Breast cancer is the most common female cancer in the world. However, in countries with access to first rate health care, there has been a rapid decline of breast cancer mortality.
In countries where mammography is commonplace we’ve seen that, when combined with treatment, only one in 10 women diagnosed with the disease will die from it. In countries without access to screening, it is estimated that five to six out of 10 women will die from it. Mammography saves lives.
With early detection and effective treatment, breast cancer can be transformed from the dreaded disease that kills about half of those suffering from it to a disease that can be managed successfully, with excellent prospects for long-term survival.
In light of Breast Cancer Awareness Month, Dr Justus Apffelstaedt, a specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue surgical oncology, answers some questions about mammograms.
What do we need to know about mammography?
Once a lump can be felt in your breast, the disease has already been present for about 5 years. But, in the majority of cases, the malignancy could have been picked up with mammography before the lump can be felt. The initially slow growth of breast cancer, coupled with its detectability on mammography, makes it an ideal disease to be screened for.
Physical examination by a doctor or a specially trained nurse cannot, on its own, decrease the rate of breast cancer mortality. Regular self-breast examinations, thermography, and other alternative methods do not have the capability of detecting breast cancer in the early, crucial stages, as a mammogram does.
What do we need to know about the procedure?
Walking in as a healthy woman and potentially being diagnosed with cancer is an experience that induces a lot of anxiety. Plus there is often concern about the procedure itself, especially for women who have not experienced a mammogram before.
While it may be difficult, it is important to try to relax as much as possible. During a mammogram the breast tissue is spread out and compressed between plates. This is necessary to get the detail needed, and tension can make it difficult for the radiographers to position the breast accurately. While a well-performed mammogram may be uncomfortable for a few moments, it should not be painful.
Digital mammography
These days, full-field digital mammography is available in South Africa. As with other digital advancements, the film and the chemical development are replaced by an electronic detector panel, computers and software. The process is similar to taking a picture with your digital camera. Unlike film mammograms, the images can be manipulated digitally to change elements such as contrast levels, brightness and colours. You can also enlarge parts of the picture, making detection easier. Digital images can also be subjected to computer assisted detection, where a computer marks suspicious areas and alerts the doctor to potential trouble spots.
Digital mammography has been shown to improve cancer detection in all women below age 50 and premenopausal women. In addition to quality, the radiation dosage in digital mammography is about that of conventional mammograms, plus the examination time is much faster, and chemicals are not used in the development process, making it friendlier for the environment.
What are some common concerns around mammograms?
We sometimes get asked whether breast compression can cause breast cancer. Breasts are extremely resistant to even major trauma and the compression during mammography doesn’t affect the breast tissue at all. It’s essential that the breast be compressed to get an effective image which means the breast tissue has to be spread out to allow breast structures to be seen. Compression also means that the X-ray dose required can be reduced.
Some women are also concerned that mammograms are exceedingly painful. This should not be the case. Women with very sensitive breasts may experience only slight discomfort, provided the mammogram is performed properly. In cases where the breasts are painful before the mammogram, the pain should be treated first and only then should the mammogram be taken.
Breast-care best practice
The good management of your breast health is related to age, as older women are at greater risk.
Age 20 to 39:
Know your family history of breast cancer.
Schedule a clinical breast examination by a health-care professional every 3 years.
Examine your breasts yourself monthly.
Age 40 and over:
Schedule an annual mammogram.
Arrange for an annual clinical breast examination by a health-care professional.
Examine your breasts yourself monthly.
It is important to empower yourself with knowledge around the latest advance in breast treatments and technologies. Early detection of breast cancer is crucial to long-term survival. Practising good breast health and keeping up on the latest technological advances can help you detect abnormalities in your breasts before they become life-threatening.