Early detection increases chances of surviving breast cancer
The Head of the Breast Unit at the Dr George Mukhari Academic Hospital (DGMAH), Professor Dikeledi Mokone, reiterates that early diagnosis of breast cancer increases chances of survival.
Mokone is a general surgeon with interest in breast disease (breast surgeon). She was appointed as the Head of the Breast Unit at DGMAH in 2007. Although she oversees the breast oncology unit, most of her patients are of benign diseases.
“We focus more on breast cancer because it is one of the leading causes of death. Early diagnosis of breast cancer increases chances of survival,” she explained.
Regardless of continuous awareness campaigns about the disease, Mokone said a lot of breast cancer patients still wait until the disease has advanced before getting medical help.
“People tend to wait until it is too late and when we ask why they waited so long, they say it was not painful. Breast cancer is not painful in its initial stages. It is rare that a patient will experience pain in its early stages,” she said.
She said although breast cancer is mainly a disease that affects women, men also get it although it is rare.
“It is important for males who have family members who have been diagnosed with breast cancer to start self-examining their breasts and consult a doctor or clinic if they suspect any signs. The symptoms to look out for are the same for both genders,” she explained.
Breast cancer signs
She said breast cancer presents mostly as a lump in the breast, but in rare cases it presents as a lump in the armpit, and the lump grows and becomes hard. It can also present with a nipple discharge, swelling of the breast, changes in skin texture, inflammation of the breast, among other signs.
She added that every woman must examine her breasts at least once a month by looking at their breasts in a mirror for any changes in skin texture, redness or shape, then feel for lumps or changes in the underarm and breast area using the pads of their fingers in a circular pattern with varying pressure and finally, squeeze the nipple to check for discharge.
Once a patient has been diagnosed with cancer, their case is investigated further to determine how far the cancer has progressed.
One-stop shop
The breast unit at DGMAH is different from all other hospitals in the country because it is headed by general surgeons.
Unlike other hospitals where breast cancer patients are diagnosed and investigated by general surgeons, have their cases discussed by a multidisciplinary team for treatment, referred to a medical oncologist for chemotherapy administration and get referred for surgery, at DGMAH, Mokone and her team see the breast cancer patients through the whole process.
“The only thing that we do not do is radiotherapy, but we refer patients who need it to Steve Biko Academic Hospital,” she said.
The breast unit has two clinics which operate on Tuesdays and Thursdays. The team sees between 5 000 and 7 000 patients per year.
Although most of her patients are of benign disease, the unit receives about 165 to 170 newly diagnosed breast cancer patients per year who visit the clinic more than once because their cases must be investigated and treatment must start right away.
After investigations, some of the patients are referred to surgery while the majority start chemotherapy. Those who are on chemotherapy must go for six or eight cycles of the therapy every four or six weeks.
“We do not discharge a patient with breast cancer because we must keep following up with the patient for the first two years, on a three to six months basis after treating them. After the first two years, we follow up with the patient annually,” she added.
A concerning trend
Mokone is mostly concerned that there seems to be an increasing number of young African breast cancer patients, and this is not exclusive to South Africa but a global challenge. Although she could not provide statistics, this is a worrying trend.
“Every type of cancer in young people is very aggressive and, in most cases, young patients tend to present cases of advanced cancer. Another challenge is dealing with patients who do not respond well to chemotherapy. Seeing the health status of a patient deteriorating affects us as professionals and it takes a toll on us, because at the end of the day we want people to be well,” she said.
As the head of the unit, Mokone is primarily responsible for overseeing and supervising all activities at the breast clinic, including performing surgery on patients. Her team comprises four surgeons, including herself, two interns, two oncology nurses, one professional nurse and two assistant nurses.
She leads meetings attended by multidisciplinary teams alongside the medical oncologist to discuss breast cancer cases.
She also lectures undergraduate and post-graduate students at Sefako Makgatho Health Sciences University (SMU), supervises their research and occasionally chairs and delivers presentations during academic meetings, together with heads of other units.
Breaking barriers
Mokone completed her undergraduate studies and went to specialise as a general surgeon at SMU, where she further trained as a sub-specialist breast surgeon.
Her research interests are in breast pathology, particularly, as it affects the indigent population of South Africa. In 2022, Mokone was announced as the first African woman, to become a professor of Surgery in South Africa.
“I do not have a PhD like other professors. I became a professor by promotion through the work that I have been doing, including in supervising students, chairing high level meetings, attending congresses, organising, participating in outreach programmes and being an examiner for post-graduate students, among other things,” she explained.
“It is a humbling achievement because I believe everything that happens is due to God. I have been looking forward to doing my PhD although time is not on my side because I am turning 65 in November,” she said.
Although she has achieved a lot throughout her career, seeing patients survive breast cancer remains her biggest achievement.
“Survival in breast cancer is poorer, but we have a few patients who survive until 15 years later since their first diagnosis and this gives us hope as professionals”.
Academically, seeing her students graduate warms her heart.