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In this important Q&A, Dr. Justus Apffelstaedt explains why breast health is about so much more than mammography. Dr.Apffelstaedt is a specialist surgeon with an interest in breast, thyroid, and parathyroid health, as well as soft tissue surgical oncology.

What exactly do you mean by “breast health is more than just mammography”?

Breast health awareness should start as soon as breasts develop in young girls. Women between 20 and 39 should know their family history of cancer and should conduct breast self-examinations monthly.

Women over 40 should broadly know about the advances in breast health and must continue monthly self-examinations.

The importance of a breast health consultation

In addition, women over 40 must have an annual breast health consultation. This should include a detailed breast health history, physical examination, mammogram, and breast ultrasound. If women are low-risk (as in there is no family history of cancer), there are also four main lifestyle choices that could dramatically lower the risk of developing breast cancer.

Four main lifestyle choices to reduce your risk of developing breast cancer

These include maintaining a healthy weight, exercising regularly, ascertaining risk when taking hormone therapy, not smoking, and limiting alcohol intake.

If you have a family history of any form of cancer, it is recommended that genetic testing is discussed to understand your breast cancer risk. Benign conditions such as benign lumps, mastalgia and more also fall into the breast health category.

Most benign conditions do not signify an increased risk of breast cancer. Taking care of your breast health is lifesaving! Early detection means early treatment!

If a possible cancer is detected, what then happens?

The diagnosis will be established by needle core biopsy under local anesthesia and; if necessary, under imaging (mammographic or ultrasound) guidance.

The most effective way to treat breast cancer is with a multidisciplinary approach. It combines and integrates a number of treatment options that include surgery, radiation, chemotherapy, and hormonal and biological agents.

Specialist centres, which see more than 150 breast cancer cases per year, will achieve the best results as the most accurate diagnosis can be made and the most appropriate treatment options chosen.

The importance of a multi-disciplinary approach

A multidisciplinary treatment approach involves an oncologic surgeon, a radiation oncologist, a medical oncologist, and a plastic surgeon who have to optimally time and sequence the individual treatments.

In a well-run multidisciplinary breast clinic, out of 100 women with breast cancer, about 50 will have breast-conserving therapy. Another 45 will have a mastectomy with immediate reconstruction.  Only 5 will leave the theatre with neither their own breast nor a reconstructed breast. 

What if a woman is really young and worried about fertility? What would your approach be? 

While breast cancer as such does not have any known effect on fertility, its treatment of it does have profound implications. Fortunately, most breast cancer occurs in women who have finished family planning.

For the few who have not, each treatment has its own implications for fertility. For example, radiation cannot be given at any stage of the pregnancy but is safe outside of pregnancy.

Be informed and understand all risks

Chemotherapy is safe in the second and third trimesters of pregnancy, but generally decreases fertility on a long-term basis. Hormonal therapy cannot be given during pregnancy. Women on hormonal therapy should not get pregnant but after the conclusion of treatment, fertility will normalize. Surgery during pregnancy may lead to spontaneous miscarriage, but has no effect on fertility.

The issues involved are very complex, and a balance of treatment needed to ensure survival with the individual’s desire to fall pregnant needs to be found. It is self-evident that this requires an experienced treatment team.

We highly recommend that the patient is informed on how the recommended cancer treatment may affect fertility before starting treatment, as the patient needs to understand these risks. 

Furthermore, the patient needs to be informed about fertility management options such as egg or embryo freezing. 

Men can get cancer too! Should they also go for breast health check-ups?

For every 100 women that we see with breast cancer, we see one man. Therefore, the risk is low – particularly in comparison to cancers such as lung, prostate, or colon. The National Cancer Registry states that the lifetime risk of suffering breast cancer in males is between 1 in 500 and 1 in 1000, depending on race.

Men of any age may develop breast cancer. However,  it is usually detected in men between 60 and 80 years of age (compared to women who are usually detected from the age of 35). It is estimated that cancer-causing genetic abnormalities are at least 2 – 4 times more common in males with breast cancer than in females.

Diagnosis of a disease-causing genetic mutation will greatly impact the patient’s management and also has important consequences for other family members. Genetic testing has therefore become part of routine care in males with breast cancer. Men with breast cancer typically have a lump that can be felt.

Men’s breasts are not often as big as women’s and a mass is, therefore, more easily palpated by a man. On the other hand, in contrast to women, men do not seek healthcare as readily and most cases that we see are fairly advanced.

We therefore recommend that males with high breast cancer incidences in their families undertake genetic testing to understand their risk and then screen accordingly. 

Why do you support CSI initiatives such as The Ditto Project?

Because breast health is about more than mammography! Reach for Recovery (R4R) and I share the same belief: that all women facing breast cancer must be treated with dignity and have the same access to care, regardless of whether they can afford it.

The Ditto Project aims to help women regain their self-confidence, giving them access to high-quality silicone breast prostheses and also assisting them – through local branches of R4R – to ensure they choose the correct shape and size for their bodies. The Western Cape branch now also provides a fitted mastectomy bra at hugely subsidized costs.

Dr. Justus Apffelstaedt

With a breast cancer diagnosis, there is the possible trauma of the diagnosis. There are also the physiological side-effects of the various treatments (hormone fluctuations, fatigue, nausea, pain), the dramatic changes to your body following mastectomy as well as side effects from radiation and chemotherapy treatments such as weight gain or loss, for example.

Self-esteem, cancer, and breast health

Some women struggle with the feeling of having ‘lost their wholeness’. All of this can lead to self-esteem issues, and in some cases, even depression. The work that The Ditto Project does is of immense value.

Not only from an aesthetic viewpoint, by providing a prosthesis, but from a psychological viewpoint; by providing a sense of wholeness to those who feel a physical loss.

Reach for Recovery wants to help women who are dependent on public health services to feel confident again after a traumatic diagnosis and surgery.

We believe that breast prosthesis is an important step in her recovery. This is especially true for women from communities where there is still a stigma attached to cancer diagnoses. A more natural appearance with a breast prosthesis, together with the emotional support is important. This will enable women to continue to receive help from Reach for Recovery volunteers through support groups, and will help her to return to her normal life.

Want to know more?

For more info on Dr. Apffelstaedt, visit www.apffelstaedt-hoosain.com. For more info on The Ditto Project, visit https://www.apffelstaedt-hoosain.com/the-ditto-project/

Read more about beating breast cancer

Other breast health articles by Dr. Apffelstaedt include: https://longevitylive.com/wellness/beating-breast-cancer-with-dr-justus-apffelstaedt/

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Dr. Justus Apffelstaedt

Dr. Justus Apffelstaedt is a specialist surgeon with a particular interest in breast, thyroid, and parathyroid health management, as well as soft tissue surgical oncology. Dr. Apffelstaedt has published about 50 peer-reviewed articles in scientific journals both nationally and internationally. He has also presented about 60 invited papers at national and international scientific meetings. Additionally, he has had about 100 scientific papers read at national and international scientific meetings.

The content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional.

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