Breast cancer is the type of cancer most commonly diagnosed in South African women. In fact, it is so common that 1 in every 27 South African women will be diagnosed with breast cancer in her lifetime.
October is International Breast Health Awareness Month and it's a great opportunity to find out more about this disease, its causes and treatment.
Professor Justus Apffelstaedt, associate professor at the University of Stellenbosch and Head of the Breast Clinic at Tygerberg Hospital, has put together a Q&A on the most frequently asked questions about breast cancer.
Can mammograms cause breast cancer?
No. For over 40 years, millions of women have undergone mammography. As with all radiography, it involves exposure to X-rays, but the dosage levels used are very low.
Modern mammographic techniques have also improved greatly over the past years. Our Full Field Digital Mammography machine uses only 0,1 to 0,2 rad's per X-ray, which is an extremely low dosage of radiation.
The question has been asked whether compression can cause breast cancer. Compression doesn’t affect the breast tissue at all. It’s essential that the breast be compressed if a useful mammogram is to be obtained. Breast tissue is spread out to allow breast structures to be seen. Compression also means that the X-ray dose required can be reduced.
Patients should make sure that they have their mammograms done at a centre where modern mammography units are in use.
I’ve been told that mammograms are very painful.
Although the breast is compressed, many women who undergo mammography do not experience any pain. Women with very sensitive breasts may experience slight discomfort.
Can diet affect my risk of developing breast cancer?
Yes. The results of a recent study funded by the US government indicate that a diet containing less than 20% kilojoule intake of dietary fat reduces the risk of the recurrence of breast cancer by 24% in women who have previously survived breast cancer.
This reduction in risk was even larger in women who had oestrogen-receptor negative breast cancer (which is traditionally more difficult to treat).
I would like to have cosmetic breast surgery. Should I have a breast check-up first?
Prior to having cosmetic surgery, it is always advisable to go for breast cancer screening. Any surgery to the breasts will make future evaluation of the breasts more complicated and it therefore increases the chances of missing an existing cancer.
I have breast prostheses. Can I still have a mammogram?
Yes. Breast augmentation does not constitute an increase in glandular tissue, therefore you are not more at risk. It is necessary that an experienced mammographer takes your mammogram, as special techniques are needed to show all breast tissue.
My mother was diagnosed with breast cancer when she was 42.
I fear that I am going to get breast cancer too.
If you have a strong family history of pre-menopausal breast cancer in your family, genetic screening may be indicated. Prior to the screening, we recommend that you undergo genetic counselling at a recognised centre, which will include a discussion on the implications of finding a genetic defect.
There are genetic screening models that are able to provide you with an indication of your risk for developing breast cancer. If your risk of carrying a defective gene is not high, earlier annual mammographic screening for breast cancer may be recommended as a precautionary method.
If my breast check-up is fine, why do you recommend that I have a mammogram every year?
Most international breast cancer societies recommend annual mammographic screening as the best precautionary method of detecting breast cancer early, which will decrease the chances of needing a mastectomy.
Why is a clinical breast examination important when I have a mammogram done?
One out of ten breast cancers do not image on mammography.
It is therefore very important to have a clinical breast examination done at the same time as a mammogram and breast ultrasound. These three procedures constitute the most comprehensive check-up and provide accurate results.
What is the best time of the month to have a mammogram done? My breasts are tender during menstruation.
We recommend you have a mammogram about a week after menstruation when your breasts are less tender.
A mammogram should only be mildly uncomfortable; however, if you are concerned about the tenderness of your breasts, it is advisable to see a trained breast health physician. In this instance, a clinical evaluation and an ultrasound can be done. If anything suspicious is detected, an immediate mammogram may be required . If nothing is found but the tenderness persists, you may be advised to start treatment and postpone the mammogram for a few weeks until your breasts return to normal.
Please note that an ultrasound does not replace a mammogram, which remains the best tool for the diagnosis of breast cancer.
2-3g of evening primrose oil per day for 2-4 weeks may be helpful in reducing breast tenderness.
Do antiperspirants cause breast cancer?
Antiperspirants do not cause breast cancer!
Rumour has it that antiperspirants prevent the body from purging dangerous toxins, which subsequently causes a build-up of these toxins in the lymph nodes under the arms. The build-up of these toxins is then proposed to lead to cell mutations and the development of breast cancer.
Please note that these rumours are totally unfounded and can in no way be substantiated by research. Sweat consists of 99,9% water, sodium and potassium, making it an insignificant method for the body to purge toxins.
The body purges toxins through the kidneys and liver.
Does breastfeeding affect my risk of developing breast cancer?
There are a few studies that have indicated that women who have breastfed have a lower risk of developing breast cancer. However, this does not mean that they will not develop breast cancer at some stage. An annual mammogram from the age of 40 remains best practice.
Can an injury to the breast cause breast cancer?
An injury to the breast cannot cause breast cancer. However, it can cause a non-malignant lump. Fat necrosis can develop which is when tissue dies off due to trauma and becomes hard. This is not a form of cancer and does not develop into cancer over time, but can often be mistaken for cancer on a mammogram.
What types of signs should I look out for?
-Lumps of any size or thickening of the breast tissue.
-Changes in the shape of the breast or persistent discomfort.
-Discharge from the nipple that is not associated with pregnancy or breast feeding.
Breast self-examination: 8 steps