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Breasts: Five things to know about them and their care

Did you know? Good care is out there in public and private hospitals, but check your medical aid.

Carol-Ann Benn jokes that she may not know her way around a stove, but she definitely knows her way around a breast.

“I can tell you I can’t teach anyone how to cook. I can’t even tell you how to switch on an oven but I can tell you about sensible breast healthcare,” she says.

One in 29 South African women will be diagnosed with breast cancer in her lifetime, according to the 2011 national cancer registry.

Benn, the cancer expert at the helm of the Breast Care Centre at Johannesburg’s Helen Joseph Hospital, tells you five things you should know about breast health whether you’re newly diagnosed or looking to cut your risk.

1. Not all screening is created equal

South Africa does not have national breast screening guidelines but the Cancer Association of South Africa recommends women 20 years and older do monthly self-examinations. The organisation says people 40 years and older should go for mammograms.

Ultrasounds, mammograms and biopsies can all be used to diagnose breast cancer, but you may want to put the brakes on visiting mobile mammography centres.

“There should be no place for mobile mammogram units,” she says.

“I had a lady in the rooms the other day in a state because somebody had come around with free breast exams in the office and told her she had a problem. She had extra breast [tissue] but because they were teaching them how to examine themselves incorrectly in an office all they were doing driving unnecessary fear,” Benn explains.

What is often missing from the mobile screening equation? Doctors who can guide patients in the next appropriate test to confirm suspicions.

“Doctors need to take responsibility and take a history take an examination write notes that you are medically responsible for and then decided who goes for what testing,” Benn cautions.

A better approach? Benn says clinic nurses should consider referring women for community screenings at hospitals where trained survivors can counsel prospective patients in their home languages. Bonus: these counsellors can also help with follow-up support.

2. Check the fine print of your medical aid cover

You think that just because you have medical aid, you’ll be covered. Benn says think again. She says a mammogram, ultrasounds and some types of biopsies to diagnose cancer can cost between R8 000 and R22 000 and you may be stuck footing the bill.

“In the private sector, this may not be covered by all medical aids and some will only cover this once you’re [diagnosed] on and registered on to your oncology [programme] whether it’s a prescribed minimum benefit or not,” she says.

And prescribed minimum benefit or not, you may still end up in a government hospital.

“I think of the amount of people I see who are on the low-end medical schemes because [their scheme] only covers [treatment] in government facilities, or at certain hospitals that may not have specialist multi-disciplinary units.

“The argument given is that you can’t fly business class if you have only paid for an economy seat. The problem is not the seat but that some people may be on an entirely not safe plane with their medical scheme option That’s fine…but people need to now what they are signing with their medical aids, as well as what their company has signed them onto Patients need to know what they’re getting,” she says

3. Good care in private and public facilities

If you or someone you know is diagnosed with breast cancer and referred to government facilities, Benn says you should know that good care is out there.

You should ask your oncologist if they work in a multidisciplinary team that includes surgeons, radiologists and nurses. Benn says this helps to ensure a high standard of care where specialists can work to double check each other.

You can find these kinds of teams in the private and public sector, she says.

4. Just diagnosed? Don’t rush into decisions

Some people may think that breast cancer spreads rapidly and Benn cautions this is a misperception.

“We have a fear that cancer will go around your body in five minutes like [the beanstalk] in Jack and the Beanstalk and kill you. That’s actually not true. Breast cancers are slow-growing. Some often  come through the [skin of the] breast before they spread into the body,” she explains.

“There is no such thing as an emergency breast cancer treatment or biopsy. So if they pick up something concerning on your mammogram, you should have time to think about it and work out the cost and work out where you are going.”

5. Have hope

According to Benn, nine out of 10 people with breast cancer will be alive five years down the line if they are diagnosed early.

Benn says: “We no longer need to chop breasts offs because we can do breast-saving operations. We can achieve, in government and private, cancer surgeries that do not make women lead terrible lives. We’ve come a long way.”

Laura Lopez Gonzalez is a freelance health journalist and editor. She was Bhekisisa's news editor then deputy editor between 2016 and 2020. Follow her on Twitter @LLopezGonzalez