One in 28 SA women affected by breast cancer

Breast cancer is the most prevalent cancer amongst women in South Africa, affecting one in 28 women, and in urban communities, the incidence is as high as one in eight, according to National Health Laboratory statistics.

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 Prof Jackie Smilg, chairperson 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, Smilg said, and “the gold standard remains the mammogram”, which can find breast changes years before physical symptoms develop.

Regular screening

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,” 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,” explained 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.

Some myths dispelled

Smilg dispelled some 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.

The RSSA and BISSA also agree with the view of international organisations that claims of over-diagnosis of breast cancer are “vastly inflated due to key methodological flaws in many studies”.

Of the 10 per cent of women who are referred for further examination following an inconclusive mammogram, most simply received additional mammographic views or ultrasound for clarification. Only one to two per cent 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,” added Smilg.

Do it now

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,” 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 to 25 per cent. This can be calculated by a doctor or online at https://www.cancer.gov/bcrisktool/

Who is at risk of developing breast cancer?

Every woman is potentially at risk of getting breast cancer. However, certain factors will place them in a higher-risk category, including:

• Age: The risk of developing breast cancer increases as one gets older; however, one out of eight invasive breast cancers are found in women younger than 45.

• Family history: Breast cancer risk is higher among women whose close blood relatives have had the disease. Having one first-degree relative (parent, sibling, child, or maternal grandmother) with breast cancer approximately doubles a woman’s risk. Having two first-degree relatives increases her risk to three-fold.

• Personal history: A woman with cancer in one breast has a three to four times increased risk of developing a new cancer in the other breast or in another part of the same breast. This is different from a recurrence (return) of the first cancer.

• 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. Unfortunately, dense breast tissue can also make it harder for doctors to spot problems on mammograms, which makes regular self-examination and regular screening even more important.

• Overweight or obese women: Research in the past has shown that being overweight or obese increases the risk of breast and other cancers. More recently, a larger study suggested overweight and obese women diagnosed with early stage, hormone-receptor-positive breast cancer have a higher risk of the cancer coming back (recurrence) and are less likely to survive the disease. Healthy eating and weight management are especially important.

• Lifestyle factors: Excessive alcohol use, little to no physical activity, smoking and diets high in saturated fats increase the risk of breast cancer.

• Radiation to the chest before 30 years of age: Radiation to the chest to treat another cancer (not breast cancer) such as Hodgkin’s disease or non-Hodgkin’s lymphoma, results in a higher-than-average risk of breast cancer.

• Race/ethnicity: White and Asian women are slightly more likely to develop breast cancer than black and coloured women. Breast cancer is the most prevalent cancer among white and Asian women and the second most common cancer among black and coloured women.

• Hormonal environment: 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 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 past users of hormone replacement therapy (HRT) have a higher risk of being diagnosed with breast cancer. 

References

* https://cansa.org.za/womens-health/
*https://www.gov.za/BreastCancerAwarenessMonth2020