Breast cancer is a quarter (24.11%) of all cancer in South African women. In 2022 alone there were over 11,000 new cases. And it is the main cause of cancer deaths in women worldwide. It is also increasingly discovered in women under 40. This trend reflects global patterns: younger women are diagnosed more aggressive forms of the disease, which underlines the need for early detection and consciousness. While a lot of attention is paid to, the meaning of the mammograms and the knowledge of the symptoms, which happens after breast cancer diagnosis, is more mysterious. This is because the next steps differ depending on the diagnosis and recommended treatment options. Dr. Maré du Plessis, specialist at Mediclinic Milnerton, gave his expertise.
Meet the experts: Dr. Maré du Plessis is a specialist surgeon at Mediclinic Milnerton. She works as part of a team with oncologists to take care of breast cancer patients.
Is the self -examination still important?
For mammograms, experts can now see very small lesions at an early stage. “But sometimes a patient feels a lump and this abnormality does not show up in mammography. We always encourage the patients to examine themselves,” explains Du Plessis. Conclusion: Yes, the self -examination and the screening of mammography in combination are crucial and recommended.
You feel a buddy in your chest – what now?
“You have to see a doctor who can carry out an examination and then order the cludes examinations,” says Dr. You Plessis. Based on this findings, the doctor will most likely recommend a biopsy to extract a sample of the tissue within the chest to determine whether it is cancer -like. If there is a cancer diagnosis, the next step is to determine in which stage the cancer has progressed. Finally, the oncologist will speak to them before deciding on the treatment. This is determined by the clinical findings and further radiological studies.
“In the case of advanced cancer, chemotherapy treatment is usually displayed before the operation to reduce the tumor,” explains Dr. You Plessis. “With the first and two breast cancer, the operation is usually the first step.”
Read more: What you should know about breast cancer as a young woman
What is a biopsy?
The biopsy is a medical process that removes cells, tissue, tissue or liquid from the body – with breast cancer, tissue – to examine and test whether there is cancer. And no, there is no need to include surgery, says Dr. You Plessis. “The biopsy is almost always carried out by the radiology team, under ultrasound instructions or through the so -called stereotactic biopsy,” he explains. “You use the mammogram machine to locate the lump with a needle, and then a needle biopsy is carried out.”
When does surgery occur in breast cancer?
“The treatment of breast cancer is diverse,” says Dr. You Plessis. “Operation is generally the main way, but there are other forms of treatment.” This includes chemotherapy, radiation therapy and in some cases hormonal therapy. Sometimes Dr. You Plessis A transfer after a mammogram has taken up the lump, or the patient felt the lump, so that no diagnosis has been made yet. “In other cases,” he explains, “a general practitioner has already sent the patient to the biopsy, and the cancer diagnosis has already been made. I will always work as a team with an oncologist, since the operation is only one of the many components of breast cancer treatment.”
Ultimately, the treatment depends on the stage of the cancer, which depends on the size of the clump and whether there are indications of the lymph nodes in the armpit or in the axilla (the arm is connected to the shoulder). And her oncologist also wants to know whether cancer is in the body elsewhere.
Dr. You Plessis explains how some cases are evaluated:
“If it is one or two cancer in the stage, there is usually only an operation. Sometimes there is the possibility of radiation therapy or potentially hormonal therapy even after the first stage and two breast cancer surgery. In certain cases of earlier stages of breast cancer, chemotherapy can still be displayed.
With breast cancer in the third stage, we almost always do what we call neoadjuvant chemotherapy. That means the tumor is too big for the operation. To achieve clear margins and ensure the success of the curative operation, we wait for chemotherapy to shrink the tumor, which can take about six months. In most cases with breast cancer in stage three, the patient will also have radiation therapy after completing the operation. “
Read more: 11 symptoms of breast cancer in women who are not lumps
When is hormonal therapy carried out – and what about chemotherapy?
“Some breast cancer is sensitive to estrogen and progesterone,” explains Dr. You Plessis. “The circulating estrogen progesterone in the patient’s bloodstream grows the tumor.” If the pathologist takes up this, hormonal therapy is given in the form of an estrogen and progesterone blocker (hormonal therapy). This helps to reduce breast cancer.
Chemotherapy can be displayed before or after breast cancer operation, as in the above cases. Neoadjuvant chemotherapy is a treatment that occurs in this case before the main treatment. “It was developed to reduce the size of the tumor and to fix the lymph nodes in the armpit (the armpit),” says Dr. You Plessis. “Adjuvant chemotherapy means that we give chemotherapy after the operation. This is generally done when cancer has been regarded as early breast cancer, but the testing of the tissue after the operation shows a higher stage. Or if a type of breast cancer is more susceptible to returns.”
Does mastectomy always mean both breasts away?
“We not only offer a patient a bilateral or double mastectomy just because he has breast cancer. The risk of complications with bilateral mastectomy prevails – if it is not medically necessary,” says Dr. You Plessis.
But! If you have the genetic BRCA 1OR -BRCA -2 mutation (which means that there is an 85 to 90% chance to develop breast cancer again in the future), it is advisable to undergo a double (bilateral) mastectomy. And for all young breast cancer patients, patients under 40 or patients with breast cancer history, says Dr. You Plessis that they test the BRCA 1 and 2 genes.
Options available
“There are generally three options for breast cancer patients, and these options are decided by consultation,” says Dr. You Plessis. “Either you have a lumpectomy (a wide local excision) or a mastectomy or a bilateral/double mastectomy.” With a mastectomy, the entire breast is removed. If a lumpectomy is displayed for a smaller tumor, the patient can still have a mastectomy.
These decisions are based on the size and stage of the tumor and the size of the tumor in relation to the size of the breast. “For example, a lumpectomy on a small breast may not have a cosmetically acceptable result. We can advise a mastectomy in this scenario,” says Dr. You Plessis.
And also no superior treatment, says Dr. You Plessis. “The mastectomy is not superior to a lumpectomy in terms of oncological results or the chance of healing,” he says. “If the tumor is small and can be properly removed by a lumpectomy, we would generally recommend it.”
According to Dr. You Plessis then receives radiation therapy. This serves to minimize the likelihood of a remaining microscopic cancer. “A patient must therefore be ready to carry out radiation therapy after the operation if he undergo lumpectomy,” he says.
What is the healing rate for breast cancer?
After completing all available modalities of breast cancer treatment, the five -year survival rate of the first stage and the second stage is between 90 and 100 percent. In the third stage disease, the five -year survival rate is close to 70 percent.
Read more: What the stages of breast cancer means, including the estimated survival rate of the individual one
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