Detecting breast cancer

Professor Jackie Smilg, chairperson, Radiological Society of South Africa’s (RSSA) sub-specialty group, the Breast Imaging Society of South Africa (BISSA).

Every woman is potentially at risk of getting breast cancer.

Men can get breast cancer too.

While breast cancer cannot be prevented, there are important
steps to take to detect breast cancer early,
even before physical symptoms appear, and before it has a chance to spread.

As frightening as a cancer diagnosis is, the good news is that medical advances and early screening and diagnosis result in more women surviving and beating cancer with less aggressive and invasive treatment.

Breast cancer is now the leading cancer in women in SA and will affect 1 in 28 South Africans in their lifetimes. This figure is even higher in urban communities in South Africa, where the incidence is as high as 1 in 8 according to National Health Laboratory statistics.

This insidious disease continues to be the subject of intensive educational campaigns to encourage women of all ages and socio-economic backgrounds to subscribe to early detection and diagnosis.

The mammogram remains the gold standard for breast screening and is the foundation of early detection of breast cancer. Regular mammograms can often help find breast cancer at an early stage, when treatment is most likely
to be successful. One
of the greatest advantages of a mammogram is that it can find breast changes years before physical symptoms develop.

The goal of screening tests for breast cancer is to find the disease before it causes symptoms. Breast cancers found during screening exams are more likely to be smaller and still confined to the breast.

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 the actual screening, and the cost.

Results from many decades of research clearly show that women who have regular mammograms are more likely to have breast cancer found early, less likely to need aggressive treatment and more likely to be cured.

It is important to dispel the myths that the negligible doses of radiation used in modern mammography can possibly produce breast cancer or represent any danger to the body, including the thyroid gland. There is simply no scientific evidence to support this.

Contrast mammography, where contrast investigates the vascularity (blood supply) of a lesion, promises to be a valuable problem-solving tool. In women with a significant family history of breast cancer or special circumstances, mammography can also be followed by ultrasound in both screening and symptomatic examinations and/
or breast MRI
(magnetic resonance imaging).

Certain factors put women at higher risk of developing breast cancer:

* Age – The risk of breast cancer increases as one gets older. However, 1 out of 8 invasive breast cancers are found in women younger than
45.

* Family history – Breast cancer risk is higher among women whose close blood relatives have this 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 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 dense breast tissue (as identified 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.

* Contact the RSSA at 084 293 9789, email radsoc@iafrica.com or visit www.rssa.co.za