This October, for Breast Cancer Awareness Month, the Breast Imaging Society of South Africa (BISSA) is emphasising the importance of early detection through regular self-examinations, even as early as one's 20s, and annual mammograms starting from the age of 40.

Dr Peter Schoub, Chair of BISSA, a sub-specialty group of the Radiological Society of South Africa, says early detection of breast cancer dramatically improves survival rates and reduces the need for aggressive treatment.

“One of the most significant challenges in South Africa is the late-stage diagnosis of breast cancer when the cancer is advanced, reducing the chances of successful treatment. This late diagnosis is often due to a lack of awareness, limited access to healthcare facilities, and socioeconomic inequalities.”

“Although most of the major medical schemes offer a yearly complimentary mammogram screening to women over the age of 40, only about 20% take advantage of this service.”

Dr Schoub says although breast cancer becomes more common as one gets older, breast cancer is on the rise amongst women in their 30s.

“Young women experience more aggressive breast cancer that progress rapidly and would be at an advance stage by the time of diagnosis, increasing the risk of cancer spreading to other parts of the body.”

“Breast cancer affects women of all ages, races and socio-economic circumstances. We urge women to regularly check their breasts for any irregularities and have a clinical breast examination by a GP, gynaecologist or a nurse at least once a year. Any abnormality, regardless of age or family history, warrants an immediate medical consultation with a healthcare professional.”

He says the goal of screening for breast cancer is to find the disease before it causes symptoms. Regular screening is more likely to find breast cancers when they are small and still limited to the breast area which is vital for successful treatment and survival, since the size and extent of the spread are the most crucial in predicting the outcome of a breast cancer diagnosis.

WHO IS AT RISK OF DEVELOPING BREAST CANCER?

Every woman is potentially at risk of getting breast cancer. However, certain factors will place them in a higher risk category, including: · Age: The risk of developing breast cancer increases as one gets older, however 1 out of 8 invasive breast cancers are found in women younger than 45.

• Family history: Women with close blood relatives who've had breast cancer are at higher risk.
• Personal history: A woman with cancer in one breast has a 3-4 times increased risk of developing a new cancer in the other breast or in another part of the same breast.
• Dense breast tissue: Women with dense breast tissue (as identified on a mammogram) have more glandular tissue and less fatty tissue and thus a higher risk of breast cancer.
• Overweight or obese women: Research in the past has shown that being overweight or obese increases the risk of breast and other cancers.
• Lifestyle: Excessive alcohol consumption, lack of physical activity, smoking, and diets high in saturated fats contribute to risk.
• Hormonal factors: Women who have not had a full-term pregnancy or have their first child after age 30 have a higher risk of breast cancer compared to women who gave birth before age 30. Breastfeeding can lower breast cancer risk, especially if a woman breastfeeds for longer than one year. Women who started menstruating younger than age 12 have a higher risk of breast cancer later in life. The same is true for women who go through menopause when they are older than 55. Current or recent past users of hormone replacement therapy (HRT) have a higher risk of being diagnosed with breast cancer.

HOW TO SELF-EXAMINE YOUR BREASTS

The breast changes throughout the menstrual cycle and it is important to always self-examine at the same time of the month, usually a week after your period when your breasts are less tender due to fluctuations in hormone levels.

Visual examination – sit or stand, without clothing, in front of a mirror with your arms to your side and look for changes in size, shape, symmetry, puckering and dimpling.

• Physical examination – lying down so that your breast tissue spreads out making it easier to feel, or in the shower using soap to glide more easily over your breasts:
• Use the pads of your three middle fingers, not your fingertips, to examine.
• Apply different pressure levels – light to feel the breast tissue closest to the skin, medium to feel deeper, and firm to feel the tissue closest to the chest and ribs.
• Use a methodical technique such as beginning near the collarbone, then moving towards the nipples, in a clockwork fashion.
• Allow enough time and don’t rush the examination.

SIGNS TO LOOK OUT FOR

It’s important to note that many lumps may turn out to be harmless, but it is essential that 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, or
• a lump or knot near the underarm area.