LIFESTYLE NEWS - Fear, misconceptions and misinformation can prevent women from seeking help when they notice changes in their breasts, potentially delaying the diagnosis and treatment of breast cancer.

Breast cancer affects one in 28 South African women and is the most frequently diagnosed cancer among women in the country, accounting for about a quarter of new cancer diagnoses annually.

 It is also the second-leading cause of cancer deaths among South African women.

During Breast Cancer Awareness Month, the Breast Imaging Society of South Africa (BISSA) is encouraging women to seek medical advice about concerning breast changes rather than allowing fear to stand in the way of early diagnosis.

Dr Gerrit Dekker, a radiologist at Mossel Bay Radiology and a member of BISSA, a subspecialty group of the Radiological Society of South Africa, says delays in diagnosis and treatment can allow cancer to spread, potentially requiring more intensive treatment and affecting survival prospects and quality of life.

“A diagnosis is not an automatic death sentence and does not necessarily mean radical treatment such as chemotherapy or mastectomy,” says Dr Dekker.

He explains that modern breast cancer treatment is tailored to the individual patient and the characteristics of the tumour. Many women diagnosed with early-stage breast cancer can undergo breast-conserving surgery, such as a lumpectomy, usually followed by radiotherapy. For appropriately selected patients, survival outcomes can be comparable to those of women who undergo a mastectomy.

Not every patient requires chemotherapy, as hormonal and targeted treatments have expanded the range of available options.

Why fear can delay diagnosis

Some women may ignore or conceal possible breast cancer symptoms because they fear the diagnosis, the prospect of losing a breast, changes to their body image or how a partner might react.

Practical obstacles can also delay care, including transport costs, distance from healthcare facilities, waiting times, financial pressures and difficulties obtaining referrals.

These challenges can be particularly significant for people who rely on South Africa’s public healthcare system.

Patients who are diagnosed at a more advanced stage may require more intensive treatment and face a poorer prognosis.

“The central challenge is not the absence of world-class breast care in South Africa, but the fact that most women cannot access it when and where they need it,” says Dr Dekker.

He stresses that most breast lumps are benign, but any new or persistent lump or other concerning change should be assessed promptly by a healthcare professional, such as a clinic nurse, general practitioner or gynaecologist.

A new lump in the breast or armpit, breast or nipple pain, changes to the skin or a change in nipple shape should not be ignored.

“A woman who has a new lump or any other change that causes concern should have it assessed as soon as possible, even if a recent screening mammogram was normal,” he says.

Common breast cancer myths

Misconceptions about breast cancer screening and diagnosis can create unnecessary fear and discourage women from seeking care.

Myth: Mammograms are too painful.

Some women experience discomfort or brief pain during a mammogram, but breast compression lasts only a few seconds for each image. Compression helps produce clearer images, improving the radiologist’s ability to identify suspicious changes.

Women who are still menstruating may find it more comfortable to schedule their mammogram for the week after their period, when their breasts may be less tender.

Myth: Mammograms cause cancer because of radiation.

Mammograms use a low dose of X-ray radiation, and their use is regulated. For women for whom screening is recommended, the benefits of detecting breast cancer early generally outweigh the small radiation risk.

Myth: A needle biopsy spreads cancer.

Dr Dekker says there is no good evidence that a properly performed needle biopsy causes breast cancer to spread. A biopsy is an important part of establishing an accurate diagnosis and helping doctors determine the most appropriate treatment.

Myth: Breast cancer only affects women with a family history.

Although family history and inherited genetic variants can increase risk, most women diagnosed with breast cancer have no known family history of the disease.

Age, breast density, reproductive and hormonal factors, and other aspects of health can also influence risk. A formal risk assessment is more useful than relying on family history alone.

Myth: A breast lump is not concerning if it does not hurt.

Early breast cancer can be painless and may be too small to feel. Waiting for pain to develop is therefore not a safe approach.

Screening mammograms can identify some cancers before a lump can be felt, which is why women should discuss appropriate screening with their healthcare providers.

Why regular screening matters

Mammography plays an important role in the early detection of breast cancer. Regular screening can help establish a baseline against which future images can be compared, allowing radiologists to identify changes that may need further investigation.

Bringing previous mammograms or their images to appointments can also help radiologists assess changes over time and may reduce the need for additional investigations.

Screening recommendations vary according to age, individual risk and medical history, so women should discuss the appropriate screening schedule with a healthcare professional.

Importantly, screening is intended for people who do not have symptoms. Anyone who notices a new lump or other concerning breast change should seek assessment rather than waiting for their next scheduled mammogram.

Know your breasts

BISSA encourages women to become familiar with the usual appearance and feel of their breasts so that changes are easier to recognise.

Breasts naturally change throughout the menstrual cycle, and there is no single appearance or texture that is normal for everyone. Becoming familiar with your own breasts can help you notice changes, although self-examination cannot replace recommended screening or professional assessment.

When checking your breasts, consider the following:

• Look in the mirror: With your arms at your sides, look for changes in breast size, shape or symmetry, as well as skin puckering, dimpling or swelling. Repeat with your arms raised.
• Feel the breast tissue: Using the pads of your fingers, gently feel the breast and surrounding area, including the armpits. Check for unusual lumps, thickening or changes from what is normal for you.
• Be thorough: Examine the entire breast area in a systematic way, including the area towards the collarbone and underarm.
• Pay attention to changes: If you notice something new or persistent, arrange an assessment rather than trying to determine the cause yourself.

Warning signs not to ignore

Although many breast changes are not caused by cancer, any new or persistent change should be assessed by a healthcare professional.

Seek medical advice if you notice:

• A new lump or swelling in the breast or armpit.
• A change in breast size, shape or appearance.
• Skin dimpling, puckering, ridges or irritation.
• A nipple that turns inward or develops a new change in appearance.
• Redness, scaling, peeling or thickening of the nipple or breast skin.
• Nipple discharge other than breast milk, particularly if it occurs spontaneously, affects one breast or contains blood.
• Persistent breast or nipple pain or another unexplained change.

Breast Cancer Awareness Month serves as a reminder that early assessment can make a meaningful difference. While a concerning change does not automatically mean cancer, ignoring it can delay the answers and care a woman may need.

The message from BISSA is clear: know your breasts, understand the warning signs and seek professional advice promptly when something changes. Fear and misinformation should never prevent you from taking the next step towards protecting your health.

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