Breast health myths

Are mammograms really painful? Do smokers run a higher risk of developing breast cancer?
With so many myths and preconceived notions on the internet and in our minds, it is often difficult to determine what is fact and what is fiction.
Professor Justus Apffelstaedt, Associate Professor at the University of Stellenbosch and Head of the Tygerberg Hospital Breast Clinic, helps to set the record straight.
MYTH 1
The incidence of breast cancer in younger women is increasing.
TRUTH
Breast cancers in younger women who are of ­celebrity status is resulting in increased media ­coverage of their cases, but typically, breast cancers develop in women between the age of 50 and 70.
MYTH 2
The contribution of chemotherapy to reducing mortality is significant.
TRUTH
A multidisciplinary approach that combines a number of treatment options that include surgery, radiation, chemotherapy, hormonal and biologic agents is most effective. Specialist centres, which see more than 150 cases of breast cancer per year, will achieve the best results as the most accurate diagnosis will be made and the most appropriate treatment options chosen.
MYTH 3
Smoking increases your risk of breast cancer.
TRUTH
Breast cancer is one of the few cancers where risk is not increased due to smoking.
MYTH 4
A mammogram is a mammogram.
TRUTH
The accuracy of mammographic diagnosis in screening, which forms the bulk of all mammography performed in Namibia and South Africa, depends on:
1. Optimal equipment used to produce the ­mammogram. These days full-field digital mammographic equipment is regarded as state of the art.
2. The optimal image as produced by a radiographer specialised in mammography.
3. The optimal reading of the image is usually provided by doctors who specialise in breast imaging and who have possibly received overseas training in mammography interpretation.
4. A process of rigorous quality control, where all outcomes are recorded and regularly analysed.
Only where all of these conditions are met will the promise of lowering the mortality rates from breast cancer and the increase in breast conservation be realised.
MYTH 5
It doesn’t make a difference where you are treated.
TRUTH
A very important but often overlooked factor is where a patient is treated. It has been shown that dependent on where the woman is treated for breast cancer, the risk of death within 5 years can be up to 60% higher in environments where only few breast cancers are treated versus­ ­environments where more than 150 breast cancers are treated per year. This effect is larger than any chemotherapy, hormonal therapy and radiation.
MYTH 6
Removing the entire breast is better than breast conservation.
TRUTH
Breast cancer metastasizes to places outside of the breast. A tumour in the breast will not kill you – the spread of the cancer to the brain, lungs etc. will. As breast cancer often does that early in the course of the disease, a mastectomy will not guarantee you better survival than breast conserving therapy.
Should a radical mastectomy be necessary, breast reconstruction can take place during the same operation. A multidisciplinary treatment approach involves: The oncologic surgeon, a radiation oncologist, a medical oncologist and a plastic surgeon to optimally time and sequence the individual treatments.
In a well-run multidisciplinary breast clinic, out of 100 women with breast cancer, 60 will have breast-conserving therapy, 35 will have a mastectomy with immediate reconstruction and only five will leave the theatre with neither their own breast nor a reconstructed breast.
MYTH 7
My breast cancer wasn’t detected by mammography.
TRUTH
High quality mammography will detect about 95% of all breast cancers. Breast cancers that do not image are rare if the above criteria of a breast imaging centre are met.
MYTH 8
Mammograms are painful.
TRUTH
If the breasts are painful, a mammogram should not be done until the reason for the tenderness has been addressed. Well-trained mammographers should be able to assist you in relaxing. When you are relaxed, the pectoral muscles behind the breast relax, which should result in a painless mammogram.