For most women having a breast examination with a medical practitioner is a rather nerve-racking experience.

"What if they find a lump?" And if they do: "What if it is cancerous? Will I have to have my breast removed?" These are just some of the thoughts that can race through the mind.

The good news is that by far the majority of lumps in the breast — nine out of ten — are benign or non-cancerous, according to Dr Shirley Lipschitz a diagnostic radiologist specialising in women's health, who operates out of the Netcare Linksfield and Netcare Sunninghill hospitals.

Highly-treatable condition

Furthermore, great advances have been made in breast cancer medicine; so much so that the condition is often highly treatable today, particularly if it is detected early. Also, having a malignant tumour does not necessarily mean that the patient must have a full mastectomy, as there are many breast conserving treatment options available today.

Breast cancer is a malignant tumour that forms in the cells of the breast tissue. Dr Lipschitz says that there are many different types of breast cancer, but some are much more common than others. The prognosis depends upon the type of breast cancer and how far the disease has progressed.

"More and more women are realising the importance of detecting cancer early," continues Dr Lipschitz. "They are therefore having regular breast screenings with their doctors and are learning how to self examine their breasts for lumps etc."

Regular breast examinations

Dr Lipschitz says that women over 40 should have a clinical breast examination at least once a year while those in their 20s and 30s should go once every three years.

The mammogram, which is an x-ray of the breast, is the best known and most commonly used way to screen for breast cancer. It can allow medical practitioners to see if there are any abnormal growths in the breasts that may require further investigation.

Ultrasound is recommended as a problem-solving imaging modality. While it could mean that your doctor wants to check something out more closely, more often than not he or she just wants to get a better picture of what is going on in your breasts. Dr Lipschitz says that in South Africa it is quite common practice to do ultrasound screening in certain types of breasts.

If a lump in the breast is hard and has uneven edges it is more likely to be cancerous. Most cancerous lumps are also painless. Do keep in mind, however, that if a lump that fits this bill does appear, it is not necessarily cancerous.

Treatment options

What are the treatment options for breast cancer? Unlike the old days, if the doctor decides on surgery it doesn't necessarily mean that it will be a full mastectomy. There are other surgical options such as lumpectomies, in which the lump itself and surrounding tissue is cut out, but the breast is saved.

There are also a number of other options that may be used before surgery is even considered. It all depends on the type of cancer that is discovered. According to Dr Lipschitz, recent advances in oncology mean that the type of cancer can be very clearly pinpointed and treatment can be more tailored. She says a whole range of old and new treatments can be called into play.

One familiar treatment option is radiation therapy, or radiotherapy. In this treatment, which is often used after surgery to complete the treatment programme and ensure no cancer cells survive, high‑energy beams are focused on the treatment area. The beams damage cells in their path, the healthy and the cancer cells alike. However, cancer cells are less stable than normal cells, and very active, so they are less likely to recover from the damage. Radiation therefore destroys them.

The aim of chemotherapy is to do a systemic 'search-and-destroy', going through the blood stream to find any cancer cells which have escaped the breast region and could be spreading to other parts of the body. Chemo works by interfering with cell division. Unfortunately, certain other cells are also good at rapid division, such as those in your hair — which is why chemo often makes your hair fall out.

Chemo is dreaded because of its side-effects, but even those are improving as the drugs improve. Better drugs to cope effectively with side-effects such as nausea are readily available.

Many cancers depend on hormones to grow (the prime hormone in the case of breast cancer being oestrogen). Hormonal therapy fights hormone‑receptor‑positive breast cancer. These drugs work by blocking the ability of oestrogen to 'switch on' cancer cells and trigger their growth.

The increased use of screening has improved the amount of breast cancers found before they can do serious harm, says Dr Lipschitz. There are also a number of drugs and treatments being developed with the result that the outlook for breast cancer patients is improving year-on-year. No longer does breast cancer mean the inevitable loss of your breast or your life. Those diagnosed with the condition should therefore continue to live in hope.

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