Breast cancer remains one of the most significant health concerns for women worldwide. Dr Justus Apffelstaedt, a breast health specialist and surgeon, stresses that early detection is the most effective tool for improving breast cancer outcomes.
While the common belief is that breast cancer primarily affects older women, this assumption puts younger women at risk of delayed diagnosis. In South Africa, breast cancer occurs in approximately 1 in 6 women under 40, and it tends to be more aggressive in these younger patients. Breast cancer awareness is key.
The reality of breast cancer in South Africa
As a specialist in breast health, I see many patients who are unaware of the true risks. According to the National Cancer Registry (NCR) of 2019, breast cancer is the most common cancer among South African women, with a lifetime risk of 1 in 27. However, I believe this statistic is an underestimation – particularly in urban areas – where the real risk could be closer to 1 in 10. In countries such as the USA and UK, the incidence is similarly high, but survival rates are significantly better due to earlier detection through routine mammographic screening.
Why early detection matters
Early detection is crucial because it drastically improves the chances of survival. According to the American Society of Clinical Oncology (ASCO), if breast cancer is detected when still confined to the breast, the five-year survival rate is as high as 99%. Mammograms remain the gold standard for early detection, and I recommend annual mammographic screening for women starting at age 40, as long as there are no additional risk factors.
Understanding your risk factors
Some patients are at a higher risk of breast cancer due to lifestyle or environmental factors, which can often be managed. These include:
- The use of certain types of hormone replacement therapy, which can increase breast cancer risk.
- Being overweight.
- Consuming large amounts of alcohol.
- Smoking, which is linked to a higher risk of breast cancer, particularly in younger premenopausal women.
- Eating an unhealthy diet with too few fruits and vegetables.
- Leading a sedentary lifestyle.
However, other risk factors are beyond the patient’s control, such as:
- A high prevalence of cancer in the family.
- A previous personal diagnosis of cancer.
- Genetic predispositions.
- Having a first pregnancy after the age of 35.
If any of these factors are present, I strongly advise seeking medical advice to assess potential risks. Following a discussion, we can perform breast imaging – mammography, ultrasound, or, in genetic cases, an MRI – or conduct genetic testing to determine whether preventative measures should be taken.
The case for regular screening
In my practice, we’ve gathered data that clearly demonstrates the impact of early detection. If cancer is found through routine mammographic screening, our patients have a 10-year survival rate comparable to that of women without breast cancer.
However, women who come to us with a lump already present in the breast have a 10-year recurrence rate of 1 in 3, and they often require much more intensive treatment. Among those whose cancers were detected via screening, only half required chemotherapy, a third needed biological therapies, and a quarter fewer needed radiation therapy compared to those who came in with a lump.
Empowering patients through knowledge
Regular screening from the age of 40 – or earlier, if necessary – is key to detecting breast cancer in its early stages. When we catch breast cancer early, treatment is simpler, and the chances of avoiding heavy treatments or a mastectomy are much higher. Being informed about your risks and the power of early detection can make all the difference in surviving breast cancer.
As a breast health specialist, I cannot stress the importance of education and proactive health measures enough. Prevention starts with understanding the risks and taking action through screening.
About the author
Dr Justus Apffelstaedt is a former Associate Professor of Surgery and Head: Surgical Oncology Service, University of Stellenbosch. Dr Justus Apffelstaedt earned a Medical Degree and a Doctorate in Medicine in Germany, as well as an MMed and FCS(SA) in South Africa and an MBA from Bond University in Australia.
He has represented developing countries on the Breast Surgery International (BSI) council and is a founding member and first chairman of the Breast Interest Group of Southern Africa (BIGOSA).
He is a fellow and life member of the International Union Against Cancer (UICC) Fellows.
He is excellent at translating complex medical terminology into easily understood language and is a proponent of proactive breast health management through extensive dissemination of information to the general public.
His breast service is the only one in Africa to publish peer-reviewed data comparable to international breast practices in breast screening. He is also the author and co-author of several publications in peer-reviewed national and international journals on breast cancer screening and breast health issues.
His current interest and field of practice includes breast health. thyroid, parathyroid, and soft tissue tumours.
He has practices in Cape Town, South Africa, and Windhoek in Namibia.