According to Dr Pramod Reddy, director of the Durban Breast Clinic and the Surgical Screening Clinic, despite Covid-19, breast cancer screening is as important as ever.
At the onset of the COVID-19 pandemic, elective medical procedures, including cancer screening, were largely put on hold to prioritise urgent needs and reduce the spread of COVID-19 in health-care facilities. One consequence of this has been the substantial decline in breast cancer screening. The shutdown of elective health services during the outbreak may have far-reaching consequences on health-care provision in South Africa. There has also been a decline in elective consultations, diagnostic biopsies, and surgical management of breast pathology. Quantifying the negative impact on breast cancer screening will only be assessed in the months to come.
Many patients have delayed seeking medical advice due to their fears surrounding the potential risk for contracting COVID-19 during their visit to health facilities.
The number of mammograms, ultrasounds and MRIs had significantly declined due to the lockdown, and although confidence in the system is returning, it will take months to recover from this backlog.
It is vitally important for women to continue with self-breast examination, to ensure that one remains breast aware. The concerning clinical features that require a more urgent assessment include:
• A new lump (please note that this could be solid or cystic)
• Pathological nipple discharge, which is a blood-stained or watery, spontaneous, unilateral discharge.
• Nipple retraction (usually unilateral)
• Skin changes (oedema/swelling or tethering)
• Axillary/armpit lymph glands
• It is important to remember that breast cancers are usually painless.
What are the recommended mammographic screening guidelines?
Risk stratification for breast cancer is important to evaluate one’s personal risk for developing breast cancer. Elevated risk factors include a strong family history of breast cancer, a personal history of a proliferative breast disorder or a previous history of cancer, increased breast density, and using hormone replacement therapy (HRT). Obesity, smoking and medical co-morbidities also contribute to risk elevation.
It is recommended that mammographic screening commence at the age of 40, annually for high-risk females, and biennially for average-lifetime risk females.
What if there is an abnormality?
If an abnormality is identified, either clinically or radiologically, it is important to have it assessed by a Breast Clinician. If the lesion is concerning, then a biopsy is usually performed by your breast surgeon, or it will be scheduled to be done by a radiologist. It is important not to delay this intervention, because early diagnosis is associated with better outcomes and cure rates.
It is important to know that most clinical facilities have taken all the necessary precautions to ensure the safety of patients during procedures. And remember, always wear an appropriate mask, practice social distancing and appropriate hand sanitising.
Dr Pramod Reddy, Director of the Durban Breast Clinic & The Surgical Screening Clinic and Specialist Breast Surgeon. Visit www.durbanbreastclinic.co.za for more information.