Q & A’s with our specialist family physician Dr. Sheena Mathew
October is Breast Cancer Awareness month. Breast Cancer has in one way or the other affected someone we know or someone close to us. Breast cancer survival rates have increased, and the number of deaths associated with this disease is steadily declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease. Desiree Munn, the Practice Manager has asked Dr. Sheena Mathew to answer some frequently asked questions about breast cancer and to also put our minds at ease about some myths relating to this dreaded disease.
1. Is checking for lumps yourself in your breasts sufficient?
Women should regularly check their breasts for any irregularities and have a clinical breast examination by a doctor at least once a year. Breast examinations alone is insufficient, and the mammogram is still the gold standard for screening breast imaging. The main advantage of the mammogram is that it can detect breast changes years before physical symptoms develop, helping us to find breast cancer at an early stage when treatment will be most successful.
2. Are older women more likely to develop breast cancer?
Yes, breast cancer is uncommon under the age of 30 years and steadily increases to a maximum at 60 years of age. 2/3 of women who develop breast cancer are postmenopausal.
3. Are most breast lumps cancerous?
The majority of breast lumps are not cancerous, but a good rule is to consider any lump in the breast as cancer until proven otherwise by the triple test (clinical breast examination, imaging with mammography ±ultrasound ±MRI, and biopsy).
4. What are the warning signs that a breast lump might be malignant rather than benign?
- Hard and irregular lump
- Skin puckering
- Nipple distortion/blood stained discharge/eczema
- Skin oedema
- Post-menopausal women
5. Does breast cancer only target women or can men get breast cancer too?
Men can also get breast cancer. 20% of men with breast cancer have a close relative with breast cancer. 10% of breast cancer among men is caused by mutations in the BRCA2 gene. BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. Men in families with BRCA2 gene mutations are more likely to develop cancer than men in families with BRCA1 gene mutations.
6. Some middle age women have never been for a mammogram, is that dangerous?
Do you still need to go for mammograms after menopause?
There is sufficient research that shows that women who have regular mammograms are more likely to have breast cancer detected early, less likely to need aggressive treatment and more likely to be cured. Cancer Association of South African (CANSA) advocates:
- Women aged 40-54 should have an annual mammogram.
- Women aged 55 and older can switch to a 2 yearly mammogram or have the choice to continue screening with a yearly mammogram.
- Screening should continue as long as a woman is in good health and expected to live 10 years or more.
Women with personal history of breast cancer, family history of breast cancer, known BRCA1 or BRCA2 gene mutation, 1st degree relative with BRCA1 or BRCA2 gene mutation, radiation therapy to the chest between ages of 10-30 years are at high risk for breast cancer. This group of women need to begin annual screening at earlier ages of 25-30 years. In women less than 35 years, ultrasound imaging is better than a mammogram.
7. Lately, there is talk that the radiation from mammograms can cause breast cancer, is that true?
Many experts believe that the low-dose exposure to radiation received from doing a mammogram is not sufficient to increase your risk of breast cancer. The effective radiation dose following CT abdomen/pelvis is 10mSv (millisieverts) compared to Mammography dose of 0.4mSv. In all cases, each women’s individual risk and benefit needs to be considered taking into account age at exposure and genetic profile especially in older women who are survivors of early-stage breast cancer.
8. Is there a common cause for breast cancer?
According to the National Cancer Institute, 12% of women in the general population are at risk of developing breast cancer. By contrast, studies estimate that 72% with BRCA1 mutation and 69% with BRCA2 gene mutation are at risk of developing breast cancer. Other factors that increase the risk of developing breast cancer include:
- Family history (1st-degree relative doubles the risk, having two 1st degree relatives with breast cancer increases your risk three-fold)
- Personal history of having breast cancer increases the risk of developing new cancer in the other breast or another part of the same breast
- Dense breast tissue identified on a mammogram
- Being overweight or obese
- Lifestyle factors (excessive alcohol use, sedentary lifestyle, smoking, diets high in saturated fats)
- Radiation to the chest before 30 years of age to treat other cancers like Hodgkin’s or non-Hodgkin’s lymphoma
- Ethnicity (White women more at risk than African/Asian/Hispanic women)
- Hormonal (the 1st child after age 30, started menstruation at younger than 12 years age, menopause started when older than 55 years)
9. True or False – Can wearing deodorant contribute to breast cancer?
Antiperspirants have aluminum-based compounds as their active ingredient and concerns emerged that these compounds might have estrogen-like hormonal effects which might promote the growth of breast cancer cells. According to the National Cancer Institute, there is no scientific evidence linking the use of antiperspirants or deodorants to developing breast cancer.
10. Can contraception cause breast cancer?
Although studies suggest that the prolonged use of hormonal contraception (>5 years) was associated with a higher risk of breast cancer when compared to women who had never used hormonal contraceptives, this risk was still very small. The risk of breast cancer needs to be weighed against the benefits of using contraceptives such as effective contraception, management of irregular menstruation/heavy bleeding, reduction in risk of ovarian/endometrial/colorectal cancer later in life. Women who have been diagnosed with breast cancer or with a high risk of breast cancer have non-hormonal contraceptive methods that are available to them.
11. Can Hormone Replacement Therapy cause breast cancer?
The risk of breast cancer attributable to Menopausal hormone therapy (MHT) equates to an incidence of <0.1 per 1000 women per year. This risk is similar to the increased risk of breast cancer associated with factors like a sedentary lifestyle, obesity and alcohol consumption. Data seems to suggest that the risk is more with combined MHT and might be related to the duration of therapy with the risk decreasing once treatment is stopped.
Should you be concerned about Breast cancer and wanting information about early detection for Breast Cancer for yourself or anyone in your family, please contact us at Blouberg Family Practice or make an online appointment at Blouberg Family Practice for an assessment.