The incidence of breast cancer among South African women is increasing. It is the most prevalent cancer amongst white and Asian women and the second most common cancer among black and coloured women in South Africa.

Reduce risk through regular examinations:

• Facts about breast cancer

Early detection of the condition can lead to effective treatment and a positive prognosis. About 90% of patients survive for many years after diagnosis when breast cancer is detected at the early stages.

Regular self-breast examination and regular mammograms are key to early detection.

Presenting yourself early for treatment may result in more effective treatment, leading to a reduction in pain and suffering and a significant decrease in loss of life.

The designation of October as Breast Cancer Awareness Month in South Africa reflects a nationwide drive by public and private healthcare structures to raise awareness of this debilitating disease across all races and class structures.    

• Self-examinations

While not all breast lumps indicate cancer, they should be investigated, especially if accompanied by other changes in breasts or the under-arm area, such as lumps, texture changes, thickening, dimpling, changes in shape or size of nipples or breasts, tenderness, discharge, rash or swelling, or one breast suddenly being slightly larger than the other.

Research has shown that a regular Breast Self-Examination (BSE), plays an important role in discovering breast cancer, compared to finding a breast lump by chance. A BSE should be done once a month, preferably at the same time of day, following a woman’s menstrual cycle.

If you feel or see any change in your breasts or underarms, arrange for a Clinical Breast Examination at your local CANSA Care Centre, primary health care centre or health practitioner.

• Clinical Breast Examinations

A Clinical Breast Examination (CBE) is a visual and manual examination of the entire breast, from the collarbone to the bra line, and from the armpit to the breast bone. It is advisable to have a CBE as part of your annual medical check-up. Should any abnormalities be detected you will be referred for further testing by a medical professional. If you do have a lump or abnormality identified by a breast specialist, the next step will be imaging (radiography).

• Radiology Examinations

Normally this includes a mammogram with at least two views (but sometimes more) and an ultrasound of the breast and armpit. Often in women under 35 years the breast is too dense to rely on mammograms to see the problem, so an ultrasound is done instead. Newer methods of diagnosis such as MRI scan may also be useful in some cases.

Mammograms (a special X-ray to detect lumps in the breast), should also form part of your annual medical check-up, for the purpose of non-symptomatic breast screening, especially for women between 40 and 55 years and those who have other risk factors such as mutated BRCA1 or BRCA2 genes. Mammograms can save lives by finding breast cancer as early as possible. When caught early, localised cancers can be removed without resorting to breast removal (mastectomy).

Several radiology practices are offering discounted mammograms in October. Contact the Radiological Society of SA (RSSA) on 011 794 4395 or visit www.rssa.co.za to arrange for a mammogram.

• Risk factors

The risk for breast cancer increases as women grow older, but many women under the age of 40 are diagnosed with breast cancer. All women are at risk, and in particular women with a family history of breast cancer. Being overweight, inactive, consuming alcohol, poor dietary habits, smoking and exposure to chemicals also increase risk.

• Pathological diagnosis

If the breast specialist or radiologist is concerned about the lump or mass they see, they may wish to do a core needle biopsy. That is because no diagnosis can be made for certain without a tissue sample taken by biopsy. This is best done by the radiologist because they use X-ray or sonar guidance. This sample will be sent to a pathologist who will cut the sample into small slices and stain them specially to allow easy identification of any abnormalities or cancers. Testing takes at least 48 hours. 

• Breast cancer treatment

The most important thing to remember is that breast cancer is not a death sentence, nor is it an emergency. By the time a cancer is palpable (at 1cm) it has been present in your breast for at least five years. There is never a requirement for an emergency mastectomy, and sometimes the best treatment for breast cancer is to begin with chemotherapy rather than considering immediate surgery. So even if there is cancer present, you have time to consider your options, follow advice or seek another opinion.

• Breast Cancer staging

Patients often ask at what stage their cancer has been diagnosed and how advanced it is. Although this might seem very important, in actual fact the character of the cancer, the way it behaves and reacts to treatment, is more important. For instance, an early stage but aggressive cancer may progress more quickly than a large, low-activity tumour.

Staging systems to classify breast cancer are determined on clinical and laboratory findings. The most commonly used staging system is the TNM staging system, which allows doctors at particular centres to compare their results with other centres all over the world. Thus treatment regimens in South Africa can be compared with those in the UK and the USA.

The T refers to tumour size, N to nodal status, and M is used to determine metastatic disease, which is when cancer has spread beyond the breast and regional lymph nodes to the rest of the body. Metastases are little islands of tumour cells that have spread from the primary cancer and taken root in distant tissues and organs. It is these metastases that eventually cause death. 

Part of the staging is to perform certain tests to determine whether the cancer has spread, including a chest X-ray, bone X-ray, brain scan (MRI), abdominal ultrasound (sonar and CAT scan) and blood tumour markers.

There are four stages of cancer. Stage 1 usually means that a cancer is relatively small and contained within the organ it started in. Stage 2 means the breast cancer is growing, but is still contained in the breast or growth has only extended to the nearby lymph nodes. Stage 3 cancers are locally advanced (greater than 5cm), and Stage 4 cancers have spread to elsewhere (M+).

It is your patient right to know as much as you want about your cancer and to ask about new treatments. Remember that your time with your doctor is just that: YOUR TIME.

So take as much time as you need during a consultation. It is your body and your life so become involved with your health.

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