As the leading type of cancer among women in South Africa, breast cancer affects approximately 19,4-million women aged 15 years and older. According to Cansa, a solid knowledge of our own body is crucial in detecting any abnormalities, and it’s important to go for regular screenings and to do self-checks throughout the year.

Professor Justus Apffelstaedt, Associate Professor of Surgery at the University of Stellenbosch and Head of the Breast Clinic at Tygerberg Hospital, says, ‘Breast cancer is the most common cancer in women globally and in South Africa. About one in 10 women in urbanised areas will be affected by breast cancer in their lifetime. While this statistic may seem alarming, breast cancer is a highly curable disease when detected early. It is important that women follow a strict regimen of screening and self-examination.

‘Women from the ages of 20 to 39 should know their family history of breast cancer, schedule a yearly consultation with a professional with a special interest in breast health (including a breast examination) and should conduct breast self-examinations monthly,’ says Apffelstaedt. ‘Women over 40 should know about the latest advances in breast-cancer treatments and technologies, should have an annual mammogram and clinical breast examination, and should conduct breast self-examinations monthly. If there is a problem, treatment and follow-up by super-specialised doctors in a multidisciplinary environment has the best results.’

Apffelstaedt tells us about two rare forms of breast cancer that we need to be aware of, namely inflammatory breast cancer and Paget’s disease of the nipple.

What are they?

Inflammatory breast cancer is a special clinical manifestation of very aggressive breast cancer, while Paget’s disease of the nipple is a special clinical manifestation of a very slow-growing, indolent breast cancer.

How often does do they occur?

‘Only about one to two percent of all breast cancers in our breast clinic are true inflammatory breast cancers, which is why it is often missed,’ Apffelstaedt says. With regard to Paget’s disease of the nipple, Apffelstaedt says that fewer than one percent of all breast cancers in their breast clinic manifest as Paget’s disease of the nipple, which is why this is often missed too.

How do I recognise it?

For inflammatory breast cancer, an area of redness of the skin of the breast appears that is not caused by other signs of infection. This is can be a rash that comes and goes, but is focused on the skin on the breast area. With Paget’s disease of the nipple, a small scab or nipple erosion appears and very slowly starts to get bigger without any redness, but only on one nipple.

How is the diagnosis made?

With regard to inflammatory breast cancer, a doctor will be able to make a diagnosis with a skin biopsy, which needs to show an invasion of lymph vessels by cancer. In this case, a mammogram and ultrasound are usually not helpful.

For Paget’s disease of the nipple, a biopsy of the nipple must be done and if it’s a positive diagnosis this will show an early cancer in the milk ducts. A mammogram may show signs of an early stage, noninvasive cancer but is at times not helpful.

How is it treated?

It is imperative to start with chemotherapy when it comes to inflammatory breast cancer because only when chemotherapy has cleared the signs of inflammation can surgery be performed. After surgery, radiotherapy is essential to decrease the chance of the cancer recurring. Surgery consists of a mastectomy, and reconstruction is not recommended.

Paget’s disease of the nipple requires surgery as the main form of treatment. A mastectomy with immediate reconstruction or breast-conserving therapy should have good results.

* It is important to visit your doctor to get a valid diagnosis. This information is merely to inform and not to self-diagnose.

PHOTO: iStock/Voyagerix