Keeping aBreast: what you need to know this breast cancer awareness month

Margot Brews, Head Health Risk Management Strategy at Momentum Health Solutions

Breast cancer is a persistent and growing risk for South Africans. It is the most common cancer affecting women in the country: one in 27 have a lifetime risk of getting it, equating to nearly 20 million girls and women over 15 at risk of being diagnosed with the condition. Breast cancer also currently accounts for one percent of all deaths in South Africa.

The numbers paint a bleak picture – and not just for women. The incidence of breast cancer in men is on the rise, although it is rare and typically only accounts for one percent of all breast cancers locally. The condition, though, is usually only diagnosed in the late stages, resulting in a higher risk of mortality.

Exacerbating the growing incidence of the disease in both men and women is that it is increasingly presenting at a younger age. The risk for breast cancer is driven by a family history of the disease, as well as lifestyle factors. These include a poor diet of highly processed food, a sedentary lifestyle with inadequate exercise, being overweight or obese, smoking and drinking, exposure to chemicals or toxins, and stress.

We have, in fact, seen a growing link between our levels of resilience and mental and physical health, and while stress manifests differently in each one of us, the growing data to support the link between short-term trauma and long-term stress and cancer cannot be ignored.

We can, however, lower our cancer risk by changing these lifestyle factors. Breast cancer is also imminently preventable through education and screening – in this instance, prevention is better than cure. Learning how to spot the warning signs, doing regular self-examinations, and going for regular medical check-ups and preventative screening for early detection – including thermal imaging and mammograms. The costs of screening are far lower than the economical, emotional, and social costs of contracting the disease.

Taking breast health seriously

The good news is that women in South Africa have shown that we are taking this seriously. During the pandemic, when there was a clear dip in preventative screening such as pap smears, colonoscopies and HIV screening, as well as delayed care-seeking behaviour, resulting in higher severity oncology claims, breast cancer screening bucked the trend.

There was, in fact, an increase in mammograms, showing that women continued to prioritise this particular health risk and take steps to help with early detection and treatment. We should combine this continued screening with ongoing monthly self-examinations, because these help women get to know their bodies and notice if anything seems abnormal.

Healthcare professionals recommend a monthly examination at the end of your menstrual cycle, on the same day in your cycle – or at the same time on the same day each month for women with irregular periods. The steps for a self-exam are:

1.      Do a visual inspection: Stand shirtless and braless in front of a mirror, with arms down by your sides. Look for puckering, dimpling, or changes in size, shape or symmetry, as well as any changes in the nipples. Then put your hands on your hips and do the same checks. Finish off by raising your arms above your head, and repeating the inspection.

2.      Move on to a manual inspection with your hands: This should be done both lying down, and standing up in the shower. Breast tissue spreads out more evenly when you’re lying down, so it makes it easier to pick up changes. Using soap on your hands in the shower also helps fingers move more smoothly over the breasts. The technique for the exam is the same for standing up and lying down: use the pads of your three middle fingers and apply light, medium then firm pressure in a circular pattern across the breast to feel for lumps or other anomalies. Also press the tissue under the arm and check the nipple to check for discharge. Remember to use your right hand to examine your left breast, and vice versa.  

Self-exams are critical for breast health and early detection. But they are only the start, and should not replace clinical exams and screening tests. Thermal imaging, which uses infrared to detect variations in temperature in breast tissue, has become more popular in recent years because it is less painful than a mammogram. It should not replace a mammogram, though, as mammograms are still the most effective way to accurately detect breast cancer.

Essentially, self-exams should go together with clinical exams to make sure we are able to detect and treat breast cancer early on. It is in our hands – women and men alike – to prioritise our breast health, take steps to minimise our risks, and proactively undergo screening to ensure the best possible results.