Breast cancer is the most common cancer among women in South Africa accounting for 22.6% of all female cancers. Men can also get breast cancer, with approximately 1% diagnosed. 

Health-e News spoke with Dr Diana Pillay, a radiation oncologist at the Hopelands Cancer Centre in Durban, about common questions women have about the disease.

At what age should I seriously start considering screening for breast cancer? 

“Breast cancer commonly affects women of age 50 and older, so generally speaking it’s a cancer that’s related to age. The highest risk factor is age and gender. So if you think about that age breast cancer screening should start before the age of 50.

A patient with a genetic predisposition to breast cancer should start screening as early as 25 years old.”

A genetic predisposition is the increased chance of developing a particular disease. The genetic characteristic can usually be traced back to family history. 

What does screening entail?

“We usually first encourage women to start with self-examination  (at least once a month) around 21 and then a clinical breast examination/ general check-ups (when you’re 40 and older) at least once a year, done by a nurse, GP or gynaecologist.

Mammograms – X-ray images of your breasts designed to detect cancers and other changes in breast tissue – are done at radiology units which are available in both public and private.

But it is a test that’s done once a year so if you are in the public healthcare system, you have a whole year to have it done. There are also NGOs like Pink Drive  that go out to communities with a mobile mammogram unit and offer screening.

If you feel or see any changes during self-examinations, you should visit a doctor”.  

Screening ages

“An American study showed that if screening is started at the age of 40 instead of 50,  it helps reduce mortality of breast cancer by 12 to 29%. However this is for the general population and not people with genetic predisposition.”

Is there a blood test women can have that detects breast cancer?

“No, there isn’t a blood test that can detect breast cancer, there’s no test that is as valuable as a mammogram. However if a woman has a strong family history of cancer; if you have a family that is known to carry genetic mutations like the BRCA mutation then you can have a blood test that is done to pick up that mutation.

If you’re a carrier of that mutation it doesn’t mean that you’re going to have breast cancer but you’ll have an increased risk of breast cancer.”

Other than genetics, why do people get breast cancer?

“You have modifiable and non-modifiable risk factors. Genetics are non-modifiable risk factors but account for 5 to 10% of all breast cancers, and aren’t the primary reason for breast cancer.

Other non-modifiable risk factors are age and being a woman, as well as the endogenous hormones that women make. So for example women who’ve had an early period and late menopause, never had children or few children, tend to have higher levels of hormones which puts them at risk of breast cancer.

Modifiable risk factors are things like our lifestyle. For example, excessive alcohol, smoking, lack of exercising, and unhealthy eating habits.”

Is breast cancer more aggressive in women younger than 40, and if so, why?

“Generally it is, because the average age at diagnosis is about 50, so having it at an earlier age means something predisposes you to develop it; something puts you at risk. It can be a combination of genetic predisposition and environmental issues (smoking, alcohol, etc).

Something would’ve triggered a mutation early for breast cancer to happen before 50 and biologically breast cancers are more aggressive. But oncologists generally look at the history, characteristics and stage to determine how aggressive the cancer will be without treatment.”

What is the best treatment? 

“Local treatment involves surgery and radiotherapy and systemic treatment is the use of systemic drugs like chemotherapy or hormonal therapy and now we have targeted therapy.

A decision is made by a panel of doctors as to what would be the right treatment. The best way to manage a patient’s breast cancer is as a team that involves a surgeon, radiologist, oncologist, psychologist and many more.  

In the past it used to be surgery first, but now surgeons are often consulting the oncologist because we know that patients may need to have systemic treatment before surgery. There are certain situations where this has to be done based on the type of cancer the patient has.

Surgery removes the cancer and radiation is given if it was a fairly advanced breast cancer and we want to protect the chest wall (radiation’s role is to prevent cancer from returning in the breast or chest wall and help increase survival).

Chemotherapy is decided upon based on the patient characteristics and type of cancer.”

What role does age play in the choice of treatment options?

“If the patient is younger, then the treatment options will be more aggressive because we want them to live longer. If they don’t have other comorbidities or illnesses that could prevent them using certain treatments, then options like chemotherapy and radiation would be considered. This is because they are known to help increase survival. 

For older patients we tend to have more of a gentle approach, so minimal surgery, short courses of radiation and avoiding chemotherapy, is often considered for the older patient.”

 – Health-e News