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