Breast protection in handball — staying safe and healthy on the court

On a community level, European handball has actively played its role in raising awareness. For example, current EHF Champions League Women title holders Györi Audi ETO KC have an ongoing campaign in October 2025, involving activities such as warming up in the Breast Cancer Awareness Month brand-defined pink and selling a limited edition shirt with proceeds going to a local cancer organisation. 

In 2024, Slovakia and the Faroe Islands organised a charity match featuring their national teams, where proceeds amounting to over €20,000 were donated to the fight against breast cancer. The federations intended to repeat the initiative in 2025.

RK Celje, this season featuring in the EHF European Cup and previously part of the EHF Champions League Men line-up, have played select October matches in pink jerseys to show their support.

While it is crucial that the members of the handball community impacted by breast cancer feel our support, and the value of that support cannot be underestimated, there is seemingly a slim link between breast cancer and handball. However, there are important topics surrounding the subject relevant to our sport, and it is those we aim to highlight here, with Breast Cancer Awareness Month as the original inspiration.

Physical activity decreases risk of breast cancer

Research has shown that physical activity decreases the risk of diseases such as breast cancer. A 2009 publication, “Her Life Depends On It: Sport, Physical Activity, and the Health and Well-being of American Girls and Women,” summarised the findings of 23 studies investigating the impact of physical activity during adolescence on later cancer risk, stating that those active during adolescence and young adulthood were 20 per cent less likely to later get breast cancer. 

In December 2023, UK-based research and support charity Breast Cancer Now reported their analysis of 19 studies featuring over 540,000 women. They found the most active women were less likely to develop breast cancer before menopause compared to the least active.

Here it is important to highlight the two different age brackets examined — the impact of activity at a young age and of physical activity into adulthood. Both show a decreased risk of breast cancer, which brings us to sports like handball and the ongoing goal of improving both participation and retention. When considering significant health consequences like breast cancer, the motivation to increase retention among female handball players becomes even greater.

While experts highlight that there is no single cause of breast cancer, “research has shown that exercise can lower sex hormones like oestrogen and testosterone which have been linked to an increased risk of breast cancer. Physical activity can also lower someone’s levels of insulin and growth hormone. And these molecules can help breast cancer to grow. And exercise decreases inflammation, which is linked to cancer growing and spreading,” as reported on breastcancernow.org.

The potentially severe consequences of breast injuries

Considering breast cancer and any link to handball led us to a common occurrence in the sport: physical hits to the breast(s). Are there serious consequences? And what are they?

Related to breast cancer, the current consensus is that there is no direct link between physical hits to the breasts and developing cancer as a result. However, there can be long-term consequences of breast injuries sustained through sport.

A study published in the Journal of Science and Medicine in Sport in August this year — “Breast injuries in women’s sports: a scoping review of a female-specific sports injury” by Dang et al. — highlighted a lack of research and understanding in this area. That current lack of understanding is the main conclusion — breast injuries are an area still to be more thoroughly examined, and we may learn later of more significance. For now, it seems clear enough that there can be consequences and those injuries are worth protecting against.

However, Dang et al.’s study did bring together findings from different sports that relate to current possibilities for practice. Breast injury prevalence was found to be higher in contact sports, which has a direct relevance to handball. Across the 50 sports appearing in the studies reviewed, management and prevention strategies were found to be limited, and there is also a low percentage of injuries reported.

A study of collegiate-level athletes in the US showed that breast injuries across the four sports examined — basketball, football, softball and volleyball — are common, with almost 50 per cent of the athletes surveyed reporting an injury to the breast as part of the study, but only 9.6 per cent informed anyone at the time and only 2.1 per cent received treatment. Also of note is that 18.2 per cent said their injury impacted play, making running uncomfortable, causing them to be less likely to tackle or take physical risks, or being distracted by pain. This impact on play is a concept that can be extrapolated to handball — that female players may be hurt but not say anything and potentially cause long-term consequences.

Her Playground ambassador Andrea Lekic says: “When we are talking about breast hits in handball, I think we are not at all aware how big consequences we can have and get from that, but it’s just really painful and it causes a lot of physical pain — not constantly, but it happens occasionally that it’s pretty painful. Honestly throughout my career, it has never been a topic.”

The good news is that serious breast injuries appear to be rare. “Most injuries were deemed mild-moderate in severity because most athletes continued to play, albeit with a perceived negative effect on performance. In rare cases, injuries were severe with long-term consequences and required surgical intervention,” wrote Dang et al. In those more severe cases, surgical intervention may be required, breastfeeding may be affected and there may be psychological and well as physical consequences.

Breast injuries and female player dropout

Regarding those possibly serious consequences, there are two direct links to handball to consider. One study reviewed in Dang et al.’s research focused on two gymnasts who sustained breast injuries as children, aged 10 and 11, which caused long-term deformity and asymmetry ultimately requiring surgical intervention as the girls became adults — in one of the cases due to shoulder pain as well as postural asymmetry of the shoulder, upper torso, back and neck. 

Aside from wanting to protect handball athletes from pain, it is not a big leap to consider how such an injury could impact a girl’s desire to keep playing the sport. In the cases of those gymnasts, one reported severe enough pain to restrict training for a short period, but the real damage was not clear until some years later.

The Women’s Sports Foundation says that, as of age 14, girls tend to drop out of sport at twice the rate of boys. Those dropout rates occur for a variety of reasons and can certainly not be attributed to breast injuries, but it is possible that girls and women who experience such an injury might decide they do not want to take the risk with playing handball anymore or, in the worst cases, suffer the kind of injury that leads to visible consequences that in turn impact confidence and their desire to continue the sport.

Another study featured in Dang et al.’s “Breast injuries in women’s sports” scoping review focused on a baseball player who was hit on an implanted breast. In case any might assume that an athlete with implants has taken a risk for no reason other than their appearance, remember that breast implants do not occur only for cosmetic reasons, or rather, they may be undertaken for cosmetic reasons but as a result of trauma, such as in reconstruction following cancer or another accident. 

How many women with breast implants are playing handball? When we consider both the personal choice for cosmetic reasons, the figures for breast cancer worldwide and the fact that the sport has diverse levels and leagues, the number can be reasonably assumed to be something significant. Those players are at risk of a serious injury to the breast when playing.

Fat necrosis and the formation of lumps

The other risk most relevant to handball in the context of breast injuries is fat necrosis or lumps that may form as a result of a hit, and those lumps can then cause confusion — a person might have a hit to the breast and then notice a lump, assume it is related to the injury they have suffered and then decide not to check with a medical professional. On the other hand, according to Breast Cancer Now, fat necrosis can also appear like cancer on scans and mammograms, making for a complicated situation even for medical practitioners.

Fat necrosis and other lumps resulting from injury can cause significant discomfort and also lead to dangers such as further assumptions after receiving a diagnosis. It is critical that any lump be assessed by a medical professional and that even after a diagnosis of fat necrosis any changes in the breasts be checked again.

As Norwegian star Camilla Herrem, who was diagnosed with breast cancer in June of this year, said: “I think it's so important just to check out everything. If you find something just go and check it out no matter what. Don't wait or think like, ‘ah, I can take it another time.’ I think just the most important message that I have is to just check your breasts one more time than one less time.”

Protection against injuries

How do elite handball players handle breast protection? Lekic says: “I think people are not paying attention — people are just taking it for granted. I don’t think it’s somehow at all present in our lives, in our daily talks about handball, and I think this is the way to raise awareness of how important it is to be protected from these kind of hits.

“It’s very important to protect the young girls and also the women in handball, to minimise the strength of a hit,” adds Lekic, who is already aware of equipment options for protection and has even been in touch with organisations in Australia regarding vests that are used for women in rugby. “There are many ways to stay safe and healthy on the handball court.”

Although it has not been the standard practice in handball, it seems it is time to consider breast protection more seriously. As a starting point, such injuries should be reported and managed like any other.

Then, as Lekic highlights, options are available in the way of wearable equipment, as chest protection is mandatory in some sports. While handball might not require the level of protection of fencing or martial arts, it is worth considering such protective equipment to reduce risk for our athletes, keep them healthy and happy on the court, and potentially even impact long-term retention in the game. 

Photos © Szilvia Micheller; Kolektiff Images; Istvan Derencsenyi; Torben Andresen; Roland Peka; nhcfoto.dk; Ivan Brkić / RK Podravka