Risk assessment considers several factors, including age, personal medical history and inherited genetic risk. Women with a strong family history or known risk-increasing genetic variants may require additional assessment and a different screening approach.
Screening and early assessment
Adatia said women should familiarise themselves with what is normal for their breasts and seek medical advice when they notice a new or persistent change.
Screening recommendations differ according to age, individual risk and the guidance used by healthcare providers. Mammography can detect some cancers before symptoms appear, but a woman who notices a suspicious change should not wait for a routine screening appointment.
The WHO identifies early diagnosis and screening as two distinct parts of efforts to detect breast cancer. Early diagnosis focuses on evaluating possible symptoms, while screening seeks to identify disease in people who do not have recognisable symptoms.
Finding cancer before it has spread can improve the chances of successful treatment. However, outcomes also depend on the cancer’s type, stage and the treatment available.
Treatment and psychological support
Breast cancer treatment may involve surgery, radiotherapy, chemotherapy, hormone therapy, targeted medicines or immunotherapy, depending on the characteristics of the cancer and how far it has spread.
Adatia said care should also address the psychological and practical challenges patients face during and after treatment.
At C-Care Uganda, she said, treatment plans include chemotherapy and targeted therapies where appropriate, alongside psychosocial support, management of treatment-related symptoms and attention to patients’ quality of life.
She also highlighted the importance of supportive and palliative care when needed, as well as advice on skin care following chemotherapy.
Fear of a diagnosis and concerns about treatment can influence how patients respond to symptoms. Adatia urged women not to assume that a cancer diagnosis automatically means death or that treatment experiences are the same for every patient.
During Breast Cancer Awareness Month in October, she called on women to pay attention to changes in their breasts, understand their individual risk and consult healthcare professionals about appropriate screening.
“One of the most dangerous misconceptions about breast cancer is that it must hurt, or that there must be a lump. Breast cancer does not always announce itself that way. A new change in the breast, whether it is a lump, skin dimpling, nipple inversion, unexplained discharge or a change in shape, deserves attention. And importantly, having no family history does not mean you are not at risk. Know what is normal for your breasts, know your individual risk, and do not wait for pain before seeking medical advice.”
Adatia is a medical oncologist and palliative care specialist and head of the oncology department at C-Care International Hospital Kampala.
