October is breast cancer awareness month

According to the World Cancer Research Fund, breast cancer is the most prevalent form of cancer in women by a significant margin. Statistics show that 1 in 29 South African women will be diagnosed with breast cancer in their lifetime.

This figure is even higher in urban communities in South Africa, where the incidence is as high as 1 in 8.

While these statistics are frightening, the good news is that more women are surviving a breast cancer diagnosis than 20 years ago, thanks to a combination of advanced medical treatment and most importantly of all, early diagnosis.

During Breast Health Awareness Month (October), the Radiological Society of South Africa (RSSA) and Breast Imaging Society of South Africa (BISSA a sub group of the RSSA) are stressing the importance of mammograms and how regular mammograms and breast examination can possibly save your life.

The importance of early detection of breast cancer cannot be emphasised enough in a bid to optimise treatment and hopefully avoid the need for invasive treatments.

Of all the cancers, breast cancer is the most common cancer in South African women, constituting more than 50% of all cancer diagnoses.

“Early diagnosis gives the cancer patient a higher chance of complete cure and less extensive surgery. Early detection is a critically important factor in winning the battle against breast cancer,” explains Dr. Sheldon Godinho, President of RSSA.

Mammography reported by radiologists is the foundation of early detection of breast cancer.

Mammography and breast MRI are the only recognised imaging screening tools for breast cancer and multinational, multicentre trials have demonstrated a reduction in the death rate from breast cancer in women regularly screened by mammography, due to the early detection of breast cancer.

Mammography is the mainstay examination, breast MRI is used in special circumstances.

Modern mammography is done with a very small radiation dose and there is no evidence to suggest that mammography itself can produce breast cancer or that the radiation presents any danger to any other part of the body including the thyroid gland.

Women are often persuaded by the fear of radiation risk, which is negligible, to use other ‘imaging techniques’ such as Thermography or the SureTouch system.

According to RSSA and BISSA, these are operated by personnel, often with no medical training and no training in conventional breast imaging.

They add that there is no evidence that either of these methods has any value in the screening and detection of breast cancer when compared with mammography and that they may do harm by missing breast cancers, leading to delayed diagnosis and limited treatment options, if they are used as a substitute for mammography.

“We encourage all women to start regular mammography from the age of 40, regardless of whether they have symptoms or have an abnormality – early detection is the key objective.

We also encourage all women to regularly check their breasts for any irregularities and have a clinical breast examination by a GP or gynaecologist at least once a year.

If you notice any abnormality in your breasts regardless of your age, it is essential that you consult a medical professional. Many lumps are harmless but all of them must be checked,” says Dr. Godinho.

The mammogram is the first imaging method for screening when there are no lumps or symptoms or to provide further information if a lump or abnormality is detected.

Mammography is often followed by ultrasound in both screening and symptomatic examinations. “The radiologist’s aim is to detect breast cancer before any of these signs appear.

This is why we encourage South African women to have regular mammograms to ensure that if there are any malignant cells, they are caught early and can be treated appropriately,” says Dr Godinho.

Who is at risk? Every woman is potentially at risk of getting breast cancer. However, there are certain factors that would put women in a higher risk category.

The risk factors include:

· Age - The risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older.

· Family history - Breast cancer risk is higher among women whose close blood relatives have this disease. Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk. Having 2 first-degree relatives increases her risk about 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 denser breast tissue (as seen on a mammogram) have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer. Unfortunately, dense breast tissue can also make it harder for doctors to spot problems on mammograms.

· Overweight or obese women – Research has shown that being overweight or obese increases the risk of breast and other cancers. Now, a larger study suggests that 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.

· Lifestyle factors – excessive alcohol use, little to no physical activity, smoking and diets high in saturated fats increase the risk of breast cancer. Women with a higher risk should in addition to mammography consider annual breast MRI studies.

Breast MRI is in some cases more sensitive than mammography in selected high risk patients.

Dr. Godinho emphasizes the importance of a dual approach in high-risk women: “As radiologists, we recommend that women with a significantly higher risk have an annual mammography and breast MRI.

This will increase the chance of early detection and treatment of the cancer.” The RSSA recommends that women aged 40 or older should have a mammogram every 1-2 years. Women between 50 and 75 should have annual mammography.

Women at high risk, usually due to a history of breast cancer in a close family relative, should have annual mammograms starting at an age five years before the age their family member was diagnosed with breast cancer.

High risk is defined as a lifetime risk greater than 15%. Your doctor will help you calculate this or it can be done on line at http://www.cancer.gov/bcrisktool/ In support of Breast Health Awareness Month in South Africa, the RSSA is highlighting the benefits of good breast health and promoting breast imaging for detecting breast cancer in its early stages.

All participating members of the RSSA are offering a 10% discount on mammograms and breast MRI, not paid for by medical aid schemes, during the month of October and first half of November.

Terms and conditions apply. For a list of participating members contact the RSSA on 011 794 4395, e-mail radsoc@iafrica.com or visit www.rssa.co.za.

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