Breast surgical oncologist Dr Pramod Reddy explains why every woman should be screened for breast cancer, and why South Africans no longer need to look abroad for world-class care.
One in 27. That is the lifetime risk of breast cancer for a South African woman, according to the National Cancer Registry, making it the most common cancer among women in the country.
When breast cancer is found early, while still small and confined to the breast, survival rates in well-resourced settings are above 90%. Once it has spread, however, it becomes a very different illness. Finding it before it can be felt can make all the difference.
The myth of the low-risk woman
Good health, an active lifestyle and no family history do not exempt a woman from breast cancer. Roughly eight in 10 women diagnosed have no affected relative. The biggest risk factors are simply being a woman and getting older.
Later first pregnancies, having fewer children and hormone therapy after menopause can also increase risk. Screening is not for women who think something is wrong. It is for women who feel completely well.
South African women are diagnosed younger than those in Europe or North America, and many present with more aggressive or advanced disease. With no national screening programme, women need to take the initiative.
What screening involves
A screening mammogram takes around 20 minutes. Modern digital breast tomosynthesis, or 3D mammography, takes multiple images of the breast and can detect more small cancers while producing fewer false alarms than older equipment.
Women with dense breast tissue may benefit from additional ultrasound. The right combination depends on the individual and should be discussed with a breast specialist.
World-class care on our doorstep
Breast cancer care in KwaZulu-Natal has advanced dramatically. Along the Umhlanga corridor, patients have access to technologies and treatments including 3D mammography, MRI-guided biopsy, genetic testing, PET/CT, oncoplastic surgery, sentinel node techniques, genomic tumour profiling and precise radiotherapy.
Just as important is a multidisciplinary team, bringing together surgeons, radiologists, oncologists, pathologists, geneticists and reconstructive surgeons.
A gentle instruction
If you are over 40 and cannot remember your last mammogram, book one this week. If you are younger, learn what is normal for you and ask your doctor whether you need earlier screening.
A new lump, skin dimpling, nipple change or discharge should always be assessed promptly. Do not wait for your next mammogram.
AT A GLANCE
From your twenties: Know what is normal for you and report changes promptly.
From 40: Annual screening mammography is recommended, ideally with 3D tomosynthesis, for women in good health.
Dense breasts: Ask about your breast density and whether you need supplementary ultrasound or MRI.
Higher risk: Women with certain gene variants, a strong family history or previous chest radiotherapy may need earlier and additional screening, including annual MRI. Discuss this with a breast specialist.
After treatment: Annual surveillance imaging of the treated and opposite breast is recommended.
