Early Detection Key in Fighting Breast Cancer

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Breast cancer remains the most common cancer among women worldwide while in South Africa it is still a leading cause of cancer-related deaths.

This is according to Inkosi Albert Luthuli Central Hospital (IALCH) radiologist, Dr Zakithi Mazibuko, who was on a multidisciplinary panel of experts presenting cutting-edge interventions at this year’s Hybrid Breast Cancer Update hosted by UKZN’s Discipline of General Surgery, under the leadership of Professor Boitumelo Phakathi.

Mazibuko and colleagues spoke about breast cancer’s prevalence in the country and globally, saying early detection signs included lumps on the breast, nipple retraction, nipple discharge, skin changes (discolouration), thickening or orange-peel dimples and underarm lumps.

“As radiologists and clinicians, let us continue to be the eyes that see early, the hands that act quickly, and the voices that advocate loudly because when we save a breast, we save far more than tissue; we save a woman’s story, her dreams, her tomorrow,” said Mazibuko.

Nuclear Medicine physician and Head of the Clinical Unit in the Nuclear Medicine Department at IALCH and UKZN, Dr Bawinile Hadebe, shared visual illustrations of how their work plays a key role in targeted breast cancer care.

Hadebe said nuclear medicine was a medical speciality that involved the use of radioactive substances in the diagnosis and treatment of the disease, explaining how accurate lymph node staging was essential for both prognosis (early-stage of the disease) and treatment (for regional control of the disease).

Hadebe covered an array of the specialised methods used, including scintimammography - a technique that uses small amounts of radioactive material, a special camera and a computer to help investigate breast abnormality - bone scans, multigated acquisition (MUGA) scans, FDG PET/CT scans, other molecular targets as well as the potential of pairing of diagnostic and therapeutic agents (theranostics).

Dr Pixley Ka Isaka Seme Memorial Hospital surgeon, Dr Prashti Harichunder, presented on breast conserving surgery, referring back to the ancient Greek physician and philosopher, Hippocrates, who named breast cancer as a ‘systematic disease’ because of its complexity.

Today, Harichunder and fellow captains of industry use sophisticated level 1 oncoplastic techniques to ease the disease burden in KwaZulu-Natal. They strongly emphasise the need for the counselling of patients and sensitising them to the benefits of post-operative radiotherapy. 

Presenting on oncoplastic techniques used to save the breast, IALCH breast reconstructive surgeon, Dr Elizabeth Makakole, reminded the gathering that the breast had a biological and aesthetic function, being a significant symbol for motherhood, femininity and sexuality - it is a central focus of a woman’s anatomy and identity.

Lobbying a holistic approach to care, Makakole said breast treatment should not end with cancer surgery but rather also include psychology and psychiatry where necessary. She said due to medical advancements and as highlighted by Hadebe and Harichunder, saving the patient no longer required removal of the entire breast. “We can save the patient by saving the breast, and restoring an aesthetic breast is an integral part of cancer surgery. Informing patients about breast conservation and breast reconstruction is part of breast cancer treatment,” Makakole said. She reminded participants that Breast Reconstruction Awareness (BRA) Day was an annual event held on the third Wednesday of October to educate the public about breast reconstruction options following a mastectomy.

IALCH clinical oncologist, Dr Presha Bipath, presented on systemic and radiation breast cancer therapy, and stressed the importance of multidisciplinarity in tackling the disease. Bipath discussed future directions of breast cancer care, mentioning the need to remain cognisant of special populations that include fertility considerations for women under the age of 40, male breast cancer, testing for high penetrance genes as well as de-escalation strategies for elderly folk.

Speakers applauded Department of Health efforts towards ‘one-stop-shop’ screening, saying it was important to educate the public and primary healthcare workers about early detection as well as awareness and collaboration with traditional healers as done in recent HIV interventions.

Phakathi said a diagnosis of breast cancer did not necessarily mean a woman would lose her breast. “In cases where mastectomy (removal of the entire breast) is required, breast reconstruction surgery can be offered to restore a woman’s image, thereby reaffirming her dignity and confidence.”

Phakathi thanked the speakers for their insightful and comprehensive presentations during the event. “Speakers highlighted the importance of a multidisciplinary team approach in ensuring safe and effective breast conserving surgery, while taking into consideration a patient’s wishes and opinions in treatment decision making.”

Phakathi reiterated: “Early detection remains key in enabling us to save the breast in breast cancer care, I therefore encourage all women to do a regular, monthly breast self-examination so that they are aware of how their breasts look and feel. The minute there is the slightest change, they need to seek medical help,” she said.

“I also encourage women from the age of 40 to do screening mammograms, even without any breast-related symptoms. Lastly, thank you to the organising team as well as everyone who attended. Let’s continue to spread the message of hope, love and faith in our attempts to fight breast cancer,” she added.

Words and photograph: Lunga Memela