Currently there is no national breast screening programme in South Africa. Whilst many women can undergo individual breast surveillance (mammogram and examination), the majority of women in this country do not have access to screening. Mass clinical breast screening programmes have been implemented with varying degrees of success, and two of the most common challenges to beset these programmes are that many women with a low risk of developing breast cancer have evaluations, and those with abnormality detected are not followed up.
Surgeons associated with Stellenbosch University (SU) are testing a new strategy that could make clinical breast cancer screening more accessible to women in South Africa. In a recent project, these experts utilized an international tool using an algorithm to assess a woman's risk for breast cancer. This ensures women at a higher risk are prioritized for evaluation.
“At the moment, only 8% of patients presenting to state clinics are diagnosed with early breast cancer (stage 1). The majority (60%) of breast cancer patients already have advanced cancer by the time they are diagnosed," says Dr Jenny Edge, a surgical specialist at SU's Faculty of Medicine and Health Sciences (FMHS) and Tygerberg Hospital. The more advanced a cancer is at diagnosis, the more difficult it is to treat.
Current screening methods for breast cancer include clinical breast examination by a skilled health professional, mammography, ultrasound, tomography (a specialized type of x-ray) and magnetic resonance imaging (MRI). All these methods require skilled health professionals and, in the case of imaging, can be quite expensive. These factors inhibit women from regular screening, and many only seek help once something is wrong. “Over 90% of breast cancer patients seen in the state present with a palpable breast mass. Ideally, they should be diagnosed as soon as the mass becomes palpable" Edge continues.
A team of researchers, led by Dr David Gorry, a surgical registrar at the FMHS and Tygerberg Hospital, recently ran a Risk Stratified Breast Screening project utilising the International Breast Cancer Interventions Study tool (IBIS). The tool uses an algorithm to estimate the likelihood of a woman developing breast cancer within 10 years of her current age. If the tool calculates a woman's risk to be greater than 1%, she is sent for clinical examination where she will either be cleared or sent for mammography if there are concerns. The tool has the potential to screen large populations of women as it rapidly assesses an individual's risk and identifies those who require further examination.
For the study, Gorry and team invited the nurses' corps at Tygerberg Hospital (consisting of well over 2 000 individuals) for breast cancer screening using the IBIS tool. The results, which will imminently be published in a scientific journal, showed that nurses who were exposed to breast cancer patients in the routine employment were more likely to come for breast screening.
The study was run as a feasibility study and, although many lessons were learnt, the use of risk stratification in a clinical breast screening programme proved to be workable.
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