Women urged not to let breast cancer fears delay a check

October marks Breast Cancer Awareness Month, with specialists urging women not to allow fear, myths or misinformation to delay medical assessment of breast changes.

Breast cancer affects an estimated one in 28 South African women and remains the most frequently diagnosed cancer among women in the country, accounting for about a quarter of new cancer diagnoses each year.

The Breast Imaging Society of South Africa (BISSA) says advances in screening and treatment have improved the outlook for many patients, making early assessment of possible symptoms an important part of care.

A breast lump does not automatically mean cancer

Dr Peter Schoub, who is the chair of BISSA, said delays in diagnosis and treatment can result in cancer being detected at a more advanced stage, potentially requiring more intensive treatment.

‘A diagnosis is not an automatic death sentence and does not necessarily mean radical treatment such as chemotherapy or mastectomy. Advanced treatment today is tailored to the tumour and the patient.’

According to Schoub, many women with early-stage breast cancer can undergo breast-conserving surgery, such as a lumpectomy, generally alongside radiotherapy.

He added that not every patient requires chemotherapy, with hormonal and targeted treatments forming part of the options available for some patients.

Dr Peter Schoub. Picture: Parklane Radiology.

BISSA also notes that many breast lumps are benign. However, a new or persistent lump or other unexplained change should still be assessed by a healthcare professional.

What changes should women look out for?

Possible warning signs include changes in the breast or nipple that are new or persistent.

These can include:

• A change in breast shape or swelling affecting all or part of the breast
• Skin irritation, dimpling or ridges
• Nipple pain or an inward-turning nipple
• Redness, peeling, scaliness or thickening of the nipple or breast skin
• Nipple discharge other than breast milk, particularly if it occurs spontaneously, affects one breast or contains blood
• A lump or knot in the breast or underarm area

Schoub stressed that pain should not be used as the deciding factor for whether to seek medical advice.

‘Early breast cancer may cause no pain or other symptoms and may be too small to feel. This highlights the importance of annual screening mammograms, as this can detect lumps before they can be felt.’

Mammography remains an important tool for detecting breast cancer at an early stage, as BISSA says concerns about the procedure, including fears around pain and radiation, can contribute to reluctance to undergo screening.

The organisation says mammography uses a low dose of radiation and that breast compression during the examination lasts only a few seconds for each image. Some patients may experience discomfort or brief pain during the procedure.

Schoub said the radiation exposure is highly regulated and controlled.

‘The level is safe for routine screening, and the early diagnosis benefits of less aggressive treatment and greater life expectancy far outweigh any risk.’

BISSA also rejects the idea that a needle biopsy causes breast cancer to spread, describing biopsy as central to confirming a diagnosis and determining appropriate treatment.

Another common misconception is that breast cancer is primarily a concern for women with a family history of the disease.

While inherited gene variants and family history can increase risk, Schoub said other factors also need to be considered, including age, breast density, reproductive and hormonal factors, and overall health.

‘Formal risk assessment is advised, rather than relying on family history alone.’

The absence of a family history therefore does not mean that a woman cannot develop breast cancer.

Knowing what is normal can help spot changes

BISSA recommends that women become familiar with the normal appearance and feel of their breasts so that changes are easier to identify.

The breast can change during the menstrual cycle, and women who self-examine are advised to do so at the same point in their cycle. The organisation suggests that the week after menstruation can be a suitable time, when breasts may be less tender.

For a visual check, women can stand or sit in front of a mirror without clothing and look for changes in size, shape or symmetry, as well as puckering or dimpling. The check can then be repeated with the arms raised behind the head.

A physical examination can be done while lying down or in the shower, as BISSA recommends using the pads of the three middle fingers rather than the fingertips and varying the pressure to examine tissue at different depths.

A methodical approach, such as moving across the breast in a clockwork pattern from the collarbone towards the nipple, can help ensure that the examination is thorough.

The key message from BISSA is not to attempt to diagnose a breast change at home, as a new lump, persistent change or other unusual symptom should be assessed by a healthcare professional, even if a recent mammogram was normal.

Routine screening can also provide a baseline against which future images can be compared. BISSA recommends taking previous mammogram images to subsequent appointments where possible, as comparisons can help radiologists identify genuine changes.

For women who menstruate, scheduling a mammogram during the week after the menstrual period may also help reduce discomfort caused by breast tenderness.

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**Picture: **Supplied

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