Frequently asked questions, find the answers to your questions here.
Most international cancer societies recommend annual mammographic screening as the best method of detecting breast cancer early.
It is recommended from the age of 40, unless indicated earlier.
Early detection greatly increases the chances for survival and greatly decreases the chances of a mastectomy being necessary for treatment.
There are rare forms of breast cancer (inflammatory breast cancer and Paget’s disease of the nipple for example) that can only be diagnosed by doing a clinical examination – these cancers usually cannot be seen by doing a mammogram and/or ultrasound. 5-10% of breast cancers can only be seen on a mammogram in the form of calcifications which do not always show up on ultrasound. Conversely about 5-10 % of breast cancers cannot be demonstrated on mammogram as they appear like the other normal structures of the breast, but then can be seen on ultrasound. By doing all three examinations in one visit we are able to correlate all findings and are thus better able to diagnose a cancer if it is present.
Most important uses of ultrasound in breast imaging are:
- As a primary screening tool for women under the age of 40, who do not yet require a mammogram.
- Cyst vs. solid characterization of clinically occult mammographically detected or palpable breast masses.
- Evaluation of asymmetric tissue on mammogram.
- Evaluation of palpable masses in women who are pregnant, breastfeeding or under 40 years of age.
- Guide for interventional procedures (cyst aspiration, preoperative localization, fine needle aspiration and core biopsy).
With Automated Breast Volume Scanning (ABVS) , which is 3D, the probe is moved automatically at a constant speed over the breast while images are constantly recorded. Post-acquisition image manipulation is possible with ABVS – such as three-dimensional reconstructions and rotations. Checking of images of the entire breast can be performed at a later stage as image acquisition and interpretations are separated, enabling review of images by several readers. These features greatly enhance the detection of small lesions especially in dense breasts.
The exact cause or origin of breast cancer is still being investigated by the medical profession.
In the case of breast cancer though it has been proven that certain factors do play a role in the risk for developing breast cancer. If these factors are present you are at higher risk for developing breast cancer;
- Age (older)
- Being female
- Age at first childbirth (older)
- Age at first period (younger)
- Age at menopause (older)
- Alcohol consumption
- Ashkenazi Jewish heritage
- Body weight (heavier)
- BRCA1 or BRCA2 gene mutation
- Breast density (high)
- Family history of breast cancer
- Hyperplasia (benign breast condition)
- Lobular carcinoma in situ (LCIS)
- HRT
- Personal history of cancer
- Radiation exposure from medical imaging
- Radiation treatment during youth
In any of the following cases you may consider genetic testing. Make an appointment so that your family history may be discussed and an appropriate recommendation can be made.
- one or more women in your family were diagnosed with breast cancer at age 45 years or younger.
- Family history of cancers, such as prostate cancer, melanoma, and pancreatic cancer.
- There are breast and/or ovarian cancers in multiple generations on the same side of the family.
- A female relative is diagnosed with a second breast cancer in the same or the other breast or has both breast and ovarian cancers.
- A male relative is diagnosed with breast cancer.
- There is a history of breast and/or ovarian, pancreatic, or male breast cancer in a family of Ashkenazi Jewish ancestry.
If you are at high genetic risk for breast cancer or already proven to be a carrier of a disease-causing mutation in the BRCA, ATM, CHEK or other high-risk genes, a MRI is indicated once a year. Please discuss this with your doctor at our multidisciplinary health care centre.
Although the breast is compressed, many women who undergo mammography do not experience pain. Women with very sensitive breasts may experience slight discomfort. It is also important to relax. When you are relaxed, the pectoral muscles behind the breast relax, which should result in a painless mammogram. Breasts are usually the least sensitive at about 2 weeks after menstruation starts, so this may be the best time of the month to schedule a mammogram, if this is a concern.
No. For over 40 years, millions of women have undergone mammography. As with all radiography, it involves exposure to X-Rays, but the dosage levels used are very low.
Mammographic techniques have also improved greatly over the past years. Currently employed techniques use only 0,1 to 0,2 rads per X-ray, which is an extremely low dose of radiation. This is equated to the cosmic radiation of about 30 minutes of air travel.
The question has also been asked as to whether compression can cause breast cancer. The answer is that compression doesn’t affect the breast tissue at all. For a useful mammogram, it is essential that the breast be compressed as the breast tissue needs to be spread out to allow breast structures to be seen.With appropriate compression the X-ray dose required can be reduced.
None of the above has been proven by science to cause breast cancer
Breast pain is usually due to hormonal influences on the breasts. During the menstrual cycle the breasts are being prepared for a pregnancy and subsequent breastfeeding in the same way that the womb is being prepared. The amount of fluid that is normally found in the breasts increases in volume (thus the milk glands and ducts literally swell up) up until menstruation when the hormone levels change the fluid gets reabsorbed again. Breast tissue is not static and as we get older the breast tissue is replaced by fatty tissue. This process starts around 40 years of age, but varies significantly between women. It causes a degree of fluid imbalance in the breast which may lead to new symptoms of breast tenderness or worsening of old symptoms. We call this process involution.
It is always good to have a thorough breast examination if any new breast symptoms arise. If no abnormality is found upon such a review, one of the following may be tried (try one at a time giving 4-6 weeks to monitor effect; 1-3 NOT recommended during pregnancy):
- Evening Primrose Oil 1-2grams 3 times per day.
- Mastodyn 2 tabs 3 times per day.
- Kelp 2 tabs 3 times per day (not to be used if you use thyroid medication or are being monitored for your thyroid).
- Low fat, no refined carbohydrates, high fibre diet.
- Minimise caffeine intake – bearing in mind green tea also contains caffeine.
Before having cosmetic breast surgery, it is recommended that you go for breast cancer screening. Any surgery to the breasts will make future evaluation of the breasts more complicated and can increase the chances of missing an existing cancer.
Yes. Breast augmentation does not constitute an increase in glandular tissue, so you are not more at risk. It is however necessary that an experienced mammographer does your mammogram, as special techniques are needed to demonstrate all breast tissue.
Good mammographic technique is of cardinal importance in producing high quality mammography.
A mammogram should only be mildly uncomfortable. However, if you are concerned about the tenderness of your breasts, it is advised that you see a trained breast health physician. In this instance, a clinical evaluation and an ultrasound can be performed. If anything suspicious is detected, an immediate mammogram may be required. If nothing is found but the tenderness persists, you may be advised to start treatment and postpone the mammogram for a few weeks until your breasts return to normal.
It is important to note that an ultrasound does not replace a mammogram, which remains the best tool for the diagnosis of breast cancer.
2-3 grams of Evening Primrose Oil per day for 2-4 weeks is noted to reduce breast tenderness.
Breasts are very resistant to injuries and an injury to the breast cannot cause breast cancer. Severe trauma can cause fat necrosis when tissue dies off. This is felt as a lump and can at times be mistaken for cancer on a mammogram. Fat necrosis is not a form of cancer and does not develop into cancer over time.
- Lumps of any size or thickening of the breast tissue and or axillae.
- Any kind of skin change to the breast, areola or nipple area.
- Changes in the shape of the breast or persistent discomfort.
- Discharge from the nipple – that is not associated with pregnancy or breast-feeding.
Below is an infographic to visually give you a step by step guide on how to examine your breasts.
The thyroid is a butterfly-shaped gland based at the base of the neck just below the Adam’s apple. It plays a fundamental role in the body’s endocrinal system and hormonal regulation.
It plays a fundamental role in the body’s endocrine system. It produces hormones to regulate our metabolism, growth and development, as well as our tissue function, sexual function, reproduction, sleep, and even our mood. The thyroid gland secretes two hormones, triiodothyronine (T3) and tetraiodothyronine (T4), both are made with iodine that the gland extracts from food. These two hormones intervene at various levels in our health; bone growth, mental development, stimulation of tissue oxygen consumption, fats and sugar transformation, digestive system. Thyroid hormones act on many of the organs, among others the heart, kidneys, liver and ovaries.
As the thyroid influences many of our organ functions, when it starts to be dysfunctional, the effects appear to be diverse and may not seem to come from one organ. That can make it difficult to know when to ask for a thyroid checkup. Symptoms of a dysfunctional thyroid include:
- High anxiety or depression, moodiness
- Significant gain or loss of weight
- Sensitivity to hot or cold temperature
- Joint and muscular pain.
Symptoms vary, but often patients can experience neck pain, swollen lymph nodes, difficulty in breathing and swallowing, a hoarse voice and the appearance of a lump in the neck.
There is no standard or routine screening test for thyroid diseases to establish a diagnosis. Blood tests measuring the level of thyroid hormones in the body can be performed, as well as screening tests such as ultrasound and isotope scans of the thyroid gland.. Fine needle aspiration biopsies are performed for suspicious nodules.
It is easy to confuse the thyroid and parathyroid. Some people believe they are even part of the same gland. This is a misconception. Both are part of the endocrine system, but they serve different purposes. The parathyroid is not in fact one gland, but four. Though they are small, it is quite normal for them to be up to pea-sized. The parathyroid glands operate in a similar fashion to the thyroid gland, but on a smaller scale. While the thyroid releases two key hormones that influence many organs, the parathyroid secretes only one: the parathyroid hormone, which regulates calcium, phosphorous and magnesium levels in our bloodstream.
Symptoms of a dysfunctional parathyroid include:
- Kidney stones
- Abdominal pain
- Bone pains
- Osteoporosis (fragile bones that easily fracture)
- Feeling of malaise
- Intense fatigue and weakness.
Since the thyroid and parathyroid act on different functions in our body, an isolated symptom does not prove that either of these glands are malfunctioning. In combination, however, the symptoms of a dysfunctional thyroid and parathyroid must be taken seriously. If you have developed a cluster of relevant and persistent symptoms, see a specialist. Further tests may be performed to arrive at a diagnosis and assess the appropriate treatment.
- Autoimmune diseases that affect the thyroid
Autoimmune diseases such as Grave’s disease, De Quervains’s and Hashimoto’s thyroiditis can damage the thyroid. In autoimmune disorders, the body produces antibodies that attack and damage the thyroid and so can alter thyroid function.
- Thyroid cancer
Thankfully thyroid cancers are uncommon and most are very treatable when diagnosed early. Symptoms vary, but often patients can experience neck pain, swollen lymph nodes, difficulty in breathing and swallowing, a hoarse voice and the appearance of a lump in the neck. Surgery can be performed to remove the entire thyroid or a part of it.
- Hypothyroidism results from a lack of thyroid hormones secreted into the body. Common symptoms include reduced heart rate, intense fatigue, dry skin, hair loss, weight gain that cannot be explained by improper diet, slow mentation (mental activity) and enlargement of the neck. The body seems to “slow down”.
At the opposite end of the spectrum is hyperthyroidism, an increase of thyroid hormones released into the body. Weight is lost despite a good appetite. Other symptoms include nervousness and anxiety up to full-blown psychosis, tremours, palpitations, high blood pressure, increased sweating and neck enlargement.
According to the National Cancer Institute in the US thyroid cancer can occur in any age group, although it is most common after age 30, and its aggressiveness increases significantly in older patients. Approximately 1.2 percent of all men and women will be diagnosed with thyroid cancer during the course of their lifetime.
Thyroid cancer is unique in that thyroid cells are the only cells in the body able to absorb iodine. This gives thyroid cancer treatment a couple of options. Surgical removal of the thyroid gland is the preferred therapy. In case there is a high risk of recurrence or the tumor cannot be removed surgically, most thyroid cancers can be treated with radioactive Iodine. Thyroid cells are the only cells in the body that absorb significant amounts of iodine. This is useful: Radioactive Iodine can be given for most thyroid cancers as treatment. It does not lead to hair loss, nausea, pain etc). The decision around treatment plan will be made between the surgeon, the patient and an oncologist.