Breast cancer is the most common cancer among women in South Africa – 1 in 25 of them have a lifetime risk of getting it, according to the National Cancer Registry’s 2016 report, its most recent.
The risk is 1 in 11 for white women, 1 in 18 for Asian women, 1 in 19 for coloured women, and 1 in 41 for black women.
But early screening and detection of the disease dramatically improves women’s chances of survival and reduces the need for aggressive and invasive treatment.
October is Breast Cancer Awareness Month and the Breast Imaging Society of South Africa (BISSA) urges women to regularly self-examine and have an annual mammogram from the age of 40.
“Breast cancer affects all ages, races and socio-economic circumstances. As frightening as a cancer diagnosis is, the good news is that modern medical advances and early screening and diagnosis result in more patients surviving and beating cancer with less aggressive and invasive treatment. The need for early and accurate detection simply cannot be over-emphasised,” said Professor Jackie Smilg, chairwoman of Bissa, which is a sub-speciality group of the Radiological Society of South Africa (RSSA).
“Early breast cancer detection reduces deaths, extends life expectancy, and improves life quality, and early detection through mammography also enables less extensive surgery, fewer mastectomies, and less frequent or aggressive chemotherapy.”
The goal of screening for breast cancer is to find the disease before it causes symptoms, Professor Smilg said, and “the gold standard remains the mammogram”, which can find breast changes years before physical symptoms develop.
Regular screening is more likely to find breast cancers when they are small and still limited to the breast area – this is important for successful treatment and survival, since the size and extent of the spread are the most crucial in predicting the outcome of a breast cancer diagnosis.
“Mammography, performed by radiologists, is the foundation of early detection – regular mammograms can often help find breast cancer at an early stage when treatment is most likely to be successful,” Professor Smilg said.
As with all cancer screening, recommendations for breast cancer screening rely on a combination of factors involving evidence about the risk of the condition, the benefits and harms of screening, and the cost.
“Several other breast imaging technologies, including tomosynthesis, C-view imaging and contrast mammography, have brought a new dimension to the fight against breast cancer. Digital tomosynthesis allows multiple levels of breast tissue to be interrogated and it is now possible to create a 2D mammogram from these tomosynthesis slices. Contrast mammography, where contrast investigates the vascularity of a lesion, is a valuable problem-solving tool,” said Professor Smilg.
In women with a significant family history of breast cancer or special circumstances, mammography can also be followed by ultrasound and/or breast MRI in both screening and symptomatic examinations.
Professor Smilg dispels a number of myths surrounding mammography. “There is simply no scientific evidence to support the idea that the negligible doses of radiation used in modern mammography can cause breast cancer or represent any danger to the body, including the thyroid gland”.
She said women were often persuaded by this “irrational fear of radiation risk” to use alternative “imaging techniques” such as thermography, use of light emitting devices or systems that “feel” masses.
“There is no evidence that these methods have any value in the screening and detection of breast cancer when compared with mammography. They are often operated by personnel with no medical training and no training in conventional breast imaging and may in fact cause more harm by missing breast cancers, leading to delayed diagnosis and limited treatment options,” she said.
Of the 10% of women who are referred for further examination following an inconclusive mammogram, most simply received additional mammographic views or an ultrasound for clarification. Only 1-2% of women were required to undergo a needle biopsy because of a screening mammogram.
“The short- term anxiety that could come from an inconclusive test result simply doesn’t outweigh the many lives saved each year by mammography screening. Ultimately any inconclusive result warrants further and deeper investigation. Women should decide for themselves whether the short-term anxiety outweighs the risk of dying from breast cancer. When it comes to dealing with a potentially life-threatening disease as pervasive as cancer, it makes sense to opt for the most effective, decisive, and conclusive screening technology, which remains the mammogram,” said Professor Smilg.
The RSSA and Bissa encourage all women to start regular mammography from the age of 40 and to continue to do so every year until age 70, regardless of whether they have symptoms or have an abnormality.
Women should regularly check their breasts for any irregularities and have a clinical breast examination by a GP or gynaecologist at least once a year. Any abnormality, regardless of age or family history, warrants an immediate medical consultation with a health-care professional.
“Many lumps may turn out to be harmless, but it is essential that all of them are checked,” Professor Smilg said.
Women at high risk, usually due to a history of breast cancer in a close family relative, should have annual mammograms and MRI starting five years before the age their family member was diagnosed with breast cancer or from age 40, whichever comes first.
High risk is defined as a lifetime risk greater than 20-25%. This
can be calculated by a doctor or online at http://www.cancer.gov/bcrisktool/