This Women’s Month, internationally acclaimed specialist surgeon and breast health specialist Professor Carol-Ann Benn addresses some of the uncertainties and misperceptions that may hold people back from breast cancer screening and provides practical advice on the questions to ask before treatment.
“Most people who get breast cancer don't have risk factors, so they think it can't happen to them. Breast cancer is unfortunately one of the most prevalent cancers among women, affecting approximately one in 27 women over the age of 15 years,” says Prof Benn, founder of the Netcare Milpark Breast Care Centre of Excellence.
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“Although a family history of cancer, on either biological parent’s side of the family, can contribute to higher individual risk, young people do not fit into the usual screening age group, where mammograms are recommended for women over 40. Younger women who have breast cancer usually present with a symptom such as a mass in the breast, nipple discharge, or enlarged lymph nodes.
“Symptoms such as these should always be investigated, preferably by ultrasound scan. Do not simply wait until your next monthly cycle or hope that it will resolve itself ¬– being proactive about your breast health at any age is crucial. Although survival rates are improving all the time, early detection can make a great difference to the treatment journey and prognosis.”
Professor Benn urges anyone who detects a breast lump to seek second opinions and investigate all options, especially if appropriate radiology imaging has not been performed yet. “If a doctor does a physical examination only and or tells you that you are too young to have cancer, ask for an ultrasound because no doctor has eyes on their fingers that can rule out breast cancer,” she says.
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"If there is a mass, or if you are told it is a fibroadenoma, have a three-month follow-up as the minimum after your first ultrasound, as this can tell the difference between a fibroadenoma and breast cancer. If the lump grows, insist on a core needle biopsy.”
Professor Benn encourages people with a lump or suspected breast cancer to resist being pressured into making a snap decision about their treatment. “Remember, it is your body – don’t let a surgeon cut something out without knowing what it is. Under no circumstances should you agree to have surgery to ‘find out if this is cancer’.”
Prof Benn’s acronym ‘SMS’ offers practical advice if confronted with a breast cancer diagnosis:
S for Safety: do not be rushed into treatment, either surgery or chemotherapy.
M for Multidisciplinary: a multidisciplinary team must first provide you with all the options open to you, and
S for Second opinion: Seek a second opinion, listen, take notes and ask questions. Take the time to consider all the options before proceeding with treatment.
The Netcare Milpark Breast Care Centre of Excellence offers rapid access to best practice care without the person being rushed into treatment. A complete and robust multi-disciplinary review of the patient is conducted within seven days, and our process is geared towards carefully selecting the best treatment options for cancer care, taking each patient and their circumstances into consideration holistically.
Under Prof Benn’s leadership, the centre was the first breast care centre of excellence to be internationally accredited in South Africa and was invited by the American College of Surgeons’ National Accreditation Program for Breast Centers (NAPBC) to contribute its protocols for the development of international best practice guidelines.
“Breast cancer treatment has progressed significantly and the vast majority of breast health conditions do not require surgery these days. Radical mastectomies, where the entire breast and nipple are removed, are no longer used. Cancer does not ‘jump’ from one breast to the other, so if you are advised to have a double mastectomy, this should always be questioned and interrogated by a multidisciplinary team. If surgery is needed, usually women have a choice in the different types of cancer surgery.”
“Women diagnosed with breast cancer should also be informed and ask questions about the implications of their treatment options for fertility before starting any treatment. “Discussions should include conception, timing of pregnancy after treatment, the safety of pregnancy and whether breastfeeding will be affected.”
“It is emotionally challenging to face a cancer diagnosis and people often feel anger, depression, anxiety, a sense of helplessness or vulnerability and feel the unfairness of the situation. The most difficult period is often between diagnosis and treatment, but knowing more about the treatment and realistic expectations of the course of management and the future will help,” she says.
The Netcare Milpark Breast Care Centre of Excellence in Johannesburg is among the top accredited centres of its kind in the world and has always strived to provide the best standard of care both to patients with access to medical funding and those without medical insurance.
“Our holistic, person-centred approach is rooted in the South African context and includes navigators advising and coordinating support to assist patients with everything from financial issues, family and fertility care, psychological and complementary oncology services, as well as traditional medicine, geriatric care, and a buddy support system. As with all types of illnesses, knowledge is power and knowing what to expect can help you to cope on this journey,” Prof Benn concludes.
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