Breast cancer continues to kill many women in South Africa and across the globe.
Breast cancer is not one disease. There are different types and subtypes of the disease that are referred to as breast cancer. The treatment you receive for your breast cancer may be quite different from the other treatment other people you meet have.
The death toll on this disease continues to grow with many women dying due to late diagnosis.
The World Health Organization recently named cancer a global health pandemic, second only to Covid-19. Local breast cancer statistics are testament to that. According to the Cancer Association of South Africa, breast cancer accounts for over 27% of all new cancer cases of women in sub-Saharan Africa.
According to Specialist surgeon, founder of multi-disciplinary breast health centre, Apffelstaedt, Hoosain & Associates Dr Justus Apffelstaedt say these deaths are often due to late diagnosis especially when it comes to rare forms of breast cancer.
Dr Appfelstaedt says that is because these types of cancers require a certain level of medical expertise to be detected.
“Early detection and treatment of breast cancer is crucial with all forms of breast cancers. It is even more important with rare forms of breast cancers that require a certain level of expertise to be detected. For example, inflammatory breast cancer and Paget’s disease of the nipple often escape mammographic and ultrasound detection but are obvious to the skilled and experienced examiner.
Inflammatory breast cancer is a very aggressive cancer that progresses rapidly in a matter of weeks or months, says the Dr Apffelstaedt while Paget breast cancer of the nipple is the manifestation of a very slow-growing, indolent breast cancer which can take months and even years to develop.
Inflammatory breast cancer
This type of breast cancer which was recorded over 100 years ago is considered a very rare breast cancer.
Dr Apffelstaedt says only about 1-2 % of breast cancers diagnosed at his practice are true inflammatory breast cancers. It is often only detectable on mammography late in the course of the disease when the chance for cure is minimal.
“This can be a rash that comes and goes but is localised to the skin on the breast area. With these subtle clinical signs, it is often mistaken for an intercurrent infection, treated as such and missed; the diagnosis is therefore often delayed for crucial months. However, the clinical picture is very distinctive to an experienced doctor with a special interest in breast health who will recognise it with one glance,” says Dr Apffelstaedt.
Paget’s disease of the nipple
According to Dr Apffelstaedt, this type of breast cancer causes little to no pain and grows at a very slow pace, which is why the diagnosis is often missed, sometimes even for years. “It so rare that only 1% of breast cancers diagnosed at my practice manifest as Paget’s disease of the nipple,” he says.
Aerosion of the nipple that very slowly enlarges and is present only on one nipple is usually a sign of Paget’s disease of the nipple. There is no redness or other skin discolouration associated with this breast cancer.
“Again, the clinical picture of Paget’s disease of the nipple is very distinctive and an experienced doctor with a special interest in breast health will recognise it instantly. For diagnosis, a biopsy of the nipple can reveal the cancer in its early stages. While mammography may show signs of an early stage, non-invasive cancer, often it is not helpful,” says Dr Apffelstaedt.
“We all know that screening saves lives, but in cases of rare forms of breast cancer, mammography is not enough and a thorough physical examination by a seasoned practitioner with an interest in breast health can be lifesaving as these cancers are easily missed.” concludes Apffelstaedt.
