Dense breast tissue signals higher risk for breast cancer
October 26, 2020
Specialist surgeon and breast disease specialist, Professor Carol-Ann Benn, established the Netcare Milpark Breast Care Centre of Excellence in association with Netcare in 2001.
Both men and women urged to check and screen for breast cancer regularly
People with higher density breast tissue face greater risk of breast cancer, although no one is immune to the risk of developing the disease. According to renowned specialist surgeon and breast disease specialist, Professor Carol-Ann Benn, almost two-thirds of women who are diagnosed with breast cancer have no significant risk factors, highlighting the importance of all women being vigilant.
“The most important point to remember is that breast cancer is neither ageist, racist nor sexist: breast cancer can happen to anyone,” says Professor Benn, who in association with Netcare founded the internationally accredited Netcare Milpark Breast Care Centre of Excellence in Johannesburg.
“Dense breast tissue is identified through a mammogram where more than three-quarters, or 75%, of the breast is composed of fibro glandular connective tissues and glands such as the milk ducts. This is considered an independent risk factor for breast cancer, and there is an additional concern due to the increased difficulty in detecting small lesions in dense breast tissue.
“The risk this represents is significant, some four to five times higher than for similarly aged women with less dense breast tissue. If your breast tissue is dense, additional breast cancer surveillance is therefore recommended, preferably with either breast MRIs or six-monthly ultrasounds,” Professor Benn says.
Breast cancer risk factors
“Various risk models aim to develop personalised screening programmes to help categorise patients based on their risk. This should, at least in theory, allow for higher risk women to be identified for closer monitoring and more imaging tests,” she explains.
“While there have been many tools developed in an attempt to quantify risk, none are regarded as being 100% accurate. It is therefore important that both women and men regularly go for radiology screening.”
She points out that not all risk factors are modifiable, which means while there are certain risks we may have some control over such as exercising or not smoking, there are other risks such as genetic factors that we are unable to change.
Preventative benefits of aerobic exercise
“It must be emphasised that there is no sure way to prevent breast cancer, as there are many factors involved that are beyond our control. This being said, regular aerobic exercise and maintaining your body mass index (BMI) under 25 are recommended, as obesity is associated with increased breast cancer risk.
“It has been estimated that exercise decreases the risk of developing breast cancer by approximately 42%. Exercising post diagnosis and treatment has also been shown to decrease the risk of recurrence. Studies seem to suggest that aerobic exercise of moderate intensity for about 45 minutes per day could be most beneficial.
“A healthy, balanced diet and exercise are both important ways of reducing some of our modifiable cancer risks, however checking your breasts regularly remains absolutely vital, as early detection promotes better outcomes should cancer be diagnosed,” Professor Benn says.
Alcohol and breast cancer risk
“The products that are released when alcohol breaks down in our bodies are toxic to cells. Alcohol is also broken down to ‘bad oestrogens’ and promotes an overall increase in oestrogens, which is often associated with breast cancer.
“Alcohol should also be considered as ‘empty calories’, meaning it has a high calorie content without contributing significant nutritional value. The weight gain that may result from this is most commonly abdominal obesity, which is linked to higher risk of cancer. Abdominal fat can also be considered ‘carcinogenic’ in the sense that it stimulates the production of hormones associated with increased cancer risks.
“There have been some interesting recent studies suggesting that people who drink alcohol may be able to counteract its damaging effects through moderate to significant exercise,” she adds.
Checking and screening for breast health
“No one can afford to be complacent about breast cancer, and regular screening and self-examination are essential to monitoring your breast health. Whoever you are, you could develop breast cancer.
“We are unfortunately seeing a notable increase in younger women developing breast cancer and it is important that awareness of the benefits of self-examination and screening from a young age is reinforced.
“In South Africa, where healthcare resources are constrained, women and men need to examine their breasts and know how to access healthcare facilities where they can be accessed. Ideally, screening should involve screening mammograms from the age of 40.”
The Netcare Milpark Breast Care Centre of Excellence works in conjunction with the Helen Joseph Hospital (HJH) breast centre to ensure that equivalent breast care is available irrespective of access to medical funding.
The centre follows a comprehensive approach to the management of breast conditions and diseases. Multi-disciplinary teams of healthcare professionals are involved in the diagnosis, clinical assessment, counselling, treatment including breast reconstruction, and patient support.
The doctors in the multi-disciplinary team are required to follow international guidelines when proposing treatment options. Many women treated at our unit, for example, benefit from endocrine manipulation therapy followed by cryosurgery, which freezes the tumour, rather than having surgery as the first line of treatment,” Professor Benn says.
The centre is also highly focused on community initiatives including awareness, education, and access to care for patients who do not have medical insurance.
“Awareness and self-examination are our most accessible preventative screening tools, and wherever possible these should be complemented with professional breast cancer screening. There are options when it comes to treatment, and these should always be carefully considered where any cause for concern is detected.”
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With Rare Disease Day on the 28th of February 2025, the Rare Diseases Access Initiative (RDAI) is driving an evolution of the country’s healthcare, through innovative strategies to better care for over 4.2million people living with an estimated 7000 rare diseases. “As our healthcare system faces significant changes in the years ahead, it is vital that we also advocate for people living with rare diseases in South Africa, especially those with limited healthcare access,” said Kelly du Plessis, CEO of Rare Diseases South Africa (RDSA), a member of RDAI. “As part of our ongoing research and awareness efforts, RDAI has conducted an initial analysis of the incidence and prevalence of rare diseases within the country.” This research will assist in improving access to healthcare, policy development, and patient advocacy, while giving critical insight into the challenges faced by patients. “According to research, some rare diseases affect fewer than 1 in a million people, while others, such as Down syndrome, cystic fibrosis, and haemophilia, have a more recognisable prevalence,” says Dr. Helen Malherbe, RDAI lead researcher on rare disease prevalence data. “Many conditions are undetected, underdiagnosed or misdiagnosed, with too many having no information available about them at all.” The RDAI was formed in 2019 to promote a more favourable environment for those impacted by rare diseases in South Africa. Participants include Ampath, the Board of Healthcare Funders (BHF), Discovery Health, Genetic Counsellors South Africa (SASHG), the Government Employees Medical Scheme (GEMS), Health Funders Association (HFA), Medihelp, Medscheme, North-West University (NWU), Rare Diseases South Africa (RDSA), the South African Medical Association (SAMA) and The South African Medical Technology Industry Association (SAMED). The Council for Medical Schemes (CMS) participates as an observer. In the same year, Rare Disease International signed a memorandum of understanding with the World Health Organisation leading to an international rare disease policy framework. In 2021, the United Nations General Assembly moved to adopt a resolution recognising 300 million people living with rare diseases worldwide. “A general lack of awareness and delayed diagnosis remain major hurdles for those affected by rare diseases. Policymakers and healthcare stakeholders need to prioritise access to treatment, diagnosis, and support for rare disease patients,” says Bada Pharasi, CEO of IPASA, “Through this initiative, working collaboratively with stakeholders at every level of the healthcare supply chain, we can bring real and meaningful change to those affected, including family members and care givers, through smart and efficient strategies.” The globally agreed definition of a rare disease is any medical condition with a specific pattern of clinical signs, symptoms, and findings that affects fewer than or equal to 1 in 2000 persons in a population. “Most are genetic, and some are inherited and passed down in families,” Malherbe says. “Some affect only the patient’s genetic recipe, while others may be acquired during life due to infection, trauma, or environmental effects. For many, the cause is still unknown. “These conditions mainly affect children, as they are largely incurable and many are life-threatening. Some require specialised and co-ordinated care, some have limited and expensive treatment options, while others have no information or effective treatments at all,” she adds. The RDAI is calling for a patient-centred care model built on equitable access, transparency and efficiency. Naturally, this model calls for the open participation of patients, the healthcare industry, health professionals, and the Government. “The most critical elements are robust diagnosis standards, improved access to treatment, data collection and management, co-ordination of care, measurement of outcomes and ongoing collaborative research,” du Plessis says. “We need to establish rare disease advisory committees, map gaps and opportunities, establish system requirements, create a roadmap and plan a phased implementation with clear timelines.” The RDAI states that these policy development steps would be a start in quantifying the disease burden and defining standards of care. This would be followed by building and strengthening the capacity to facilitate appropriate diagnosis, treatment, continuity and data monitoring. Thoneshan Naidoo, Chief Executive Officer of the Health Funders Association noted that, “We appreciate the unique opportunity provided by RDAI which enables stakeholders across the industry to work together and identify strategies that improve equitable access to the appropriate diagnosis, treatment and healthcare services for rare disease patients, in an affordable and sustainable manner, taking account of the other pressing needs across the healthcare system.” “True innovation in healthcare is only possible through partnerships and joint advocacy efforts that raise awareness and improve access to treatment. Our long-term goal is the development of a rare diseases policy framework and guidelines for coordinated care,” says Pharasi. “Our members are united in the commitment to unlocking improved patient outcomes and improving access to services and robust health needs assessment facilities.” he concludes. About RDAI The Rare Diseases Access Initiative (RDAI) is dedicated to advocating for improved healthcare access, policy development, and patient support for those affected by rare diseases in South Africa. The initiative brings together key healthcare stakeholders, including pharmaceutical associations, funders, genetic specialists, and patient advocacy groups, to drive impactful change. About RDSA Founded in 2013, Rare Diseases South Africa (RDSA) is a non-profit organisation advocating to ensure that people living with rare diseases and congenital disorders experience greater recognition, support, improved health service and better overall quality of life. Started out of personal need following the diagnosis of organisation founder, Kelly du Plessis' son, it became evident that there was a lack of awareness and support for rare diseases in general in South Africa. About IPASA The Innovative Pharmaceutical Association South Africa (IPASA) is a voluntary trade association representing 24 leading pharmaceutical companies committed to research, development, and innovation. Our mission is to drive healthcare advancement by advocating for policies that improve patient access to safe, high-quality, and affordable medicines.
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