Cancer

Regular breast screening can lead to early detection of breast cancer and better outcomes.  

Breast cancer is the most common and deadliest cancer in South African women.

“Early screen detection of breast cancer can mean a better prognosis, an improved survival rate and less severe treatment, involving surgery and radiation but not necessarily chemotherapy as well,” says radiologist and breast imaging specialist Dr Jacqueline Kieck from Morton & Partners at Mediclinic Cape Town.

What is a mammogram?

A mammogram is an X-ray of your breast, conducted by a specialist radiographer, or mammographer. It provides much more detailed information than a physical breast examination as it can detect signs of breast cancer that are too small to see with the naked eye. It’s a safe screening approach as the radiation dose used in the procedure is very low and regulated, says Dr Kieck.

When should I have a mammogram?

Women should start having mammograms at age 40, ideally every year or at least every two to three years, says Dr Kieck, based on guidelines from CANSA and the Radiological Society of South Africa.

The risk of breast cancer increases with age, especially after 40, although women at high risk may develop it earlier. While some countries recommend routine mammograms until age 74, Dr Kieck advises continuing them if you're healthy and expect to live at least another 10 years

Reasons to have a mammogram

Apart from regular breast screenings, most women are referred by their GP or gynaecologist for a mammogram because of specific symptoms, such as mastalgia (breast pain), finding a lump in their breast, nipple discharge or a noticeable asymmetry.

Dr Kieck explains that breast pain is usually not a cause for concern and is often linked to hormonal changes. However, other symptoms may suggest a more serious issue.

“Patients under age 35 with a lump will usually be given an ultrasound rather than a mammogram,” she says. This is because younger patients have denser tissue, which is harder to read on a mammogram.”

Who is most at risk of developing breast cancer?

Dr Kieck explains that while having a family history of breast cancer increases the risk, 70% of women diagnosed with breast cancer have no family history. Other risk factors include being overweight, not getting enough exercise, drinking alcohol, smoking, having a poor diet, and exposure to chemicals.

“Every woman should have a risk assessment before age 25. This is based on family and personal histories and can give you your lifetime risk of developing breast cancer. If you have a 70% risk of developing breast cancer, you’re considered high risk and should have magnetic resonance imaging (MRI) scans from age 25. MRI is the most expensive screening tool we have, but it’s also the most sensitive and specific.”

What happens during a mammogram?

A mammogram is done using an X-ray machine that presses the breast between two plastic paddles to take two pictures of each breast. Most mammograms today are digital and create 3D images, which help detect cancer.

“One image is a compression of the breast from top to bottom, while the second image is from side-to-side. Each image takes only a few seconds,” says Dr Kieck. “This process can be slightly uncomfortable, especially for women with sensitive breasts, but it’s generally well tolerated.”

Dr Kieck advises patients not to use talcum powder or deodorant on the day of their mammogram, as these can appear on the images and block important areas. She also suggests wearing a two-piece outfit so you can easily remove your top and bra.

After the mammogram, most clinics provide patients with a report right away, letting them know if the results are clear or if further checks are needed. The official report will be sent to the patient's doctor or gynaecologist.

“Generally, patients are sent away with a reassuring message from the mammographer that the mammogram was clear,” says Dr Kieck. “Patients with dense breasts may be asked to return for an ultrasound if the mammogram was not optimal or there was a need to confirm if white areas showing on the mammogram are benign cysts or something of concern.”