Breast cancer screening

2018-10-24 06:00
PHOTO: sourced

PHOTO: sourced

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MAMMOGRAPHY is the gold standard in early detection of breast cancer, even before physical symptoms develop

Breast cancer constitutes around 25% of all cancers in women and will affect one in 28 South Africans in their lifetimes. This figure is even higher in urban communities in SA, where the incidence is as high as one in eight, 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.

“As frightening as a cancer diagnosis is, the good news is that modern medical advances and early screening and diagnosis result in more women surviving and beating cancer with less aggressive and invasive treatment. The need for early and accurate detection simply cannot be over emphasized,” says Dr Jackie Smilg, Chair of the Radiological Society’s sub-specialty group, the Breast Imaging Society of South Africa (BISSA).

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. The size of a breast cancer and how far it has spread, are some of the most important factors in predicting the prognosis of a woman with this disease. 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 screening, and the cost.

The gold standard for breast screening remains the mammogram. Mammography reported by radiologists 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. 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 also 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 no scientific evidence to support this.

“Several relatively new breast imaging technologies, tomosynthesis, C-view imaging and contrast mammography, have brought a new dimension to the fight against breast cancer. Digital tomosynthesis allows multiple levels of breast tissue to be interrogated and it is now possible to create a 2D mammogram from these tomosynthesis slices. Contrast Mammography, where contrast investigates the vascularity of a lesion, promises to be a valuable problem-solving tool”, explains Dr Smilg.

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 breast MRI.

Women are often irrationally persuaded by the fear of radiation risk, which is negligible, to use other “imaging techniques” such as thermography, use of light emitting devices or systems that “feel” masses. These imaging techniques are often operated by personnel with no medical training and no training in conventional breast imaging. There is no evidence that these methods have any value in the screening and detection of breast cancer when compared with mammography. They may do harm by missing breast cancers, leading to delayed diagnosis and limited treatment options, if they are used as a substitute for mammography. The Radiological Society of SA (RSSA) and its sub-specialty group, and the Breast Imaging Society of SA (BISSA) continue to recommend that women get yearly mammograms starting at age 40. Early breast cancer detection through mammography enables less extensive surgery, fewer mastectomies, and less frequent or aggressive chemotherapy. The RSSA and BISSA also agree with international organisations, warning that any over-diagnosis claims are vastly inflated due to key methodological flaws in many studies. It is important to point out that, as shown by international studies, the vast majority of the 10% of women returned for further examination following an inconclusive mammogram, simply received additional mammographic views or an ultrasound for clarification. Only one to two percent of women were required to undergo a needle biopsy as a result of a screening mammogram. “The short-term anxiety that could come from an inconclusive test result simply doesn’t outweigh the many lives saved each year by mammography screening. “Ultimately, any inconclusive result warrants further and deeper investigation.

“Women should decide for themselves whether the short-term anxiety outweighs the risk of dying from breast cancer. When it comes to dealing with a potentially life-threatening disease as pervasive as cancer, it makes absolute sense to opt for the most effective, decisive and conclusive screening technology, which remains the mammogram,” adds Dr Smilg.

The RSSA/BISSA encourages all women to start regular mammography from the age of 40 and continue to do so every year until age 70, regardless of whether they have symptoms or have an abnormality – early detection is the key objective.

Women at high risk, usually due to a history of breast cancer in a close family relative, should have annual mammograms and MRI, starting at an age five years before the age their family member was diagnosed with breast cancer or at 40 years – whichever comes first. High risk is defined as a lifetime risk > 20-25%. Your doctor will help you calculate this or it can be done online.

Women should regularly check their breasts for any irregularities and have a clinical breast examination by a GP or gynaecologist at least once a year. Any abnormality warrants an immediate medical consultation with a healthcare professional. Many lumps may turn out to be harmless, but it is essential that all of them are checked.

In support of Breast Health Awareness Month (October 2018), all participating members of the RSSA/BISSA are offering a 10% discount on mammograms, not paid for by medical aid schemes from October 1 to November 14. Terms and conditions apply. For a list of participating members contact the RSSA on 021 713 2601, or e-mail maria.clayton@rssa.co.za or visit Radiological Society of South Africa (RSSA).

Every woman is potentially at risk of getting breast cancer. However, there are certain factors that would put women in a higher risk category. The risk factors include: age, family history, personal history, dense breast tissue, overweight or obese women, lifestyle factors, radiation to chest before 30 years of age, race/ethnicity, and hormonal environment.

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