We’ve been told, since we were teens, that it’s important to check our boobs every month. We’re meant to look for changes in shape, size, dimpling or texture. But women’s bodies change constantly – and so do our boobs. Here, Dr Peter Schoub, Chair of the Breast Imaging Society of South Africa (BISSA), gives us straight answers to our breast self-screening questions.
Meet the expert: Dr Peter Schoub is the Managing Director and Diagnostic Radiologist at Parklane Radiology, and is the Chair of the Breast Imaging Society of South Africa (BISSA).
Breast Cancer Is On The Rise, Especially For Young Women
We are living in a new world. Once upon a time, you could leave your house with nothing but a R20 note and vibes. There was also a time when breast cancer affected women aged 50 and up. But like the value of that R20 note, things have changed. Data from South African research shows that breast cancer among young women is on the rise, reflecting global trends. Per the Cancer Association of South Africa (CANSA), breast cancer is the most common cancer among women in South Africa, accounting for 23% of all cancers.
The National Cancer Registry indicates that the frequency with which breast cancer is diagnosed increased from 2022 to 2024 for multiple age groups of women. The biggest increase was in the 50-54 age group (70-point increase) and in women aged 40 to 44 (50-point increase). However, the data show increases for other age groups, too, notably for women aged 25-29 (8-point increase) and 35-39 (17-point increase). “I think what’s important is that all women, even the young ones in their twenties, need to be aware that they can get breast cancer,” says Dr Schoub. Clearly, breast cancer among women in South Africa is a serious deal.
Why are younger women being diagnosed with breast cancer in South Africa?
It’s important to define what we mean by “young”. The definition can vary, but generally, experts say a “young” case would be any woman who is 40 or under that age. The reasons for the increase in numbers can be down to different factors. First, there is much we don’t know about the South African setting. Data keeping is simply less robust than in the Northern Hemisphere.
The hormonal factor
One significant risk factor that is not discussed enough is our exposure to our own hormones, and how that can increase your risk of getting breast cancer at any age. Basically, per this paper: “A woman has an increased risk of breast cancer if her lifelong oestrogen exposure is increased due to an early menarche (menstruation), a late menopause, and/or an absence of childbearing.”
The why: all these events, whether delayed or just cancelled (like deciding not to have kids of your own), mean that a woman’s lifetime exposure to oestrogen and progesterone is increased. For example, in childbirth and breastfeeding, women have a pause in periods, which decreases the levels of oestrogen and progesterone, thus decreasing the risk of cells in the breasts becoming cancerous. Also, scientists note an increase in young girls starting their periods sooner, which means more young women have longer exposure to sex hormones.
The same is true for women who do not give birth before the age of 30, or not at all. A 2012 meta-analysis that studied women aged 40 to 49 years found that those who used oral contraceptives, did not give birth, or who gave birth after turning 30 were associated with a “1 to 1.5 fold increased risk.”
Another reason? Women just don’t check.
Low levels of self-screening (as low as 5% in SA!), make a big impact on breast cancer rates overall. A small survey of 403 women found that while 93% of women said they know how to check their own breasts, only 27% do it monthly. That’s a problem, since experts agree that the best way to keep breast cancer rates down is to simply look for it regularly. Early detection is key.
While it’s still true that women only need to start getting mammograms once they turn 40, self-screening is a necessary and proactive way to stay healthy. By knowing your breasts well, you can track changes and know when to worry. This makes it much more likely that you’ll catch an abnormality early on – when the prognosis is best. “This is why routine self-examinations and clinical breast checks by a healthcare professional at least once a year are essential,” explains Dr Schoub. “Any abnormality, regardless of age or family history, should be evaluated by a medical professional immediately.”
READ MORE: What To Know About Breast Cancer As A Young Woman
Why Breast Self-Screening Could Save Your Life
BISSA, a sub-speciality group of the Radiological Society of South Africa, warns that breast cancers diagnosed among young women are more likely to be aggressive. These cancers often present with larger tumours and more advanced stages of the disease at diagnosis. “Even though it’s much less common when you’re young [to get breast cancer at all], it can happen,” says Dr Schoub. It’s for this reason that he strongly encourages all women to “be aware of how your breasts feel and look, and if anything feels different to you or you’re worried, you need to get it checked out, even if you are young.”
Your breast self-screening questions, answered
If you’ve done your own self-screening and know what’s good – excellent! If not, here’s some handy info about what a healthy breast actually feels like, in straight, no-BS terms.
How Do I Know If My Boobs Are Healthy?
First: some essential anatomy info. So there are two main components of breast tissue: fibroglandular and fatty. “Fibroglandular tissue are the glands and the ducts that produce milk and the fibrous tissue that holds it together,” says Dr Schoub. “And every woman has a different proportion of that fibroglandular tissue to fat. It’s largely hereditary, but it also depends on your build and your breast size.”
“Women who have denser breast tissue, in other words, a higher proportion of the fibroglandular tissue, often the breasts feel lumpier than if it’s just fatty tissue,” he continues. That said, of course it’s tough to know if your boobs are fatty or fibrous. “The reality is, a lot of women find self-examination very difficult and very stressful, because it’s not easy to tell what is normal breast lumpiness, as opposed to a developing cancer.” His rec? Get to know your boobs – right now. Pick a time of the month – let’s say right after your period ends (no tenderness) – and cop a feel. Repeat monthly, at the same time. After a while, you’ll develop a reference of your unique “normal”.
Tip – do your self-exam at the same time every month
Add to calendar. “It’s always a good idea to get to know how your breasts feel and to try and examine them yourselves once a month, preferably the same time of month.” That way, when something strange happens, you’ll know – because you’ll have a healthy baseline.
Why the same time? Boobs change. “Breast tissue is often very lumpy, and it’s different in different women, depending on the composition of their breasts. If you put on weight or lose weight, the breasts might feel different. During your period, the breast tissue might feel lumpier and more tender,” explains Dr Schoub.
How *Exactly* Do I Do A Self-Exam On My Breasts?
Dr Schoub says you should approach your check with a system in place. That way, you tick off that you’ve checked every section – the nipple, under the arms, behind the nipple, under the breast. And position matters. One arm up, the other arm checking. If you lie down, do it again – that same way – next month. Consistency matters.
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Tip – look at your tatas, too
Having visual references also makes a difference in early detection of breast cancer, says Dr Schoub. “Stand in front of a mirror; you can start with your arms by your sides and then put your hands behind your head. Those two positions will help you to pick up if there’s any asymmetry, any difference between the breasts.”
He also recommends:
- Look at the skin. Is there any dimpling or pulling in of the skin?
- Look at the nipple. Does the nipple on one side look different to the other side? Maybe it’s also pulling in or becoming inverted.
- Is the surface of the nipple is changing? If you see like a dry, peeling rash or redness, that also needs to be checked out.
How Do I Know What A Lump Is?
“It does depend, to some degree, on the size and position of the lump,” says Dr Schoub. Bigger lumps are way easier to feel and find. But small lumps can be difficult to root out, especially if they’re situated deeper into the breast tissue. Some lumps are close to the skin, too, says Dr Schoub. “A small lump feels like a little pea under the skin,” he adds. “A larger lump will feel like a grape or even a lemon. Any time that you feel a lump, it needs to be checked out.”
Feel out your tissue
To check for small lumps, Dr Schoub says to use the tips of your fingers, maybe the index and middle, and run them over your breasts. This will identify any skin-deep abnormalities.
What Do I Do If I Feel A Lump?
Rule number one: do not panic. It may be worth checking out immediately, but there may be times when you’re just not sure, says Dr Schoub. In that case, you (not must!) give it a few weeks and see if it disappears or thickens. If it goes away, it could have been a hormonal change. “If it doesn’t disappear or you’re still not sure, it’s always better to get it checked out,” he says.
Who does breast exams in South Africa?
If you’re not yet 40 and also don’t feel comfortable checking alone, there are professionals. A nurse can do it, along with a GP or gynaecologist – these last two options are likely better because they do it more often.
Frequency is important, says Dr Schoub. “You need to ask someone who is confident in examining breasts, has some experience in examining breasts and knows what they’re feeling for.” Also, try go to someone – and stick to that person. “The whole point is that having a once-off examination, whether it’s a physical exam or even a mammogram, really is not very helpful. Ideally, ask someone who examines you on a regular basis.”
Note: a clinical breast exam is not the same as a mammogram (eligible once you turn 40) or a breast ultrasound. Those costs are higher and specialised.
Where to go to get a breast exam:
- CANSA offers clinical breast exams at facilities nationwide, costing R150. Booking is essential.
- Clicks clinics offer breast exams at various locations.
- PinkDrive has a mobile unit that offers screenings. Check their website to see the schedule.
- Dis-Chem offers screenings and sometimes, promotional bundle exams, such as a combined bundle consisting of a Pap Smear, Breast Exam, and HPV Rapid Test. Prices vary.
- Breast imaging centres specialise in breast exams, mammograms and ultrasounds. Medical aid may or may not cover these, best to check.
- Public clinics are able to perform clinical breast exams. This service is free.
Source: https://www.womenshealthsa.co.za/health/feed
