Kudos to Cape Town doctor Martinique Stilwell, for tackling the controversial and sticky subject of breast cancer risk in last week’s Mail & Guardian.

Her article is a breath of fresh air – and not least because she reminds us, here in South Africa, that very often less can be more. South African women are still very much in need of clinic services near to their homes where they can talk to, and be examined by, well trained, caring community nurses.

Meanwhile, the debate about how much screening should be offered to women under 50 – aside from those with particularly high risk due to BRCA mutations – rages on.

Here at Bay Breast Care we don’t recommend that you postpone mammogram screening until over 50, especially if you have “dense” breasts – firm breasts are always popular, but the density of breast tissue vs fatty tissue makes this breast more difficult to visualise on a mammogram. Patients at high risk may need additional ultrasound screening and perhaps even Magnetic Resonance Imagery (MRI).

Radiologist Dr Sandra Basson, who trained in Germany, says that high-risk women there have scans on a six monthly basis, alternating MRI scanning with mammography to keep the mammo exposure to a minumum whilst still providing good and frequent screening that would be able to catch even a fast growing cancer in an early stage. The good news is that for Medical Aid patients, there is more acceptance these days of other methods, including the notoriously expensive MRI procedure, and this means a better service for those who need it. On the other hand, if your risk is average, keep things simple – you neither need nor want to have expensive, uncomfortable procedures that don’t add to either your peace of mind or your span of healthy life.

Martinique Stilwell’s article is a timely reminder to women to become aware of our true breast cancer risk. Those who over-estimate their risk experience needless anxiety whilst those who under-estimate can be too blasé about the need for regular screening and a healthy lifestyle.

To calculate your risk, use a breast cancer risk calculator. The first part gives you the basic risk, the second part refines that with a few more details on lifestyle.

A word of warning: for some women, the calculations aren’t accurate. The risk will come out too low if you have a BRCA mutation, and it may be too high for women who consume large amounts of phyto-oestrogens on a regular basis – for example, soya beans and soy products. More research is needed on that. However for most of us the calculator will work well and give a much better result than a pure guess based on how we are feeling at the moment!