BREAST CANCER AWARENESS
As we approach October, the month internationally acclaimed as Breast Cancer Awareness Month, the question arises “Is the hype surrounding routine mammography justified?”
Let us look at the facts:
- Breast cancer is the most common cancer in women worldwide
- World Health Organization-International Agency for Research on Cancer (WHO/IARC) reports increasing breast cancer trends worldwide
- breast cancer accounts for 1 in 10 new cancers overall and 23% of new female cancers
- 1 in 8 women will get breast cancer in their lifetime (Black South African women have a slightly lower incidence)
- From 35 – 65 years there is a 6-fold increase in the incidence of breast cancer
- Family history:
- young first-degree relative: 1 relative risk is doubled; 2 relatives 5x risk
- genetic: BRCA1 gene positive: lifetime risk 55%-65%; BRCA2 gene positive: lifetime risk 45%
As such early diagnosis means a potential cure. Late diagnosis results in potentially significant morbidity & mortality.
It is clear that the aim must be an early diagnosis and this is achievable by breast surveillance.
What is breast surveillance?
- Breast self-examination (monthly self-examination of breasts utilising a standard technique)
- Clinical breast examination (annual breast examination by a health care professional)
- Breast imaging
- Mammogram: best population-based method currently available. It should be noted that mammography will not detect all cancers
- Mammogram & ultrasound: probably higher sensitivity than mammogram alone
- Mammogram & tomosynthesis: tomosynthesis (also known as 3D mammography) is the new “buzzword” in breast imaging. Better sensitivity than mammography alone. Likely to become gold standard
- Ultrasound: poor sensitivity & specificity but useful as adjunct to mammogram & for young breasts with a low index of suspicion
- MRI: highest sensitivity of all modalities. Reserved for specific situations. This is related to cost, availability and required expertise. Generally reserved for high-risk group or where there are indeterminate findings on a mammogram.
In attempting to achieve early diagnosis it is not one of the above methods of surveillance but all three appropriately applied. At Bergman Ross and Partners Radiologists, we routinely include tomosynthesis and ultrasound with all mammograms
The current recommendation for breast imaging in South Africa:
(1) Screening mammography (to find disease prior to symptoms):
- annually all women >40 years and <70 years (unless higher than average risk)
- women >70 years can elect to have screening mammography.
- higher than average risk
(i) if family history: commence imaging at 5 yrs prior to the age that first-degree relative diagnosed if less than 40 yrs & at 40 yrs otherwise
(ii) annually in conjunction with MRI
(2) Diagnostic mammography:
- at time of suspicion/symptoms if >35yrs
A number of factors discourage women from having screening mammography. Amongst these are:
Mammograms being painful: with the advent of ergonomic improvements in mammography units and improved imaging techniques this factor is far less of a problem.
Radiation-induced cancer: although it is true that excessive radiation may induce cancer, the risk of the latter is far outweighed by the benefit of early detection of breast cancer. This is borne out by scientific research. In addition, state-of-the-art mammography units deliver far less radiation dose than those of previous eras.
Women should pay attention to their monthly cycle when booking mammograms, as certain times of the month will be uncomfortable when compressing the breast tissue.
There is a constant search for more acceptable methods of breast imaging with greater sensitivity & no or less radiation risk. A number of modalities are available, including thermography, electrical impedance, optical imaging, nuclear imaging, positron emission tomography. NONE OF THESE LISTED HAVE BEEN SHOWN TO COME ANYWHERE CLOSE TO MAMMOGRAPHY IN DIAGNOSTIC ABILITY. A negative result in these less sensitive methods may lull the patient into a false sense of security.
In summary, the risk of a woman developing breast cancer in her lifetime is sufficiently significant to warrant a greater awareness and to encourage the appropriate surveillance.
We provide mammogram services at:
N1 City Hospital 021 5951370
Kuils River Hospital 021 9006600
Sea Point. Suite 306 3rd Floor, The Point Centre. 76 Regent Road Phone 021 110 5777
*Copy supplied by Berman Ross & partners
The psychological impact of breast cancer
Breast cancer affects more than just the physical self. The most common form of cancer found in women worldwide, it often challenges patients’ ability to cope socially and emotionally. Approximately 80% of patients is reported to suffer from Post-Traumatic Stress Disorder symptoms following their diagnosis.
The level of emotional and mental distress varies from woman to woman – feelings of anger, sadness, exhaustion, and stress. A litany of complex emotions can arise due to a number of factors – coming to terms with the diagnosis and the effects of the treatment, hormonal changes, adapting life experiences and genetics.
In some ways, the ongoing psychological and emotional challenges faced by patients in recovery can feel as heavy as the physical treatments endured. Common challenges reported by patients include:
- Physical symptoms like fatigue, trouble sleeping, or pain.
- Body image disruption
- Sexual dysfunction
- Treatment-related anxiety
- Feelings of vulnerability and existential concerns regarding mortality
- Fear of recurrence
- Anxiety and depression
While these symptoms are best addressed by social workers, psychologists and psychiatrists, not all patients have easy access to these resources.
From fear to empowerment
For many breast cancer sufferers, connecting with other women who can relate to and share in their experiences have proved crucial in coping with these overwhelming psychological symptoms. There have even been studies that suggest an increased survival period from participation in such support groups.
Nonprofit organizations, like Living Beyond Breast Cancer, work to connect breast cancers sufferers and survivors across the globe with one another creating communities of support that insulate against the feelings of misinformation and isolation. Offering programmes and services developed with leading oncologists, health professionals and ally organisations, these services are available in a number of easily accessible formats for patients around the world.
Physical exercise and maintaining a regular sleep schedule have also been recognized to assist with the emotional state of sufferers. Just the provision of basic support, such as help with daily activities and transportation to and from doctor’s appointments, can significantly quell overwhelming fears, feelings and concerns of patients.
The role of early detection
One of the key factors in the prevention and treatment of many of these psychosocial symptoms remains early detection. This can make treatment easier on patients and their families, help avoid expensive late-detection measures, and prevent the physically and emotionally traumatic potential removal of the patient’s breasts.
Active supporters of women’s health and vocal advocates of the importance of awareness and early detection, Bergman, Ross & Partners (BRP), offers a comprehensive range of services for breast cancer patients that includes general X-rays, ultrasound, mammography, CT, MRI, MRI breast as well as breast biopsies. At Bergman, Ross & Partners, mammogram examinations include a breast ultrasound – a service that aids in diminishing risk and bolstering the preventative process.
For BRP, the importance of early detection in the prevention of acute, emotional trauma cannot be overstated. “We support breast cancer awareness in the form of education and are committed to preventative health screenings,” says Wendy Black of Bergman, Ross & Partners. “As approximately 65% of cancers are diagnosed too late, we try to work on preventative and early diagnosis, as it is totally treatable at that stage. If we can diagnose early, we can save so many lives.”
For more information
For further information on the practice and breast cancer awareness, please contact Bergman, Ross & Partners Radiologists on 021 110 5777 for further assistance. Suite 306, 3rd Floor, The Point Centre, 76 Regent Road, Sea Point.