Breasts: your health update

You're a woman; you have bits. You need to know how they work. This is not like the video machine that you can get someone else to programme. This is you, and it never hurts to have a little insider's insight into what can go wrong. Medical knowledge is constantly being updated.

No sooner do you know what HRT is than someone's saying it is dangerous. You book a mammogram, and next morning there's a story in the paper that says they're useless. We've tried to unpack the truth about some of the controversial issues relating to women's health, and give you a few alternative tools to handle the less salubrious aspects of peri-menopause.

Below we've compiled user-friendly, non-scary info on breast cancer and what all those terms mean. Just this once, we won't mind if you want to cut it out and keep it.

Inside your 36B
According to information from CANSA, breast and cervical cancer are the two most common cancers in women, after skin cancer, which is most common overall. Yet, for many women who are newly diagnosed with a suspect lump in the breast, the jargon of stage this and stage that, lymphomas and lesions is like a foreign language.

Here's a simplified guide we hope you never need:

A lump is found
You or your partner are more likely to find a lump in your breast than any test is simply because you're more likely to be touching it on a daily basis, and you know your breast. This accepted wisdom has caused international academic slanging matches, as some scientists say that mammograms aren't worth the expense and effort.

Yet it's indisputable that mammograms do a great job of detecting tiny clumps of dead cells (microcalcifications) that may signal the presence of breast cancer. How to decide then? On the one hand, a mammogram can't do you any harm, although admittedly there are more pleasant ways to spend a morning. On the other, they're not cheap (around R500 or more, depending on which hospital you go to).

Your medical aid may pay, and some encourage their members to have preventative care. The choice remains yours, but if you're approaching 50 and have risk factors (overweight, smoking, family history, early puberty or late menopause), you're probably not wasting time or money getting it done. 'It's still the gold standard of early breast cancer screening,' confirms Professor Justus Apffelstaedt, head of the Mamma Clinic in Cape Town.

Stage 0 – DCIS (ductal carcinoma in situ) with microcalcifications
There's nothing like a medical abbreviation followed by a really long scientific word to make us feel helpless, hopeless and out of control. But this is not that complicated. DCIS describes cells that look abnormal but are confined to the duct and haven't invaded the surrounding tissue at all. These may be as tiny as pinpricks – your partner is not going to feel them on the average Saturday night, which is where mammograms come in.

Treatment will probably be a lumpectomy (removal of the affected area) and possibly radiation to knock out any remaining abnormal cells. And while it is not known how many of these cases would have become invasive breast cancer if left alone, the prognosis is good for long-term remission after treatment. For all stages of breast cancer, there are different treatments and expectations depending on whether it's a slow- or fast-growing kind and how that type responds to the various treatments.

Stage 1 and 2 – Invasive ductal cancer
No longer staying obediently in the duct, the cancerous cells have invaded surrounding breast tissue, and perhaps the lymph nodes to a limited degree. It's called stage one if the tumour is two centimetres or less in size, or stage two if it's bigger.

Treatment will include a lumpectomy or perhaps mastectomy (removal of the whole breast) plus radiation. Depending on the case, your doctor may recommend chemotherapy before surgery to shrink the tumour, or after to kill off remaining abnormal cells. You may also be given tamoxifen, a hormonal treatment that reduces the risk of the cancer coming back. With stage-one cancer, over 95 percent of patients will be around to celebrate the 10-year all clear, and with stage-two cancer, 90 percent will live for at least 10 years.

Stage 3
Once the tumour extends to the skin or there are big lymph nodes in the armpit, it's considered stage three, even if the tumour is smaller than two centimetres in size. Treatment is the same as for stage one and two, and between 50 and 60 percent of women diagnosed at stage three will live the magic five years.

Stage 4
This is obviously the most serious stage, as it involves spreading of the cancer to other parts of the body. A new type of drug called aromatase inhibitors is used to treat advanced cancer in postmenopausal women, and, according to Professor Apffelstaedt, it has fewer side effects than tamoxifen. 'Aromatase inhibitors will shortly become the new standard in hormonal treatment of breast cancer,' he says.

Another, newer drug called herceptin is used only for a particular type of cancer that shows an excess of a structure called Her2 receptors on the cell surface.