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JSH Honours Breast Cancer Awareness Month

October 2023

Early Detection Saves Lives

“In first-world countries the five-year survival rate for breast cancer is between 80-90%. In South Africa the three-year survival rate is as low as 59%. This is a huge disparity that is due to a lack of infrastructure; South Africa is still a third-world country.” – Dr Fatima Docrat, Breast Oncology Surgeon at JSH.

JSH continues to bring state-of-the-art, holistic care to patients with the SJF Breast Centre of Excellence; a group of female specialists who have joined forces as a team of women for women, to do what they can in the quest to resolve the problem of South Africa’s significantly low breast cancer survival rate. 

“Any type of breast cancer treatment should be handled by a multidisciplinary team that includes a breast surgeon, a plastic surgeon, a medical oncologist, a radiation oncologist, your specialist physician; and then a complimentary team of support specialists that includes physiotherapists, occupational therapists, psychologists, and dieticians.” Dr Shahista Khan, a specialist physician at JSH.  “It really is a team approach, with the patient being at the centre of the team. We need to be patient-centric and patient-focused; we need to give the best level of care to every patient, with regard to what they’re ready for at any point in time along their journey to recovery.” 

Dr Khan emphasises that breast cancer treatment is not a one-size-fits-all, cut-and-paste definitive. Every patient’s needs will be different, and the chances of complete cure and survival lie strongly in how early in its development breast cancer is detected. “With breast cancer you prefer to have the option of surgery as an aim for cure; that’s why we encourage regular screening and mammograms. Surgical options are more beneficial in the early stages, increasing your chances of returning to complete health.”

Dr Docrat adds that it is essential to take the time to get to know your breasts and what “normal” feels like for your breasts; because the screening process starts with you. “It is very important to examine your breasts and know exactly when an abnormality takes place. Start by standing in front of the mirror and looking at your breasts. The main signs and symptoms to look out for are any kind of skin thickening; any redness on the skin; and any changes in the texture of the skin. After that you need to get hands-on and physically examine your breasts.” 

Personal examinations of your breasts to essentially build a relationship with them, should become a monthly routine for us all. Dr Docrat outlines these steps that women can apply to building a personal breast care regime. 

 

  • Lie down on your back and lift one arm to rest on the pillow above your head. 
  • Palpate the breast in either a clockwise or anti-clockwise direction.
  • Feel around for any bumps, lumps, or anything that feels new or out of the ordinary. 
  • It’s also very important to examine your nipples – squeeze them to see if anything suspicious comes out; nipple discharge is an abnormality. 
  • Repeat these steps with your other breast. 

 

In addition to self examination, a yearly check-up with your doctor should also be something you make time for to ensure that all bases are covered; that you regularly receive a proper check-up and examination; and so you can be referred for a sonar or mammogram depending on your age, and the results of the doctor’s initial examination. Dr Breytenbach, SJF and JSH’s resident Plastic and Reconstructive Surgeon advises; “Any lady that has found a lump in her breast and is worried that it may be breast cancer, must go and see a doctor. You can start with your GP or you can start with a breast surgeon; you have a number of options and there is a complete breast care team here at JSH who are standing by to help find the correct diagnosis.” 

“I think the biggest problem, or the biggest mistake, is that patients tend to find there’s an abnormality and then be too scared to go and have the correct diagnostic modalities applied. For example, some patients will have felt a bit of pain in their breast and instead of seeking medical advice or going for a mammogram, they wait on it. There have been cases where patients have waited a long time; sat with the pain, or the abnormality; and then when finally seeing a doctor it turned out to be cancer; which may not have been the case if they had seen to it immediately. Early detection saves lives.” Dr Khan adds.  

There is a misconception that breast cancer only affects women. Dr Docrat stresses how we need to be aware that men, although in a small percentage, are also at risk of developing breast cancer. “So, as a man it’s also very important to examine your breasts; and to become familiar with what is normal and what would be considered abnormal for you. Feel around for lumps, changes in the skin, or any fullness in the breast tissue. Should you find any of these abnormalities, seek medical attention so that you can be referred for proper investigation.” 

While on the subject of myths, Dr Docrat clears up another one for us. “The main myth that I often hear is that mammograms cause breast cancer. This is completely untrue. Mammograms are a vital part of screening and early diagnosis of breast cancer.” Any cancer that is found at an early stage has a greater prognosis. 

JSH general surgeon Dr Pieter Marais further explains, “The important thing to realise is that screening means that you have some or no symptoms whatsoever. Screening is not when you have an issue, screening is before you have an issue. Mammography is one of the modalities that we can use for early detection.” 

“Some other myths that we hear is that breast cancer can only be passed down in families. Sometimes you might be the first.” Dr Docrat warns that we can never denounce the possibility of breast cancer just because there is no history of it in our families. 

Dr Khan walks us through some of the other risk factors that we need to be aware of. “With all risk factors there are modifiable risk factors and non-modifiable risk factors. Non modifiable risk factors include things like age; if you have had children, and how many children you’ve had; if you breastfeed your children -having children and breastfeeding them can be a protective measure for breast cancer. The modifiable risk factors are things like smoking, being exposed to certain medications that are known to increase the risk of breast cancer; and if you have a family history of the BRCA* mutation. The modifiable risk factors are something you need to be more alert about as they are the ones that increase your risk of breast cancer; you also need to inform your doctors about these so that they can screen accordingly.” 

No matter which way you look at it, scheduling routine screening checks, as well as general check-ups, with your doctor/s; along with building and maintaining a regular routine of self-examination, is the best line of defence to increasing your chances of survival when it comes to breast (or any other) cancer. The SJF team at JSH are here to walk you through the journey, to support you along every step of the way. 

“We want to get you back to a fully functional woman from the diagnosis of breast cancer all the way through your reconstruction. Back to feeling like a woman; back to feeling good about yourself again; getting your confidence back. Our chances of being successful in this are heightened by early detection” Dr Breytenbach concludes, “If you feel a lump, you need radiology; you need either a sonar or mammogram depending on how big the lump is. Then you need a tissue diagnosis, which is most important. After that a biopsy will give us a pathology result; and with all that information together we will send you to the breast cancer surgeon and she will evaluate all the information to help you make a decision on the best course of action. So, it’s very important to get in touch with us. Remember, early detection saves lives.” 

Footnote: A BRCA mutation is a mutation of either the BRCA1 or BRCA2 genes, which are tumour suppressor genes. Both genes produce proteins that help repair damaged DNA, keeping the genetic material of a cell stable. A damaged BRCA gene in either location can lead to an increased risk of cancer, particularly breast and ovarian cancer in women. Men with the mutation are more likely to be silent carriers; women are more likely to develop cancer. – Wikipedia.