Where’s the lump?
The unknown symptoms of breast cancer
When Kat Balaporia stepped out of the shower and looked at herself in the mirror, she noticed that something was different. Her right breast looked larger than her left breast and when she touched it, she realised it felt heavier than normal.
“It looked really out of proportion,” says the 50-year-old local authority worker, who lives with her husband, a civil servant, in Welwyn Garden City, Hertfordshire. “It wasn’t painful or anything – just heavy. It looked like someone had put air in it and blown it up. I assumed it was hormonal, possibly premenopausal changes, and put it to the back of my mind.”
But a couple of weeks later, when her right breast had still not returned to its normal size, Balaporia decided to visit her GP and see if anything was wrong. She was referred to a local breast clinic for tests, and – to her horror – was diagnosed with breast cancer.
“It was a complete shock,” she recalls, four years later. “I just sat there with my mouth open. Then I just cried and cried and cried. I couldn’t come to terms with it, or absorb the enormity of the whole thing. I hadn’t ever considered it could be cancer. I automatically assumed you’d need to have a lump for it to be cancerous. I didn’t think the appearance of the breast alone could suggest it was cancer.”
Balaporia, who was 46 at the time, had regularly been self-examining her breasts for lumps and had previously discovered benign cysts. However, like many women, she had no idea that breast cancer could develop without causing a lump, and can present with more vague symptoms, such as heaviness, a thickness in the breast tissue, an inverted nipple, a change to the skin, or any other general change to the breast.
Balaporia was diagnosed with grade three breast cancer – suggesting it was fast-growing – and had a mastectomy, chemotherapy and radiotherapy. She says the next eight months of her life were a painful blur, and she struggled to cope psychologically.
“It was completely horrendous. The fact that I lost my femininity and my body was invaded by this horrible disease – it was a complete nightmare. I felt like I was in a big dark hole and I couldn’t climb out.
“It also affected my marriage. I’ve been married for 29 years, but my husband became my carer, and things changed slightly. His priorities towards me changed, and I suffered with poor body image and, in a way, I felt unable to be a wife. It’s only now we’re on the road to making it back to normal.”
The fact that she had cancer without showing the characteristic symptom of a lump left Balaporia traumatised. Indeed, in December 2013, when a routine mammogram showed a small speck on her left breast, she decided to have an elective mastectomy on that side, too, because she felt unable to cope with the anxiety.
“I spent years constantly worrying the cancer had come back,” she says. “It’s only in the past year that my emotional state has improved and I’ve been able to understand that not every ache and pain is suggestive of the cancer coming back.”
She has been in remission for the past two years, and is due to have breast reconstruction surgery this month, which she hopes will help her regain her identity as a woman, and move on from the experience.
Balaporia is one of the 53,000 people diagnosed with breast cancer each year in the UK. But while 75 per cent of cases will have lumps, thousands will not. A study last year, by Public Health England, found that half of women could not name any symptoms of breast cancer other than a lump; the authors warned that this lack of awareness could lead to delays in diagnosis.
“Although the most common sign of breast cancer is a lump, there are other less common, but still important, things to look out for, too, such as a change in the size or shape of the breast, changes to the nipple or unusual discharge,” says Katherine Woods, senior research communications manager at charity Breast Cancer Now. “We want women to be aware of how their breasts look and feel normally, and to check for anything unusual.
“If women spot anything unusual, we encourage them to visit their GP. Though most breast changes aren’t breast cancer, in the cases where it is, catching it early means you’re more likely to beat it. That’s why it’s so important to check regularly.”
For Natalie Haywood, 30, it was a thickening in her breast that prompted her to go to her doctor. Like Balaporia, she noticed it in the shower.
“It didn’t feel like a lump at all,” she says. “It just felt thick, and not as soft as my other breast tissue. My husband suggested I go to the GP.”
Haywood’s GP was not concerned, but referred her to a breast cancer clinic to be safe. She had several tests, before a core biopsy found cancer in her breast. Doctors then discovered that Haywood had inherited a BRCA2 genetic mutation, meaning she was at raised risk of breast cancer. She had a double mastectomy, followed by eight rounds of chemotherapy and radiotherapy.
“I was so shocked, because I was only 29 and I didn’t have a lump,” says Haywood, who is married with two daughters, aged seven and four, and lives in Leicestershire. “But my initial concern wasn’t about me – it was about my husband and the girls. You hear the words ‘you have cancer’ and think you’re going to die. The hardest part was the uncertainty. Even though I’ve had a brilliant response to chemotherapy, there’s always a fear it might come back.”
She is now in remission, and is grateful she went straight to the doctor after noticing a change to her breast. “Had I left it three or six months, it would have continued to spread and so my cancer would have reached stage four. Now, knowing what I know, I hope any woman who notices a change gets it checked out.
“Women need to be persistent. If you go to a GP and they say it’s hormonal, ask to be referred to a breast clinic. It might not be anything, but it could be the difference between life or death.”
‘I was in total shock. I couldn’t come to terms with it’