Why screening matters
Breast cancer is the most common cancer among women in South Africa. Found early, it is often very treatable. Many women diagnosed with breast cancer have no family history of it, so screening matters for everyone, not only those with affected relatives.
Mammograms: when and how often?
| Situation | General guide |
|---|---|
| Average risk, age 40 and over | Mammogram ideally every year, or at least every two to three years |
| Older women | Continue while healthy; discuss with your doctor in your 70s |
| Higher risk (strong family history, known gene change, previous chest radiotherapy) | Risk assessment by about 25; earlier screening, which may include MRI |
A mammogram is a low-dose X-ray of the breast. The breast is pressed between two plates for a few seconds, which can be uncomfortable but is brief. Booking for the week after your period can make it less tender.
Where does ultrasound fit in?
Ultrasound uses sound waves, not X-rays. It is commonly used:
- for women under about 35 with a lump, since younger breast tissue is denser and harder to see on a mammogram;
- alongside a mammogram for women with dense breasts;
- to check whether an area seen on a mammogram is a harmless fluid-filled cyst.
Ultrasound usually adds to a mammogram rather than replacing it for screening.
Dense breasts
Breast density describes how much glandular and fibrous tissue there is compared with fat. Dense breasts are common and normal, but they can make mammograms harder to read and are linked to a slightly higher risk. Your radiology report may mention density. Ask your doctor whether extra imaging makes sense for you.
Breast awareness: know your normal
Screening doesn't replace paying attention between tests. There is no need for a rigid monthly routine, but get to know how your breasts usually look and feel, including up into the armpit. See a doctor promptly if you notice:
- a new lump or thickening in the breast or armpit;
- a change in size or shape;
- dimpling or puckering of the skin, or skin that looks like orange peel;
- a nipple that has become pulled in, or a rash or crusting on the nipple;
- fluid or blood from the nipple without squeezing;
- persistent pain in one area.
Most breast changes are not cancer, but all new changes deserve a check.
Who is at higher risk?
- A mother, sister or daughter with breast or ovarian cancer, especially at a young age.
- A known gene change in the family, such as BRCA1 or BRCA2.
- Previous radiotherapy to the chest at a young age.
- A previous breast cancer or certain abnormal biopsy results.
Lifestyle factors linked to risk include alcohol, excess weight after menopause and physical inactivity.
Men get breast cancer too
It is uncommon, but men can develop breast cancer. Any lump or nipple change in a man should also be checked.
When to see a doctor
- You notice any of the changes listed above, at any age.
- You are 40 or older and have not had a mammogram.
- You have a family history of breast or ovarian cancer and haven't had a risk assessment.
Frequently asked questions
Is mammogram radiation dangerous?
The dose is low. For women of screening age, the benefit of early detection is generally considered to outweigh the small radiation risk.
Can I have an ultrasound instead of a mammogram?
For screening women over 40, ultrasound usually supplements rather than replaces mammography. Your doctor and radiologist will advise you.
I had a normal mammogram. Can I ignore a new lump?
No. A new change should be checked even if your last screen was normal.
Do breast implants affect mammograms?
You can still have mammograms. Tell the radiographer beforehand, as special views are used.
References
- Mediclinic. Mammograms: what are they and do I need one? (citing CANSA and Radiological Society of South Africa recommendations). https://www.mediclinic.co.za/en/infohub-corporate/expertise/cancer/mammograms-what-are-they-and-do-i-need-one.html
- Cancer Association of South Africa (CANSA). Breast cancer. https://cansa.org.za/breast-cancer/
- Screening mammography with special reference to guidelines in South Africa. South African Journal of Radiology. https://www.scielo.org.za/pdf/sajr/v29n1/08.pdf
This article is for general educational purposes only, like a health newsletter. It is not medical advice, diagnosis or treatment, and reading it does not create a doctor and patient relationship. Please speak to your own doctor about your situation. In an emergency, call 10177 or 112, or go to your nearest emergency unit.