By: Dr Carolina van der Westhuizen (Gynaecologist)
One of the aims in women’s health is the prevention of cancer or the early detection thereof.
Breast cancer remains the most common cancer in females in the world, followed by cervical cancer. This article is to put the focus back on the importance of screening for these two most common cancers in women.
It is common knowledge that the sooner a cancer is detected, the better the outcome of the treatment of the cancer and survival of the specific individual will be. There are specific guidelines either world- or country based that caregivers adhere to, to screen for cancers. Certain individual patient’s screening interval and type of screening (for instance those who are identified with a higher risk to develop a certain cancer) will also differ from patient to patient.
What is a screening test? It is the most reliable and cost effective test (unfortunately no screening test has a 100% reliability) to detect the majority of diseases in the general population where the disease is present, but without any signs or symptoms. That means that you already have the disease, but you are not aware of the disease. In some instances, the most reliable test is not included as a screening test due to the fact that it is very costly and only done in high risk patients.
The golden standard in the world to screen for breast cancer remains the well-known mammography (mammogram) test. It can include or exclude an accompanying ultrasound of the breast depending on the type of tissue a patient’s breast is composed off. The general guideline is to start with a baseline mammogram at age 40 (there are exceptions) and then the interval of the follow up mammogram will differ from patient to patient depending on their age, previous breast diseases/cancer, type of tissue etc. but it is usually every year or every second year. A mammogram is an X-ray of the breast that detects abnormal calcifications in the breast tissue caused by breast cancers. The calcifications in the breast caused by cancer usually looks different than the benign type of calcifications or benign cysts in the breast. Benign or new (probable cancer) calcifications are followed up or detected when a patient is taking her previous mammograms with during her follow up mammogram. That is why it is so important to take the previous mammograms with you when doing your annual or bi-annual mammogram.
There is a perception amongst some patients that a mammogram examination will increase the risk for developing breast cancer or even cause breast cancer. This is not true. The amount of radiation that a patient is exposed to during her mammogram examination is very little, it is more or less the same amount of radiation exposure you receive during a 2 to 3 hour flight in an aeroplane (tongue in cheek: nobody stops flying oversees due to the fear of contracting breast cancer due to the amount of radiation they are exposed to).
Unfortunately an ultrasound of the breast alone is not regarded as a standardized screening test to detect breast cancer. It is true that some breast cancers (minority) will be detected by an ultrasound of the breast, but it is supposed to be done in conjunction with a mammogram.
Self-breast examination still remains a very important part of the detection of breast cancer. Patients need to do self-examination in front of a mirror with the arm elevated and hand tucked in behind the head to expose the breast that is going to be examined. By doing the self-examination every month, a new lump might be identified as a lump that was not previously palpable. The breast tissue is examined in a circular motion starting under the armpit and moving onto the breast and around the centre of the breast following with an up and down motion of the hand over the entire breast again. To complete the examination, patients need to look for any signs of breast cancer that includes a retracting nipple, retracting skin anywhere on the breast and a change in skin that looked inflamed and like an orange peel. Those are cancer changes and not aging changes of the breast.
There are different “tools” available, like specific gloves or lights to examine your own breast. You do not need them, but if you do compose of something like that, please use it with caution. Your own hands and regular examinations cannot be replaced. The key here is to react as soon as possible on any new findings or changes in the breast that you are aware of.
Dr Carolina van der Westhuizen is a Gynaecologist based at Mediclinic Midstream and performs her day surgery procedures at Cure Day Hospitals Midstream.