Breast cancer is the most common cancer affecting females in South Africa and is the leading cause of cancer death, according to the National Cancer Registry. There have been significant advances in the fight against breast cancer resulting in earlier diagnosis, improved surgical and medical management, and, most importantly, better survival.
Mammographic screening for breast cancer remains the best investigation for population-based screening. Although medical schemes have introduced two-yearly reimbursements for the study, elevated-risk females should remain on an annual screening programme commencing at the age of 40. Risk-stratification can be done by your breast clinician and can assist in ensuring that the correct screening protocol is followed.
What should you do if you are concerned?
One should consult with a breast clinician if there are any concerns during the clinical or radiological assessment of your breast. Your breast surgeon/clinician may be able to assess if there is a concern of pathology or not. If possible, a biopsy should be obtained prior to any surgical intervention.
How do we treat breast cancer?
The management of breast cancer is a multi-modal therapy which may include surgery, chemotherapy, radiation therapy and targeted therapy. The treatment depends on the stage of cancer and the tumour-biology. The decision is usually made as a combined decision between the surgeon and the oncologist (multi-disciplinary team).
Is a mastectomy the best form of surgical management for breast cancer?
The recommended surgical management for early (Stage I & II) breast cancer is Breast Conservation Therapy (BCT – partial excision of the breast). The indication for Total Mastectomy (TM – removal of the whole breast) is for 1) Locally advanced breast cancer (stage III), 2) Multicentric breast cancer, 3) Patient preference, 4) Poor tumour to breast size ratio. In fact, due to the advances in the multi-modal approach to breast cancer, we are seeing improved survival in the BCT patients with a better quality of life in correctly selected patients. Today, there must be a good reason to why a female should have a mastectomy for breast cancer. Your breast surgeon should discuss the options with you.
Can the breast be reconstructed following a TM?
Yes, it most certainly can. Reconstruction can be done in the immediate (same time as the mastectomy) or in the delayed setting. The options may include autologous (own body tissue) or prosthetic reconstructions. It must form part of the discussion with your surgeon and should you be a candidate for reconstruction, a combined meeting with your surgeon and the reconstructive surgeon must be done.
Does my Medical Scheme cover a reconstruction following a TM?
Breast cancer is a Prescribed Minimum Benefits (PMB) condition and most schemes will cover (at-least in-part) the reconstruction. The level of cover depends on the plan that one is signed on to. It is a females’ right to be given the option for reconstruction, if appropriate.
By Dr Pramod Reddy (Specialist Breast and General Surgeon), Director of the Durban Breast Clinic and the Surgical Oncology Centre, based at the Busamed Gateway Private Hospital in Umhlanga, Durban.