What you need to know about early breast cancer screening

You can survive breast cancer – but the earlier you pick it up, the better your chances of making a full recovery. Two Mediclinic experts explain what you need to know.

According to the Cancer Association of South Africa (CANSA), breast cancer is one of the most common cancers in women of all races. Dr Rika Pienaar, a radiation oncologist at Mediclinic Panorama, and Dr Justus Apffelstaedt, a specialist surgeon at Mediclinic Louis Leipoldt, who has an interest in breast and thyroid health, explain why regular screening is so important. 

Women need to know the value of detecting breast cancer early, before symptoms develop, says Dr Pienaar. “The evidence shows that the benefits of early detection include mortality reduction, less aggressive treatment and a wider range of treatment options.” While some debate exists around annual screenings versus every second year, Dr Pienaar says many studies have proven a marked reduction in mortality rate among women who go for annual screening, which she recommends.  

Research by Dr Apffelstaedt and his team has demonstrated why early detection is crucial. The team examined a series of screen-detected breast cancers against cancers detected only when the women felt a lump. “We showed convincingly that in the initial treatment of the cancer, surgery remained much the same – but the need for other treatments was reduced,” he says. “Only half of the patients needed chemotherapy [with its unpleasant side-effects] and only a third of patients needed biologicals.

Screening advice for all ages

Dr Pienaar recommends that breast cancer screening should start in your 20s already and be performed regularly – even in later life.

Age 25 – All women should have their risk for breast cancer assessed from age 25, including counselling on how to lower the risk for breast cancer with lifestyle interventions. 

Late 20s-30s – Women with an average risk of breast cancer between the ages of 25-39 years, with no symptoms of breast cancer, need a clinical examination every one to three years. 

From age 40 – Have annual clinical examination, counselling and mammographic screening.

Older women – There is no upper age limit for screening, and observational studies show mortality benefit of mammographic screening even in the 80-84-year age group.

A mammogram is the gold standard of breast cancer screening, says Dr Pienaar. “Of all the various screening modalities, mammography remains the most important and is the only one to demonstrate a mortality reduction,” she says. 

Dr Apffelstaedt concurs, adding that screening relies on imaging investigations. “Of these, mammography is the most important and best breast cancer screening tool, followed by ultrasound. Ideally, both should be done together. Mammography and ultrasound usually detect cancer about two to three years before the patient or their healthcare provider feels a lump.”  

The screening will still involve a clinical exam, though, as well as a complete history. “The clinical exam is very important to find tumours while they are very small, or in cases where the tumours are not visible on the mammogram, for example, lobular carcinomas [a type of cancer that begins in the milk-producing glands],” says Dr Pienaar. 

While self-exams will never be as effective as being examined by a doctor, it’s still important to know your own breasts so you can pick up any changes that might occur between exams, Dr Pienaar cautions.  

In addition to the mammogram and clinical exam, there are other types of screening that may be used in certain circumstances, says Dr Pienaar:

• Ultrasound – a painless procedure that uses high-frequency sound waves rather than radiation to produce pictures of the breast. “Ultrasound of the breast may be used after an abnormal mammogram or in women with very dense breast tissue.” 
• MRI – uses magnets to create cross-sectional images of your breast and is also painless. “If you have a breast cancer diagnosis, MRI can help find additional tumours and assess tumour size.”  
• Artificial intelligence (AI) – newer imaging tests are being developed, but it will take time to see how effective they are. 
• Advancements in treatments
• “New kinds of treatments for breast cancer are always being studied,” adds Dr Pienaar. “For example, in recent years, several new targeted drugs have been approved to treat breast cancer. But more and better treatment options are needed.” Dr Pienaar and Dr Apffelstaedt list some current research areas:
• AI – “Using AI to interpret mammograms has proven more effective than a human reader and should come to South Africa in the very near future,” says Dr Apffelstaedt. This is an exciting tool to improve the accuracy and sensitivity of diagnosis.
• Radiation – Whether shorter courses of radiation therapy for very early-stage breast cancers are at least as good as the longer courses used now, and if different types of radiation therapy might be better than standard radiation, says Dr Pienaar. “We’re looking at more sophisticated planning and delivery systems, which reduce side-effects,” adds Dr Apffelstaedt.
• Medication – Combining drugs to see if they work better together; looking for new drugs or drug combos that could treat breast cancer that has spread to the brain; testing different immunotherapy drugs to treat triple-negative breast cancer.
• Preventing recurrence – Giving cancer vaccines with standard chemotherapy to see if this helps keep the cancer from coming back; finding new ways to treat women with hereditary breast cancer, since they have a higher chance of the cancer recurring.
• Chemotherapy – Determining if chemotherapy is needed to treat every woman with HER2-positive breast cancer.
• Surgery – Own-tissue reconstruction instead of prosthetics – although it’s complex surgery and only performed in elite clinics, says Dr Apffelstaedt. The use of sentinel lymph node biopsy (SLNB) instead of axillary lymph node dissection (ALND) in patients who have already been diagnosed with cancer. SLNB is less invasive because only the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present, whereas in ALND most of the underarm lymph node is removed.
• Genetic testing – Assessing cancer risk in healthy women and profiling established cancer in order to make management more personalised.
• Innovation – New treatment options for when breast cancer becomes resistant to current treatments.

Ultimately, with regular screening and the latest treatment, the outlook for breast cancer is much better than it was previously. “If a woman goes for regular breast cancer screening and is treated at an expert centre where the latest detection and treatment options are available, she can expect her female appearance to be preserved, her quality of life after cancer to be good, and her survival to be that of a normal woman without cancer,” says Dr Apffelstaedt.

Ask your GP to refer you for a mammogram at your nearest diagnostic centre.