October is Breast Cancer Awareness Month
Breast cancer affects one in 28 South African womenand advances in screening and treatment have dramatically improved survival rates – the key reason why fear should not stand in the way of having a lump checked out.
This October, Breast Cancer Awareness Month, the Breast Imaging Society of South Africa (BISSA) highlights that fears, myths and misinformation about the disease and its diagnosis and treatment are critical barriers to the early diagnosis of breast cancer and in turn limit prospects of survival.
Breast cancer is the most frequently diagnosed cancer in South African women across all population groups, accounting for a quarter of new cancer diagnoses every year, and it is the second leading cause of cancer deaths in women.
However, Dr Peter Schoub, chair of BISSA, a sub-specialty group of the Radiological Society of South Africa, said that delays in diagnosis and treatment, resulting in wider spread of the cancer and a need for more aggressive and invasive treatment, had the greatest impact on reducing quality of life and survival prospects.
“A diagnosis is not an automatic death sentence and does not necessarily mean radical treatment such as chemotherapy or mastectomy. Advanced treatment today is tailored to the tumour and the patient. Many women with early-stage disease can have breast-conserving surgery such as lumpectomy, usually with radiotherapy, and their survival is on par with women who have had a mastectomy. Not every patient needs chemotherapy, as modern hormonal and targeted treatments have expanded the options available,” he said.
Many women conceal, or choose to ignore, symptoms of possible breast cancer because they fear a diagnosis that could lead to mastectomy, perceived loss of their femininity or rejection by a partner.
There may also be practical barriers that cause delays in diagnosis and treatment, such as financial concerns, transport, distance to healthcare facilities, waiting times or difficulty in obtaining a referral, particularly in South Africa where about 85% of the population are reliant on public healthcare.
Patients in the public health sector are more likely to present with cancer at a later, more advanced stage, resulting in more intensive treatment and poorer prognosis. “The central challenge is not the absence of world-class breast care in South Africa, but the fact that most women cannot access it when and where they need it,” he said.
Dr Schoub said that most breast lumps or changes are benign, but advised women to exercise caution and have any new or persistent lumps in the breast or armpit, breast or nipple pain, changes in breast skin or nipple shape assessed as soon as possible by a medical professional familiar with breast assessments, such as a clinic nurse, general practitioner or gynaecologist.
“A woman who has a new lump or any other change that causes concern, should have it assessed as soon as possible, even if a recent screening mammogram was normal,” he said.
The mammogram is the “gold standard” for early detection of breast cancer but is also subject to myths that it is extremely painful or may itself cause cancer. Some patients report discomfort or brief pain during a mammogram, but it is not long-lasting as the compression takes only a few seconds for each image and improves the image quality for better detection of possible tumours.
“A mammogram involves very low-dose radiation, equivalent to a few weeks of the background radiation that we are all exposed to every day, and its use is highly regulated and controlled.
“The level is safe for routine screening, and the early diagnosis benefits of less aggressive treatment and greater life expectancy far outweigh any risk,” Dr Schoub said.
In addition, he said there was no evidence that a needle biopsy spreads breast cancer further or increases recurrence of the disease, but rather that it is “central to accurate diagnosis and planning the most effective treatment”.
Another myth is that breast cancer is only a risk with a family history of the disease, however most people diagnosed with breast cancer have no known family history.
“It is correct that family history and inherited gene variants can increase risk, but increasing age, breast density, reproductive and hormonal factors, and overall health are also important considerations.
“Formal risk assessment is advised, rather than relying on family history alone,” he said. Dr Schoub added that the absence of pain with a breast lump should not remove concern or delay seeking help.
“Early breast cancer may cause no pain or other symptoms and may be too small to feel. This highlights the importance of annual screening mammograms, as this can detect lumps before they can be felt. Waiting for pain is not a safe option, because most early cancers are painless,” he said.
Sticking to a routine of an annual mammogram helps to set a baseline from which any changes can be detected and referred for further assessment. Bringing images from previous mammograms to the next appointment also helps the radiologist to identify genuine changes and may prevent the need for unnecessary further tests. Women who are still menstruating are advised to book their mammogram for the week after their menstrual period when the breasts may be less tender.
Know your breasts
BISSA advises all women to know their breasts and not to delay assessment of any new or persistent changes. The keys are knowing the differences by both sight and feel. The breast changes throughout the menstrual cycle and it is important to always self-examine at the same time of the month, usually a week after your period when your breasts are less tender due to fluctuations in hormone levels.
Visual examination – sit or stand, without clothing, in front of a mirror with your arms to your side and look for changes in size, shape, symmetry, puckering and dimpling. Then do the same but with your arms behind your head.
Physical examination – lying down so that your breast tissue spreads out making it easier to feel, or in the shower using soap to glide more easily over your breasts:
- Use the pads of your three middle fingers, not your fingertips, to examine.
- Apply different pressure levels – light to feel the breast tissue closest to the skin, medium to feel deeper, and firm to feel the tissue closest to the chest and ribs.
- Use a methodical technique such as beginning near the collarbone, then moving towards the nipples, in a clockwork fashion.
- Allow enough time and don’t rush the examination.
Signs to look out for
It’s important to note that many lumps may turn out to be harmless, but it is essential that all of them are checked. Visit your healthcare provider if you notice any of these changes:
- a change in breast shape, swelling of all or part of the breast,
- skin irritation, dimpling or ridges on the skin,
- nipple pain or the nipple turning inward,
- redness, scaliness, peeling, or thickening of the nipple or breast skin,
- a nipple discharge other than breast milk, especially if it is spontaneous, one-sided or bloody, or
- a lump or knot near the underarm area.
