Breast cancer is the most prevalent cancer among South African women. Although most breast cancer patients are postmenopausal, there has been a growth in premenopausal breast cancer, leading to a younger presentation.

A study published in the SA Journal of Radiology reveals that breast cancer is predominantly diagnosed in patients below 40 years (premenopausal) in 5–7% of patients in developed countries and close to 20% in developing countries.

The average age of breast cancer diagnosis for women under 40 was 34 years, states the report. It also shows that younger women are diagnosed with more aggressive forms of the disease. Across all ages, breast cancer affects 1 in 27 women in South Africa, accounting for 23% of all cancers diagnosed.

“One of the biggest hurdles in South Africa remains the late-stage diagnosis of breast cancer,” says Dr Peter Scoub of the Breast Imaging Society of South Africa (BISSA).

“Late diagnosis drastically reduces treatment options and survival rates.”

Contributing factors

• a lack of awareness
• not understanding one’s personal risk factors
• socioeconomic disparities
• limited access to healthcare facilities.

“Ideally, women should start with self-examinations in their 20s with annual mammograms from the age 40,” Dr Scoub advises.

breast cancer screening goal

Detecting the disease before symptoms emerge is the aim of breast screening.

“Cancers found through routine screening are often smaller and localised, increasing the chances of successful treatment and survival,” Dr Scoub explains. “The size of the tumour and whether the cancer has spread are key factors in determining the prognosis.

“Women need to be aware of several risk factors. Understanding and monitoring these factors, performing routine self-checks and regular screening is the most powerful tool we have to improve survival.”

Read our article on breast cancer risk to learn the risk factors.

“Although some women are at higher risk than others, breast cancer does not discriminate – anyone can be affected. Any abnormality, regardless of age or family history, should be evaluated by a medical professional immediately,” Dr Scoub advises.

risk assessment

The BISSA urges women to complete risk assessments from an early age and to realise that some women are at higher risk than others and may need additional screening.

A breast cancer risk assessment tool is a helpful tool, using a statistical model to estimate a woman’s risk of developing breast cancer over the next five years as well as over her lifetime.

It typically involves several questions about the person’s medical history, reproductive history and family history. The results should be discussed with a healthcare professional.

look for signs

Many lumps may turn out to be harmless, but it is essential all of them are checked.  Visit your healthcare provider if you notice any of these changes:

• swelling of all or part of the breast
• skin irritation, dimpling or ridges on the skin
• nipple pain or the nipple turning inward
• redness, scaliness or thickening of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump or knot near the underarm area.

trends and myths in imaging and treatment

Modern technology has significantly improved the experience of mammograms. “Breast tissue no longer needs to be pressed as hard to achieve images for breast cancer screening,”says Dr Britta Dedekind, a breast surgeon at Netcare Christiaan Barnard Hospital and a member of the Breast Interest Group of Southern Africa.

“Unfortunately, the reality is that some women are diagnosed before the age of 40, so any suspicions from the patient or her healthcare practitioner should be investigated with imaging, whatever her age. Women with dense breast tissue may require ultrasound imaging to help detect abnormalities that are harder to see with mammography alone.

“A mammogram takes just a few moments, and it really is not painful – contrary to one of the most persistent myths in breast health,” she says.

“Another myth is that having a breast problem today automatically means you will need a mastectomy. Breast cancer treatment is moving toward more precise and less invasive options. Modern advances, supported by international experts, mean many patients can often avoid major surgery. The focus now is on using targeted treatments carefully to give patients better results through personalised, multidisciplinary collaboration and care.”