Breasts: an owner’s manual
Nobody wants to talk about it, but everybody needs to be informed. This helpful guide includes everything you need to know about reducing your risk of breast cancer, how it’s diagnosed and treated, and where you can get support.
We consulted the experts to help you sift through the confusion and mixed messages to create a life-saving manual for breast health.
What puts you at risk?
The Cancer Association of South Africa (CANSA) outlines the following risks:
- Genetics: 5 to 10% of breast cancers are hereditary.
- Sex (being a woman), age (risk increases as you get older) and race (Caucasian women are slightly more prone).
- Dense breasts: harder for mammograms to detect; more likely to develop cancer.
- Low levels of vitamin D can lead to a higher risk.
- Weight and inactivity: overweight and obese women are at higher risk. Conversely, regular exercise has been linked to a lower risk of breast cancer.
- Alcohol and smoking: drinking increases the risk of hormone-receptor-positive breast cancer. Smoking is linked to a higher risk in younger, premenopausal women.
- Previous breast cancer or a close relative with breast cancer lead to higher risk.
- Pregnancy and breastfeeding history: women who had their first child after 30 or haven’t had a full-term pregnancy are at greater risk. Breastfeeding can reduce this risk.
- Menstrual history: first period before 12 and menopause after 55 both lead to higher risk.
- Hormone Replacement Therapy (HRT) and radiation to the chest before the age of 30 both lead to higher risk.
- A puckering of the skin on the breast
- A lump in the breast or armpit
- A change in the skin around the nipple, or nipple discharge
- Dimpling of the nipple or nipple retraction
- An unusual increase or shrinkage in the size of one breast, or recent asymmetry of the breasts
- One breast is unusually lower than the other – nipples are at different levels
- An enlargement of the glands in and around the breasts
- An unusual swelling in the armpit
Essential preventative tests
Dr Elize Wethmar, a gynaecological oncologist at Life The Glynnwood, has one essential piece of advice: ‘Early detection saves lives! The earlier a tumour is detected, the better the prognosis.’
A low-dose x-ray of the breast in which the breasts are squashed as flat as possible (fair warning: it can be very uncomfortable). There are no real guidelines for breast cancer screening in South Africa, but in the US and UK, annual mammograms start at 50.
‘These guidelines don’t take into account different risk profiles, though,’ explains Dr Irene Boeddinghaus, an oncologist at the Life Oncology Unit at Life Vincent Pallotti Hospital. ‘The ideal is for each woman to have her individual risks assessed by her primary physician.’
Breast self-examination (BSE)
BSE can be extremely helpful – if it’s done correctly. ‘Incorrect self-examination can lead to much unnecessary fear. It’s completely natural for a woman’s breasts to be lumpy,’ explains Dr Boeddinghaus. ‘Get to know what is “normal” for you. Set a reminder to do a BSE every month, at the same time in your cycle. Take note of any changes or unusual pain and tell your doctor.’ Have a look at CANSA’s guide to doing a BSE.
Clinical breast examination (CBE)
A CBE is similar to a BSE, but will be done by your doctor or gynaecologist – usually at your annual check-up – they will be looking for any abnormalities or warning signs.
For most types of breast cancer, the only way to make a definitive diagnosis is a biopsy: removing a small amount of breast tissue to examine under a microscope.
There are various treatments available to fight breast cancer, depending on the specific diagnosis. Dr Lucienne van Schalkwyk, a breast surgeon at Life The Glynnwood, explains that ‘Being diagnosed with breast cancer is a very stressful experience, and many women experience severe anxiety when faced with the daunting prospect of treatment. It’s important to remember that each woman is unique, and each person’s experience will be different.’
Not all breast cancers are the same: they can be subdivided into different types based on biopsy characteristics – each with different ‘personalities’. Importantly, breast cancer does not automatically equate to losing a breast.
This involves the removal of the tumour and a small area of the surrounding healthy breast tissue. This is paired with radiation, a therapy that kills cancer cells or keeps them from growing while minimising damage to healthy cells.
If a large area of the breast is affected, removal of all the breast tissue may be necessary. Reconstruction can usually be performed at the same time. ‘As women, our breasts may be intimately related to our self-esteem, body image and the concept of motherhood,’ explains Dr Van Schalkwyk. ‘The loss of a breast may be just as traumatic as the loss of a limb and can cause depression and anxiety.’
‘One of the first questions I’m usually asked by a patient with breast cancer is whether she will need chemotherapy (with its associated side effects),’ she continues. ‘Certain subtypes of breast cancer respond very well to chemotherapy, others do not. Radiation is also not always necessary.’ Early-stage, oestrogen-sensitive cancers can often be managed with hormone-blocking tablets.
‘Each treatment plan is tailor-made based on numerous factors: the tumour (type, stage, profile) as well as the patient’s age, other chronic diseases and preference,’ explains Dr Van Schalkwyk. The multidisciplinary breast-care team will consult with the patient in order to decide on the best treatment plan, based on international guidelines, safety and cost-effectiveness.
‘There are wonderful new treatments for breast cancer coming out at an unbelievable rate,’ adds Dr Boeddinghaus. ‘But one of the breakthroughs that excites me most is our improving ability to decrease and downscale treatment, sparing many people unnecessary cost and side effects. This is just as important as new treatments, but it is something we often forget about.’
‘Approximately 10% of breast cancer is due to a genetic cause, most commonly BRCA 1 and BRCA 2. We would consider risk-reducing mastectomy in any patient considered to be at elevated risk of breast cancer. This would follow a complete history and physical examination, a baseline mammogram and ultrasound, and genetic counselling,’ says Dr Van Schalkwyk.
The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE. Life Healthcare Group Ltd does not accept any responsibility for any loss or damage suffered by the reader as a result of the information provided.