Breast Cancer Awareness Month

The pink ribbon has become one of the most meaningful symbols to women across the globe, representing awareness about breast cancer and support for those fighting it. 

In South Africa, it is estimated that approximately one in every 29 women is diagnosed with breast cancer, according to the Cancer Association of South Africa, making it the most prevalent cancer in women in the country. While it is sad that so many women have been and continue to be affected by this terrible illness, more is being done each day to reduce the rate of breast cancer.

As part of the Government Employees Medical Scheme's (GEMS) ongoing effort to educate existing and future members on a range of healthcare topics, we would like to explore certain important healthcare issues. This article looks at the subject of breast health this Breast Cancer Awareness Month, October 2012.

What is breast cancer?
As with all types of cancer, breast cancer occurs when abnormal cells in the breast become cancerous and begin to multiply, forming a tumour. This tumour will continue to grow and can invade and even destroy the surrounding tissue if it is not removed. There are different types of breast cancer, which grow at different rates. Some of these types grow quickly and spread to other parts of the body - this is referred to as metastasis. Other types of breast cancer spread very slowly, and if they remain undetected, can sometimes take years to spread beyond the breast.

What does it mean if a tumour is malignant or benign?
Just as there are different types of cancer, there are different types of tumours. The good news here is that not all tumours are bad. Sometimes you can develop a tumour that is not cancerous, in which case it is referred to as being benign. This type of tumour is not dangerous to your health. Malignant tumours, on the other hand, are cancerous and do pose a threat. It is important to visit your doctor for tests if you feel an unusual tumour or lump in your breast, because even though it may only be benign, there is a chance that it is malignant, in which case you will need to begin treatment as soon as possible.

What are the symptoms of breast cancer?

• The first sign of breast cancer is usually a lump in the breast or underarm that does not go away after your menstrual cycle. The lump will most probably not be painful though it may cause a prickling sensation. A lump can often be seen on a mammogram before you are able to feel it, which is one of the reasons why regular mammograms are particularly important for women at risk of breast cancer.
• Ongoing swelling in the armpit.
• Pain or tenderness in the breast that continues after your menstrual cycle.A change in the appearance of the breast, such as the size, shape, feel or temperature. A flattening or indentation may indicate the presence of a tumour. Reddish, dimpled skin on the breast can indicate advanced breast cancer.
• A change in the nipple, including shrinking, dimpling, ulceration, itching or a burning sensation.  Unusual nipple discharge that is clear, bloody or another colour should also be looked out for as while it is most probably a sign of a benign condition, it could signal cancer.

Who is at risk of developing breast cancer?
All women are at risk of developing breast cancer. It can also occur in men, although this is much less common. There are certain factors that put you at greater risk, including:

• Being age 55 and older
• Having had breast cancer before
• Having a mother, sister or daughter who have had breast cancer
• Having certain inherited genetic mutations
• Having been exposed to radiation treatments to your chest at some point
• Being obese or even just overweight
• Having started your period before the age of 12
• Having started menopause after age 55
• Having your first child after age 35
• Undergoing postmenopausal hormone therapy
• Drinking more than one alcoholic beverage per day

What screening tests should I have and when?
Having the right check-ups regularly can significantly increase your chances of beating breast cancer should you ever develop it, as the sooner you are diagnosed the sooner you can begin treatment.

Speak to your doctor about when you should start having which screenings, as opinions vary and each case is different. The following screening tests are important for early detection of breast cancer:

• Breast self-examination - speak to your healthcare provider about how to do this if you are unsure. You should conduct a breast self-examination on a regular and ongoing basis to check for any lumps and other changes.
• Breast examination by a healthcare provider - during this check-up your healthcare provider will do a thorough check of the appearance and feel of each breast to detect any lumps or other changes. Starting from the age of 20 you should have this check every one to three years, depending on what your doctor advises. From age 40 onwards you should have this check annually.
• Mammogram - this is an X-ray of the breast and is a highly effective way of identifying any lumps that may be too small to feel. It is generally recommended that women have an annual mammogram from age 40 onwards. If an abnormality is picked up from your mammogram then a diagnostic mammogram will need to be conducted.

Women who are at higher risk of developing breast cancer may need to start having certain checks earlier than others and may need to have additional tests done.

If your doctor is concerned about the results of any of your tests then a sample of the tissue in the affected area of your breast may have to be taken in order to ascertain whether or not you have breast cancer.

What should I do if I am diagnosed with breast cancer?
We at GEMS understand just how physically and emotionally devastating cancer is for the patient, and how important it is to have a support system you can lean on during this trying time. It is for this reason that we offer the GEMS Oncology Management Programme.

If you or a member of your family is diagnosed with cancer, it is important to register on the Oncology Management Programme as soon as possible as all oncology treatment requires pre-authorisation and case management.

How do I register on the GEMS Oncology Management Programme?

• Your doctor must fax your treatment plan to the GEMS Oncology Management Programme on 0861 00 4367.
• Once the Oncology Management team has received the treatment plan from your doctor, we will record your details, disease information and proposed treatment.
• Your treatment plan will be reviewed and, if necessary, a member of the clinical team will contact your doctor to discuss more appropriate or cost effective treatment alternatives. 

 After the treatment plan has been assessed and approved, an authorisation will be sent to your treating doctor. You will also receive an authorisation letter. The letter will show the treatment that GEMS has authorised, the approved quantities and how long the authorisation is valid for.

For any GEMS member queries please phone the GEMS call centre on 0860 00 4367 or visit our website at www.gems.gov.za. GEMS will assist you in every way possible to ensure your family's health and wellbeing.

Sources:
1. The World Health Organization, www.who.int
2. The Cancer Association of South Africa, www.cansa.org.za
3. The Mayo Clinic, www.mayoclinic.com 
4. WebMD, www.webmd.com
5. Breast Cancer.org, www.breastcancer.org
6. Pink Ribbon International, www.pinkribbon.org
7. Health24, ‘Cancer in South Africa: What are the stats?',  www.health24.com