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21 October 2021 | Story André Damons | Photo Supplied
Prof Alicia Sherriff, head of the Department of Oncology at the University of the Free State (UFS), says Breast Cancer Awareness Month is important as continued awareness-making of the general population on the risks and signs of breast cancer are essential to ensure early diagnoses and improve the possibility of long-term survival.

Breast cancer among South African women is increasing and is one of the most common cancers among women in South Africa and at Universitas Academic Complex in the Free State, is only second to cervical cancer. 

Prof Alicia Sherriff, head of the Department of Oncology at the University of the Free State (UFS), says 1.8% of breast cancer diagnoses in South Africa are made in men. At Universitas Annex, they treat on average 350-400 new breast cancer patients annually. They have not seen an increase in cancer cases in the past two years; Prof Sherriff says the COVID-19 pandemic definitely had an impact on patients accessing health care and patient referrals.

It is for this reason that Breast Cancer Awareness Month is so important since continued awareness-making of the general population on the risks and signs of breast cancer are essential to ensure early diagnoses and improve the possibility of long-term survival. Early detection is of the utmost importance, since breast cancer is treatable and curable. Awareness is critically important in all age groups and communities. 

Globally, female breast cancer has now surpassed lung cancer as the leading cause of cancer incidence in 2020, with an estimated 2.3 million new cases, representing 11.7% of all cancer cases. 

This is a according to an article in the American Cancer Society which also states that breast cancer accounts for one in four cancer cases in women and is the cause of deaths for one in six patients. It is the fifth leading cause of cancer mortality worldwide, with 685,000 deaths.

According to Prof Sherriff, breast cancer is the abnormal growth of breast tissue. The cause is unknown in most patients but there are some factors that increase your risk of developing breast cancer; for example familial genetic syndromes, smoking and excessive alcohol use and obesity. 

“It is important to note that a person can develop breast cancer even if there is no family history or any of the above-mentioned risk factors. The risk of developing breast cancer increases with age. That said, women as young as 18 years of age have been diagnosed with breast cancer. Self-examination is important so women can be familiar with their breasts and any change will be picked up early. When you self-examine always do it at the same time of the menstrual cycle to experience an equal impact of the hormonal cycle in the female body,” says Prof Sherriff. 

Breast cancer in young women

Less than 2% of patients diagnosed with breast cancer are younger than 34years of age, but it is important to realise that it can happen and if it does arise in the younger age group it tends to be more aggressive and related to genetic mutation.

“The young breast tends to be very dense and therefore more difficult to interpret on a mammogram. For females younger than 40-45 years or women with dense breast tissue, breast sonar is advised to evaluate the breast and sometimes an MRI (magnetic resonance imaging) might be requested, but this is not standard practice. 

“Reproductive and hormonal risk factors to consider are: Early age at menarche, later age at menopause, advanced age at first birth, fewer number of children, less breastfeeding, menopausal hormone therapy, oral contraceptives. These factors all increase the duration of the female breast being exposed to higher levels of estrogen. Certain lifestyle risk factors (alcohol intake, excess body weight, physical inactivity) also increase the levels of hormonal exposure,” says Prof Sherriff. 

Breast cancer rising 

According to an article in the American Cancer Society, incidence rates of breast cancer are rising fast in transitioning countries in South America, Africa, and Asia as well as in high-income Asian countries (Japan and the Republic of Korea), where rates are historically low. 

Dramatic changes in lifestyle, sociocultural, and built environments brought about by growing economies and an increase in the proportion of women in the industrial workforce have had an impact on the prevalence of breast cancer risk factors which include the postponement of childbearing and having fewer children, greater levels of excess body weight and physical inactivity, and have resulted in a convergence toward the risk factor profile of Western countries and narrowing international gaps in breast cancer morbidity.

“Some of the most rapid increases are occurring in sub-Saharan Africa. Between the mid-1990s and mid-2010s, incidence rates increased by more than 5% a year in Malawi (Blantyre), Nigeria (Ibadan), the Seychelles, and 3% to 4% a year in South Africa (Eastern Cape) and Zimbabwe (Harare). Mortality rates in sub-Saharan regions have increased simultaneously and rank now among the world’s highest, reflecting weak health infrastructure and subsequently poor survival outcomes. 

“The five-year age-standardised relative survival in 12 sub-Saharan African countries was 66% for cases diagnosed during 2008 through 2015, sharply contrasting with 85% to 90% for cases diagnosed in high-income countries during 2010 through 2014. The country-specific estimate was as low as 12% in Uganda (Kyadondo) and 20% to 60% in South Africa (Eastern Cape), Kenya (Eldoret), and Zimbabwe (Harare),47% comparable to 55% in the US state of Connecticut and 57% in Norway during the late 1940s,48 3 decades before the introduction of mammography screening and modern therapies,” the article reads.

Low survival rates in sub-Saharan Africa are largely attributable to late-stage presentation. According to a report summarising 83 studies across 17 sub-Saharan African countries, 77% of all stage cases were stage III/IV at diagnosis. Because organised, population-based mammography screening programs may not be cost effective or feasible in low-resource settings, efforts to promote early detection through improved breast cancer awareness and clinical breast examination by skilled health providers, followed by timely and appropriate treatment, are essential components to improving survival.

Physical symptoms and treatments 

Prof Sherriff says screening (checking for disease when there are no symptoms) for breast cancer in the normal population should start at age 40-45, where possible and yearly mammogram with sonar would be preferred. If there is a strong family history with the diagnoses of breast cancer earlier screening should start five to 10 years prior to first diagnoses. Self examination is an essential component of screening. 

The physical symptoms you can experience that might be indicative of breast cancer are:
- A lump in the breast which does not have to be painful 
- Changes of the skin of the breast referring to dimpling, the colour, or texture
- Changes in the appearance of the nipple (areola)
- A clear or bloody discharge from the nipple

The treatment for breast cancer consists of a combination of surgery, chemotherapy, radiation therapy and hormonal therapy. The treatment is individualised based on patient and cancer factors. Some patients will need all of the above whilst others may not. It is essential that the decision on the appropriate management is made in collaboration with the patient as part of the multidisciplinary team of specialists and allied health care workers.

News Archive

Is milk really so well-known, asks UFS’s Prof. Osthoff
2011-03-17

Prof. Garry Osthoff
Photo: Stephen Collett

Prof. Garry Osthoff opened a whole new world of milk to the audience in his inaugural lecture, Milk: the well-known (?) food, in our Department of Microbial, Biochemical and Food Biotechnology of the Faculty of Natural and Agricultural Sciences.

Prof. Osthoff has done his research in protein chemistry, immuno-chemistry and enzymology at the Council for Scientific and Industrial Research (CSIR) in Pretoria and post-doctoral research at the Bowman-Grey School of Medicine, North Carolina, USA. That was instrumental in establishing food chemistry at the university.
 
He is involved in chemical aspects of food, with a focus on dairy science and technology. He is also involved in the research of cheese processing as well as milk evolution and concentrated on milk evolution in his lecture. Knowledge of milk from dairy animals alone does not provide all the explanations of milk as food.
 
Some aspects he highlighted in his lecture were that milk is the first food to be utilised by young mammals and that it is custom-designed for each species. “However, mankind is an opportunist and has found ways of easy access to food by the practice of agriculture, where plants as well as animals were employed or rather exploited,” he said.
 
The cow is the best-known milk producer, but environmental conditions forced man to select other animals. In spite of breeding selection, cattle seem not to have adapted to the most extreme conditions such as high altitudes with sub-freezing temperatures, deserts and marshes.
 
Prof. Osthoff said the consumption of the milk as an adult is not natural; neither is the consumption of milk across species. This practice of mankind may often have consequences, when signs of malnutrition or diseases are noticed. Two common problems are an allergy to milk and lactose intolerance.
 
Allergies are normally the result of an immune response of the consumer to the foreign proteins found in the milk. In some cases it might help to switch from one milk source to another, such as switching from cow’s milk to goat’s milk.
 
Prof. Osthoff said lactose intolerance – the inability of adult humans to digest lactose, the milk sugar – is natural, as adults lose that ability to digest lactose. The symptoms of the condition are stomach cramps and diarrhoea. This problem is mainly found in the warmer climates of the world. This could be an indication of early passive development of dairy technology. In these regions milk could not be stored in its fresh form, but in a fermented form, in which case the lactose was pre-digested by micro-organisms, and the human population never adapted to digesting lactose in adulthood.
 
According to Prof. Osthoff, it is basically the lactose in milk that has spurred dairy technology. Its fermentation has resulted in the development of yoghurts and all the cheeses that we know. In turn, the intolerance to lactose has spurred a further technological solution: lactose-free milk is currently produced by pre-digestion of lactose with enzymes.
 
It was realised that the milks and products from different species differed in quality aspects such as keeping properties and taste. It was also realised that the nutritional properties differed as well as their effects on health. One example is the mentioned allergy against cow’s milk proteins, which may be solved by the consumption of goat’s milk. The nutritional benefits and technological processing of milk aroused an interest in more information, and it was realised that the information gained from human milk and that of the few domesticated species do not provide a complete explanation of the properties of milk as food. Of the 250 species of milk which have been studied, only the milk of humans and a few domesticated dairy animals has been studied in detail.

Media Release
15 March 2011
Issued by: Lacea Loader
Director: Strategic Communication
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: news@ufs.ac.za

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