The Cell C #Playing4PinkSA Invitational Polo in association with Samsung on October, 4, 2015, at the Inanda Club in Johannesburg, will be a celebration of women who have survived a mastectomy- and it creates an opportunity for everyone to inform themselves about the disease, assess their risk of contracting cancer, how to avoid it, and equally importantly, how to support someone who has cancer or has survived cancer.
The following information is courtesy of Reach for Recovery, a national Breast Cancer Support Organisation.
You can also visit their website www.reachforrecovery.org.za.
GLOBAL INCIDENCE OF CANCER
South Africa is ranked 50th on the World Cancer Research Fund’s list of countries with the highest cancer prevalence rates. Prostate cancer is the number one cancer diagnosed amongst South African men followed by lung, oesophagus, colon/rectum and bladder cancer. Amongst women, the most prevalent is breast cancer followed by cervical, uterus, colorectal and oesophageal cancer.
GLOBAL INCIDENCE OF BREAST CANCER
Breast cancer is the most common cancer and the leading cause of cancer deaths among women worldwide. Breast cancer is arguably the most-researched cancer in the world. Environmental factors, including diet and lifestyle, have been widely investigated, but these variables have not been able to explain international or ethnic variability in breast cancer.
BREAST CANCER INCIDENCE SOUTH AFRICA
Breast cancer is the most common cancer amongst women in South Africa and it is increasing in incidence. According to the National Cancer Registry of 2009, breast cancer is diagnosed in approximately one in every thirty three (33) women in South Africa. It is especially concerning that large numbers of women with breast cancer are found in rural areas.
In South Africa breast cancer is most prevalent amongst white and Asian women and is the second most common cancer among black and coloured women
NATIONAL BREAST CANCER STATISTICS (NATIONAL CANCER REGISTRY, 2009)
White = 1 in 18
African = 1 in 49
Asian = 1 in 17
Coloured = 1 in 22
New cases in 2009 = 6219
15-19 = 4
20 – 24 = 17
25 – 29 = 88
30 – 34 = 224
35 – 39 = 467
40 – 44 = 625
45 – 49 = 765
50 – 54 = 760
55 – 59 = 761
60 – 64 = 694
65 – 69 = 601
70 – 74 = 480
75 – 79 = 294
80 – 84 = 229
85+ = 135
Although the statistics above are very “old” (2009), they are the only official statistics for South Africa that we have!
Available statistics from South Africa indicate that breast cancer is much less common in non-white populations than in whites. In my opinion, the available statistics are incomplete and outdated. They reflect rather the lack of access of women from disadvantaged communities to health care than a true difference in incidence of breast cancer. On the contrary, there are indications from other countries that in non-white populations, breast cancer strikes about 10 to 15 years earlier than in white, usually at an age between 40 and 50. At this age, many women still have to look after children and are working; therefore, the social impact of this serious disease is much greater in disadvantaged populations.
Professor Justus Apffelstaedt
GLOBAL INCIDENCE OF BREAST CANCER AMONGST YOUNGER WOMEN
Approximately 7% of women with breast cancer are diagnosed before the age of 40 years, and this disease accounts for more than 40% of all cancer in women in this age group. Breast cancer at an early age is more likely to be associated with an increased familial risk, especially in women harbouring a germline BRCA1 mutation. An American population-based study evaluating 50,000 women indicated that the combination of obesity, high calorie intake, and sedentary lifestyle is a risk factor for premenopausal women.
INCIDENCE OF BREAST CANCER AMONGST YOUNGER WOMEN IN SOUTH AFRICA
In South Africa an alarming increase in the incidence of breast cancer among young black women, a group that was previously considered to have the lowest breast cancer risk, is reported. The majority of South African women have limited knowledge of their relative risk of developing breast cancer, of associated risk factors and of the diversity of potential breast cancer-related symptoms. A need for breast health awareness from an early age is vital. An investigation done to establish the awareness of breast and cervical cancers among women of African descent in rural and urban South Africa, published in 2002, showed that one fifth of the respondents had not heard of these cancers and one third did not know about tests for breast cancer. Breast self-examination techniques were only known by half of the population studied.
WHAT IS THE SURVIVAL RATE FOR BREAST CANCER PATIENTS?
Survival rates are worse for younger women with breast cancer when compared to those in older women. According to Dr Carol Benn, 90% of women will be alive after five years if the cancer is detected early. A mammogram detects early symptoms of breast cancer or even pre-cancer signs that enable doctors to prevent or minimise the impact of the condition. Detecting the tumour before it is 2cm in diameter enables a 90% survival rate.
Studies have found that a woman diagnosed with Stage I breast cancer has an 88% chance of cure. Diagnosed at Stage IV, the survival rate dramatically decreases with only 15% of those diagnosed surviving for more than 5 years. Regular self-examination and mammograms play a key role in the early detection of breast cancer and high risk female consumers who have a positive family history for example, should essentially undergo the procedure once a year.
According to Professor Justus Apffelstaedt, breast cancer must be considered a chronic disease. It is estimated that the precursor lesions of breast cancer are about 10 – 15 years in the breast before a cancer develops. Initially, the cancer grows very slowly for several years. For two or three years, it is only detectable by mammography (before it can be detected by doctors or the woman herself by feeling for lumps). If it is detected and treated during these years, it is curable in the majority of cases. Once it can be felt as a lump, its growth has become rapid; treatment will have to be intensive and the chances for a cure decline fast.
CAN PHYSICAL ACTIVITY REDUCE THE RISK OF BREAST CANCER?
Exercise boosts the immune system and helps you to keep your weight in check. With as little as three hours of exercise per week, or about 30 minutes a day, a woman can begin to lower her risk of breast cancer. This doesn’t require going to a gym either. Power walking is more than sufficient!
CAN A HEALTHY DIET HELP TO PREVENT BREAST CANCER?
A nutritious, low-fat diet (30 grams or less) with plenty of fruits and green and orange vegetables can help reduce the risk of developing breast cancer. A high-fat diet increases the risk because fat triggers estrogen production that can fuel tumor growth.
DOES SMOKING CAUSE BREAST CANCER?
Smoking is a confirmed risk factor for many types of cancer. Research done in 2012 has confirmed that smoking is a contributing risk factor for developing breast cancer. Additionally, second hand smoke is also a risk factor for cancer. So if you are a smoker, help yourself in a significant way and join a smoking cessation program to help you stop. The day you stop smoking the healing can begin and each week in which you are smoke-free, you give yourself increasing advantages for a healthier life. Smoking also directly contributes to heart and other lung diseases, too.
CAN DRINKING ALCOHOL INCREASE THE RISK OF BREAST CANCER?
Moderation is key. One drink per day has been shown to slightly increase the risk of breast cancer. Having more than one drink per day has shown to be a more significant risk factor, and the alcohol content doesn’t matter: wine, beer or a mixed drink. Alcohol also increases estrogen in your bloodstream.
IS THERE A LINK BETWEEN ORAL CONTRACEPTIVES AND BREAST CANCER?
There is an increased risk of breast cancer for women who have been using birth control pills for more than five years. However due to the low amount of hormones in birth control pills today, the risk is relatively small. But if a young woman has a significant family history of breast cancer, her gynecologist may recommend taking a break for a year from the pill at the 5-year time frame then resuming again for another 5 years. Although evidence-based research data does not offer strong support for this standard of care, it has nevertheless become an increasingly common practice.
HOW DOES MENSTRUAL AND REPRODUCTIVE HISTORY AFFECT BREAST CANCER RISKS?
Women who began their menstrual cycles before age 12, have no biological children, or had their first child at 30 or older, or began menopause after 55 are at a higher risk. This means that research has proven that the number of menstrual cycles a woman has over time influences risk.
DOES BREASTFEEDING LOWER MY RISK OF BREAST CANCER?
Breastfeeding may slightly lower the risk of breast cancer. There is evidence that breastfeeding for more than five months in total (one or more babies) can reduce a woman’s risk of breast cancer compared to women who do not breastfeed. It also shows that the longer a woman breastfeeds, the greater the protection. However, women who breastfeed still get breast cancer and many women are either unable to breastfeed or choose not to. It’s also important to remember that the three main risk factors for breast cancer – gender, increasing age and a significant family history – are ones we can do nothing about.
IS THERE A LINK BETWEEN HRT AND BREAST CANCER RISK?
Taking HRT (hormone replacement therapy) after the age of 50 is associated with a small increased risk of developing breast cancer. The type you take and how long you take it for may affect the risk, and the risk also reduces over time once you stop taking HRT.
Combined HRT (oestrogen and progestogen) accounts for six extra cases of breast cancer in every 1,000 women who take it for five years between the ages of 50 and 59. There appears to be no increased risk if it’s taken for less than three years. Oestrogen-only HRT has a lower risk than combined HRT.
Having a risk factor doesn’t mean that someone will develop breast cancer. And even if a risk factor is identified in someone with breast cancer, there’s no way of proving that this was the cause.
WILL TAKING THE CONTRACEPTIVE PILL INCREASE MY RISK OF BREAST CANCER?
Many studies have looked at whether taking the oral contraceptive pill increases the risk of developing breast cancer. These have produced conflicting results, with some finding an increased risk and others not. Experts agree that any increase in risk is likely to be small and only applies when you are taking the pill.
Younger women are more likely to be taking the pill, and breast cancer is much less common in younger women, with more than 8 out of 10 cases occurring in women who have been through the menopause. The oral contraceptive pill is an effective way of preventing an unwanted pregnancy. If you have concerns about taking it, talk to your GP.
HOW OFTEN SHOULD I DO A BREAST SELF EXAM (BSE)?
Give yourself a breast self-exam once a month. Look for any changes in breast tissue, such as changes in size, feeling a palpable lump, dimpling or puckering of the breast, inversion of the nipple, redness or scaliness of the breast skin, redness or scaliness of the nipple/areola area, or discharge of secretions from the nipple.
If you discover a persistent lump in your breast or any changes, it is very important that you see a physician immediately. Though 8 out of 10 lumps are benign, all require evaluation to confirm that they are not cancerous.
CAN WOMEN WITH BREAST IMPLANTS HAVE A MAMMOGRAM?
Yes, they can. The mammogram (breast x-ray) may not be as clear because the implants can obscure some of the breast tissue. Therefore, other tests may also be done. Women with breast implants need to tell the radiographer that they have breast implants.
DOES A FAMILY HISTORY OF BREAST CANCER PUT SOMEONE AT A HIGHER RISK?
Although women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history. Statistically only 5-10% of individuals diagnosed with breast cancer have a family history of this disease.
IF NO ONE IN THE FAMILY HAS HAD BREAST CANCER, CAN YOU STILL GET IT?
Yes, you can. When women learn that breast cancer can be a genetic disease, they often think this means it is a disease that must be inherited. But that’s not the case. A genetic disease is one that is caused by a genetic mutation that is either inherited or arises spontaneously. Only about 30 percent of the women who develop breast cancer have a family history of the disease. The other 70 percent have what is called a “sporadic occurrence.” This means there is no known family history of the disease.
CAN BREAST CANCER TREATMENT AFFECT A WOMAN’S FERTILITY?
Yes, some treatments for breast cancer, like chemotherapy, can affect your ability to become pregnant. It’s important to talk to your specialist team about fertility before you begin treatment.
ARE MAMMOGRAMS PAINFUL?
Mammography does compress the breasts and can sometimes cause slight discomfort for a very brief period of time. Patients who are sensitive should schedule their mammograms a week after their menstrual cycle so that the breasts are less tender.
DIGITAL VS. FILM MAMMOGRAPHY: WHICH IS BEST?
There are two kinds of mammograms: digital and conventional film. Both use X-ray radiation to produce an image of the breast. Conventional mammograms are read and stored on film. Digital mammograms are read and stored in a computer so the data can be enhanced, magnified or manipulated for further evaluation. There are no other differences between the two.
Studies show that in most cases, digital mammograms read by specialized radiologists are more than 20 percent more accurate at detecting breast cancer than traditional mammograms read by generalists.
HOW OFTEN SHOULD I GO TO A HEALTH PROFESSIONAL FOR A CHECK-UP?
You should have a physical every year which should include a clinical breast exam and pelvic exam. If any unusual symptoms or changes in your breasts occur before your scheduled visit, do not hesitate to see the doctor immediately.
WHAT KIND OF IMPACT DOES STRESS HAVE ON BREAST CANCER?
In 2012, some research studies have shown that factors such as traumatic events and losses can alter immune system functions, and when immune functions are altered cancer cells may have an opportunity to get themselves established within one’s body. What has been shown is that it is not the fact that a major life crisis has occurred but instead how the individual reacted to this event and coped (or didn’t cope). Therefore, identifying ways to keep your stress level in check is wise.
AFTER A MASTECTOMY, CAN I HAVE MY BREAST RECONSTRUCTED?
Yes, today most mastectomy patients can have breast reconstruction. Age is not a factor in determining whether a woman can have reconstructive surgery, nor is the type of mastectomy or the placement of the mastectomy scar. Women who have had radical mastectomies (removal of the breast and chest wall muscles) or modified radical mastectomies (removal of the breast with the chest muscles left intact) can have breast reconstruction. Also, it does not matter how much time has elapsed since a woman’s original cancer surgery. Breast reconstruction, depending on the procedure, can be performed at the same time as the mastectomy surgery or years later.
WHAT IS A BREAST PROSTHESIS?
A breast prosthesis is an artificial breast from worn in your bra to simulate the shape and weight of your natural breast.
WHAT DOES A BREAST PROSTHESIS LOOK LIKE?
Prostheses are available in different shapes and sizes, as well as different degrees of firmness. They are shaped to follow the natural contour of a woman’s breast or part thereof, sometimes including the outline of a nipple. The upper surface of the prosthesis feel soft and smooth, while the part resting against the skin may differ. It can be smooth and firm, made of fabric, be flat or hollow, with or without soft edges. It is specifically designed to be worn comfortably.
WHAT IS A BREAST PROSTHESIS MADE OF?
A breast prosthesis is made of silicone with a covering of polyurethane, lightweight foam or fibre filler. Its weight is determined by the amount of silicone, foam or filler used.
HOW SOON AFTER SURGERY CAN I START TO WEAR A PROSTHESIS?
You will have to wait six to eight weeks after surgery before you can wear a silicone prosthesis. Your surgeon will advise you when you are ready. If you are having radiotherapy your skin may be sensitive and you should then wait until the sensitivity has disappeared. You can wear a soft prosthesis initially and during the recovery phase you may prefer to wear a soft seamless camisole top instead of a bra.
HOW DO I PURCHASE A BREAST PROSTHESIS?
Breast prostheses are provided by qualified fitters. Consult Reach for Recovery for contact details of providers of prostheses and post-mastectomy bras. Indigent women may qualify for a subsidised prosthesis through Reach for Recovery’s Ditto Project.
If the prosthesis and your bra fit correctly, no-one will be able to see that you are wearing a breast prosthesis.
WHERE CAN I FIND A BREAST CANCER SUPPORT GROUP?
Reach for Recovery is a national Breast Cancer Support Organisation. Visit their website at www.reachforrecovery.org.za.