Breast Cancer Awareness Month: Risk factors, the signs and self-examination tips

THE most prevalent cancer among women in South Africa is breast cancer, affecting 1 in 27 women and 23% of all cancers diagnosed, confirmed by the Breast Imaging Society of South Africa (BISSA).

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This October, which is Breast Cancer Awareness Month, BISSA is placing emphasis on the importance of early detection. They encourage regular self-examinations, even from as early as 20 years old, and annual mammograms starting from the age of 40.

Dr Peter Schoub, chair of BISSA, a sub-specialty group of the Radiological Society of South Africa, says early detection of breast cancer dramatically improves survival rates and reduces the need for aggressive treatment.

“Although most of the major medical schemes offer a yearly complimentary mammogram screening to women over the age of 40, only about 20% take advantage of this service.”

“One of the most significant challenges in South Africa is the late-stage diagnosis of breast cancer when the cancer is advanced, reducing the chances of successful treatment. ”

He attributes late diagnosis to a lack of awareness, limited access to healthcare facilities and socioeconomic inequalities.

Dr Schoub says that although breast cancer becomes more common as one gets older, breast cancer is on the rise among women in their 30s.

Who is at risk of developing breast cancer?

• Age: The risk of developing breast cancer increases as one gets older, however, 1 out of 8 invasive breast cancers are found in women younger than 45.
• Family history: Women with close blood relatives who’ve had breast cancer are at a higher risk.
• Personal history: A woman with cancer in one breast has a 3 to 4 times increased risk of developing a new cancer in the other breast or in another part of the same breast.
• Dense breast tissue: Women with dense breast tissue (as identified on a mammogram) have more glandular tissue and less fatty tissue and thus a higher risk of breast cancer.
• Overweight or obese women: Research in the past has shown that being overweight or obese increases the risk of breast and other cancers.
• Lifestyle: Excessive alcohol consumption, lack of physical activity, smoking and diets high in saturated fats contribute to risk.
• Hormonal factors: Women who have not had a full-term pregnancy or have their first child after age 30 have a higher risk of breast cancer compared to women who gave birth before age 30. Breastfeeding can lower breast cancer risk, especially if a woman breastfeeds for longer than one year. Women who started menstruating younger than age 12 have a higher risk of breast cancer later in life. The same is true for women who go through menopause when they are older than 55. Current or recent-past users of hormone replacement therapy (HRT) have a higher risk of being diagnosed with breast cancer.

How to self-examine your breasts

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 and symmetry or puckering and dimpling.

Physical examination – Lying down so your breast tissue spreads out makes it easier to feel for abnormalities. Or in the shower, you can use soap to glide more easily over your breasts. Make sure to:
– 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:

• 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 or thickening of the nipple or breast skin,
• a nipple discharge other than breastmilk, or
• a lump or knot near the underarm area.

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