Busting breast health myths

Myth 1

There is an increase in the incidence of breast cancer among younger women.

Truth

Increased media coverage of cases of younger women with celebrity status being diagnosed with breast cancer contributed to the perception that there has been a marked increase in the occurrence of breast cancer among younger women. However, the majority of breast cancer patients in South Africa and abroad have typically been and still are women between the ages of 50 and 70.

Myth 2

Chemotherapy is the most important factor in reducing breast cancer related deaths.

Truth

The most effective way to treat breast cancer is with a multidisciplinary approach, combining a number of treatment options that include surgery, radiation, chemotherapy, hormonal and biologic agents. Specialist centres, which see more than 150 breast cancer cases per year will achieve the best results, as the most accurate diagnosis can be made and the most appropriate treatment options will be chosen here.

Myth 3

Smoking increases your risk of breast cancer.

Truth

Recent research has found that many women will not increase their risk of getting breast cancer by smoking. There is, however, a subset of women with a specific genetic make-up that prevents them from detoxifying cancer-causing chemicals in cigarette smoke efficiently. These women do indeed have an increased risk of breast cancer when smoking.

Myth 4

All mammograms are equal and mammograms don’t mean much in breast cancer treatment.

Truth

The bulk of all mammography performed in South Africa is for screening purposes. The accuracy of mammographic diagnosis during screening depends on:

1. Using optimal equipment to produce the mammogram. Full-field digital mammography should be the minimum.
2. The optimal image is produced by a radiographer specialising in mammography.
3. The optimal reading of the image is provided by doctors who specialise in breast imaging and who have possibly received overseas training in mammography interpretation.
4. A process of rigorous quality control, where all outcomes are recorded and regularly analysed.

Only where all of these conditions are met will it be possible to realise the promise of lowering mortality rates from breast cancer and increasing breast conservation rates.

High quality breast imaging will detect about 95% of all breast cancers. Breast cancers that do not image are rare if the above criteria of a breast imaging centre are met.

Myth 5

It doesn’t make a difference where you are treated.

Truth

A very important, but often overlooked factor is where a patient is treated. It has been shown that dependent on where the woman is treated for breast cancer, the risk of death within 5 years can be up to 60% higher in environments where only few breast cancers are treated versus environments where more than 150 breast cancers are treated per year. This effect is larger than any chemotherapy, hormonal therapy and radiation.

Myth 6

It is better to remove the entire breast when you have breast cancer.

Truth

Breast cancer metastasises to places outside of the breast. The tumour in the breast will not kill you – the spread of the cancer to the brain, lungs etc. will. As breast cancer often spreads to other areas early in the course of the disease, a mastectomy will not guarantee you better survival than breast conserving therapy. Should a radical mastectomy be necessary, breast reconstruction can take place during the same session that the mastectomy is performed.

A multidisciplinary treatment approach involves an oncologic surgeon, a radiation oncologist, a medical oncologist and a plastic surgeon who have to optimally time and sequence the individual treatments. In a well-run multidisciplinary breast clinic, out of 100 women with breast cancer, 60 will have breast conserving therapy, 35 will have a mastectomy with immediate reconstruction and only 5 will leave the theatre with neither their own breast nor a reconstructed breast.

Myth 7

Mammograms are painful.

Truth

A mammogram, when performed by an experienced mammographer, is not a painful procedure.

Well trained mammographers should be able to help you to relax. When you are relaxed, the pectoral muscles behind the breast will relax, which should result in a painless mammogram.If the breasts are painful, a mammogram should not be done until the reason for the tenderness has been addressed.

At most, a mammogram may be a little uncomfortable. However, the short-term discomfort outweighs the long-term benefits.

Myth 8

After breast augmentation it will be harder to detect breast cancer and you’ll be more at risk.

Truth

You will not be more at risk after you had breast augmentation, as it does not constitute an increase in glandular tissue. It is very important to have your mammogram taken by an experienced mammographer because special techniques are needed to demonstrate all breast tissue.

Myth 9

I’ve had a mammogram which reported as no evidence of cancer, so I don’t have breast cancer.

Truth

As with every other screening procedure, mammography has its limits. Next to suboptimal mammographic technique, where obvious cancers are not imaged e.g. due to poor positioning of the breast, or a cancer that is present is overlooked by the mammogram reader, there are a certain number of cancers that cannot be detected by mammography.

Often these are detectable on ultrasound, particularly automated breast volume scanning. Very few breast cancers will be missed by an experienced team employing both mammography and ultrasound.

Dr Justus Apffelstaedt is a specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue surgical oncology.