A breast of the facts

October is Breast Cancer Awareness month and the fight is on to educate women in what is now the second leading cause of death in South African women, leading causeafter cervical cancer. Over 30% of new cancer cases is breast cancer and there is an increase in women under 35 years of age - referred to as young women - diagnosed with this type of cancer. Unfortunately, even today, women are still not fully aware of all the facts relating to this disease.

“While genetic causes of breast cancer accounts for only 10% of all cases, a family history of any type of cancer is also relevant. Other contributing risk factors include a first pregnancy after 30 years of age; a prolonged exposure to oestrogen; early menstruation; late menopause and increased body fat,” says Dr Carol-Ann Benn, a specialist surgeon who helped establish the Netcare Breast Care Centre of Excellence, and also a senior lecturer in the Department of Surgery at the University of Witwatersrand. Dr Benn also says: “One of the biggest causes for concern at the moment is the increase of breast cancer in young women as lumps in the breast are often ignored because of the misconception that this cancer does not occur in women under 35. Also, the myths surrounding breast cancer have still yet to be dispelled.”

Dr Carol Benn says it is important to know the myths and the facts.

Myth: Taking the oral contraceptive pill causes breast cancer.
Reality: Taking the pill only gives a minimal increased risk of breast cancer.

Myth: If the lump isn’t painful, it can’t be cancerous.
Reality: Nine times out of 10, breast cancer is painless. Any lump should be investigated. Possible causes could be fibroadenomas or cysts and women over the age of 35 may need to have lumps removed but only after a needle biopsy tissue diagnosis has been made.

Myth: Hormone Replacement Therapy causes breast cancer.
Reality: The risk of breast cancer from HRT may  increases after 5 years of HRT.

Myth: If I am diagnosed with breast cancer I have to have a mastectomy.
Reality: Surgery is not always disfiguring.

Myth: If my breasts hurt, I have breast cancer.
Reality: Only a small percentage of breast cancer causes breast pain. However, an examination to exclude chest wall pain and non-breast sources of pain, followed by a mammogram and/or sonar to exclude cancers, masses or cysts is essential.

Myth: I have nipple discharge, so I must have breast cancer.
Reality: Blood stained or clear nipple discharge should be evaluated by a doctor and usually require surgical removal of the duct causing the problem. Nipple discharge is sometimes mistaken for Pagets disease and must be checked by a doctor.

Pagets disease is a lesion that resembles a scaling, oozing, weeping manifestation of the nipple skin and areola. It is sometimes associated with nipple discharge and normally affects one breast, mimicking eczema. “It is important to recognise this lesion as more than 90% of women with Pagets disease have some underlying breast cancer. A clinical examination and ultrasound or mammogram is essential and it is imperative that a skin biopsy is conducted regardless of the results of the previous examination or tests and it is one of the few types of cancer that should be treated with a mastectomy and immediate reconstruction.” says Dr Benn.

It is important to regularly check the breasts for lumps and if one is detected, to go to the doctor. “A doctor should use three modalities to assess the breast, commonly known as the triple assessment, by using the triple assessment, there is little chance of missing a cancer,” says Dr Benn. The three modalities are: clinical examination; mammography and ultrasound and needle tissue biopsy. In most cases, it is not necessary to undergo a general anaesthetic to determine whether or not a lump is cancerous. All women should undergo all three assessments, although women under the age of 40 should opt for the breast ultrasound due to the increased density of breast tissue in younger women.

If a cancer is diagnosed, then a few days should be taken to consider all the options. Each patient is individual and should be treated as such. One of the foremost centres for breast cancer is the Netcare Breast Care Centre of Excellence and offers patient counselling, referrals for diagnostic and evaluation to surgical, radiological, chemotherapeutic and reconstructive intervention, management of all breast diseases, workshops for the medical and public communities and screening to provide early breast cancer detection.