When last did you test for these three Big-Cs?
Drickus Maartens • July 9, 2020
Cervical, breast and prostate cancers can be treated, especially when diagnosed early
Cervical, breast and prostate cancer are among the more common types of cancer and are increasingly affecting younger people in South Africa. Many younger people still have the misconception that only older people get cancer, whereas these days we are seeing increasing numbers of individuals in their 30s and early 40s being affected, oncologist Dr Karen Motilall advises.
“I cannot emphasise enough that early detection can make an enormous difference and that many cancers are now curable if they are detected early, with various treatment options we can explore,” says Dr Motilall, a specialist clinical and radiation oncologist who practises at Netcare
Clinton, Netcare Union and Netcare Mulbarton hospitals, south of Johannesburg.
“While there are certain warning signs that may indicate the presence of cancer, by the time symptoms appear, the cancer may have already started to spread, which can make treatment more difficult. It is therefore important to reduce our risk factors where possible, and get into the routine of having regular check-ups and encouraging our loved ones to do the same.”
“Treatment may involve surgery, chemotherapy, radiation therapy including Gamma Knife radiosurgery, or any combination of these options, depending on the type of cancer, stage of cancer, the individual’s age and overall health, as well as their personal choice. We explore the options with each person to explain the benefits, side effects and potential risks, so that the individual has the information they need to make an informed decision about their treatment in consultation with their treating oncologist,” she notes.
Radiation therapy involves the use of high-energy rays, which damage the DNA in cells to either kill the cancer cells or stop new cancer cells from forming. While radiation can cause some damage to healthy cells in the area around the cancerous tumour or lesion, the advanced technology that we use today at Netcare oncology centres are highly targeted to the cancerous cells to minimise damage to healthy tissue.
Dr Motilall explains that radiation therapy can be administered either internally or externally. “External radiation therapy involves the person lying on a treatment table under the radiation machine, and the therapy is delivered to the specific area of the body where the cancer is located. The rest of the body is shielded from the radiation to prevent unnecessary exposure.”
Netcare Clinton Hospital’s oncology centre offers external radiation therapy through external beam radiation therapy, intensity modulated radiotherapy (IMRT) and image guided radiation therapy (IGRT). The different types of radiation therapy refer to the method in which the radiation is delivered to the tumour or lesion. The radiation oncologist, medical physicist and radiation therapist work together in a multi-disciplinary team to determine which type of radiation would be the most appropriate treatment option for each individual.
“Internal radiation or brachytherapy places radioactive material inside the body either directly on the tumour or near it. Internal radiation therapy has applications for cervical, prostate, perianal, breast, lung, head and neck cancers. Prostate brachytherapy is available at Netcare Union and Netcare Mulbarton hospitals,” Dr Motilall explains.
Multi-disciplinary teams of healthcare professionals at Netcare Clinton Hospital’s oncology centre are involved in the diagnosis, clinical assessment, counselling, treatment and psychosocial support. The centre offers surgery, radiation and chemotherapy, and provides the specialised care required for paediatric oncology patients.
Netcare furthermore has a unique service for patients namely navigators, who assist patients in coordinating their care to ensure a smooth transition from one phase of treatment to the next. These specially trained nurses serve as the point of communication between the patient and the various medical and allied healthcare professionals who are involved in their treatment.
Dr Cindy Aitton, head of Netcare’s Cancer Care Division, says Netcare embraces a holistic approach to cancer treatment that emphasises the unique requirements of each individual.
“We strive to provide each person with all-round support, while remaining respectful of the deeply personal journey of each and every person who has been diagnosed with and is undergoing treatment for cancer. We recognise that every person will have their own way of coping, and our approach is to offer not only world-class clinical treatments but also caring, professional guidance that is empathetic to patients’ individual needs,” she concludes.
Symptoms, risks and testing for three common cancers:
Cervical cancer
Symptoms that may be associated with cervical cancer include unexplained weight loss, abnormal vaginal bleeding such as between menstrual periods or after sexual intercourse, persistent pelvic pain or lower back pain, and swelling in one leg.
Increased risk factors include smoking, human immunodeficiency virus (HIV), human papillomavirus (HPV), a promiscuous male sexual partner or having many sexual partners and sex at a young age, among others.
“While the HPV vaccine has helped to protect women from certain strains associated with cervical cancer, it is important to note that the vaccine does not provide full protection and girls who have had the HPV vaccine should still have regular PAP screenings,” Dr Motilall says.
There are a number of options for treating dysplasia, which means there are abnormal and potentially pre-cancerous cells present, and it is often possible to prevent the development of cervical cancer if the condition is detected at this early stage.
Breast cancer
A lump or swelling in the breast, changes to the appearance or texture of the skin on the breast or nipple, nipple discharge or pain in the breast are potential signs of breast cancer.
Apart from smoking, other risk factors include obesity, drinking alcohol, hormone replacement therapy or use of the contraceptive pill, early onset of menstruation or menopause after the age of 55. In addition, a family history of breast or ovarian cancer, previous radiation therapy, having children after the age of 30, or not having a full term pregnancy are also associated with increased risk for breast cancer.
“Regular breast examinations, including both self-examinations and professional examinations, as well as mammograms particularly from the age of 40, are integral to the early detection of possible breast cancer.”
Prostate cancer
Symptoms include more frequent or difficulty urinating, a sensation of the urine flow being blocked, or the presence of blood in urine or semen and should be immediately investigated.
Risk factors include age, obesity and family history of cancer, particularly prostate cancer.
“Men should have regular digital rectal examinations, and prostate-specific androgen tests so that if cancer is detected, we can take the necessary steps to treat it and prevent its spread as early as possible.”
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The lives of millions of South Africans with a litany of rare diseases can be vastly improved, and even saved, by addressing challenges in identifying, studying and treating their conditions. With Rare Disease Day on the 28th of February 2025, the Rare Diseases Access Initiative (RDAI) is driving an evolution of the country’s healthcare, through innovative strategies to better care for over 4.2million people living with an estimated 7000 rare diseases. “As our healthcare system faces significant changes in the years ahead, it is vital that we also advocate for people living with rare diseases in South Africa, especially those with limited healthcare access,” said Kelly du Plessis, CEO of Rare Diseases South Africa (RDSA), a member of RDAI. “As part of our ongoing research and awareness efforts, RDAI has conducted an initial analysis of the incidence and prevalence of rare diseases within the country.” This research will assist in improving access to healthcare, policy development, and patient advocacy, while giving critical insight into the challenges faced by patients. “According to research, some rare diseases affect fewer than 1 in a million people, while others, such as Down syndrome, cystic fibrosis, and haemophilia, have a more recognisable prevalence,” says Dr. Helen Malherbe, RDAI lead researcher on rare disease prevalence data. “Many conditions are undetected, underdiagnosed or misdiagnosed, with too many having no information available about them at all.” The RDAI was formed in 2019 to promote a more favourable environment for those impacted by rare diseases in South Africa. Participants include Ampath, the Board of Healthcare Funders (BHF), Discovery Health, Genetic Counsellors South Africa (SASHG), the Government Employees Medical Scheme (GEMS), Health Funders Association (HFA), Medihelp, Medscheme, North-West University (NWU), Rare Diseases South Africa (RDSA), the South African Medical Association (SAMA) and The South African Medical Technology Industry Association (SAMED). The Council for Medical Schemes (CMS) participates as an observer. In the same year, Rare Disease International signed a memorandum of understanding with the World Health Organisation leading to an international rare disease policy framework. In 2021, the United Nations General Assembly moved to adopt a resolution recognising 300 million people living with rare diseases worldwide. “A general lack of awareness and delayed diagnosis remain major hurdles for those affected by rare diseases. Policymakers and healthcare stakeholders need to prioritise access to treatment, diagnosis, and support for rare disease patients,” says Bada Pharasi, CEO of IPASA, “Through this initiative, working collaboratively with stakeholders at every level of the healthcare supply chain, we can bring real and meaningful change to those affected, including family members and care givers, through smart and efficient strategies.” The globally agreed definition of a rare disease is any medical condition with a specific pattern of clinical signs, symptoms, and findings that affects fewer than or equal to 1 in 2000 persons in a population. “Most are genetic, and some are inherited and passed down in families,” Malherbe says. “Some affect only the patient’s genetic recipe, while others may be acquired during life due to infection, trauma, or environmental effects. For many, the cause is still unknown. “These conditions mainly affect children, as they are largely incurable and many are life-threatening. Some require specialised and co-ordinated care, some have limited and expensive treatment options, while others have no information or effective treatments at all,” she adds. The RDAI is calling for a patient-centred care model built on equitable access, transparency and efficiency. Naturally, this model calls for the open participation of patients, the healthcare industry, health professionals, and the Government. “The most critical elements are robust diagnosis standards, improved access to treatment, data collection and management, co-ordination of care, measurement of outcomes and ongoing collaborative research,” du Plessis says. “We need to establish rare disease advisory committees, map gaps and opportunities, establish system requirements, create a roadmap and plan a phased implementation with clear timelines.” The RDAI states that these policy development steps would be a start in quantifying the disease burden and defining standards of care. This would be followed by building and strengthening the capacity to facilitate appropriate diagnosis, treatment, continuity and data monitoring. Thoneshan Naidoo, Chief Executive Officer of the Health Funders Association noted that, “We appreciate the unique opportunity provided by RDAI which enables stakeholders across the industry to work together and identify strategies that improve equitable access to the appropriate diagnosis, treatment and healthcare services for rare disease patients, in an affordable and sustainable manner, taking account of the other pressing needs across the healthcare system.” “True innovation in healthcare is only possible through partnerships and joint advocacy efforts that raise awareness and improve access to treatment. Our long-term goal is the development of a rare diseases policy framework and guidelines for coordinated care,” says Pharasi. “Our members are united in the commitment to unlocking improved patient outcomes and improving access to services and robust health needs assessment facilities.” he concludes. About RDAI The Rare Diseases Access Initiative (RDAI) is dedicated to advocating for improved healthcare access, policy development, and patient support for those affected by rare diseases in South Africa. The initiative brings together key healthcare stakeholders, including pharmaceutical associations, funders, genetic specialists, and patient advocacy groups, to drive impactful change. About RDSA Founded in 2013, Rare Diseases South Africa (RDSA) is a non-profit organisation advocating to ensure that people living with rare diseases and congenital disorders experience greater recognition, support, improved health service and better overall quality of life. Started out of personal need following the diagnosis of organisation founder, Kelly du Plessis' son, it became evident that there was a lack of awareness and support for rare diseases in general in South Africa. About IPASA The Innovative Pharmaceutical Association South Africa (IPASA) is a voluntary trade association representing 24 leading pharmaceutical companies committed to research, development, and innovation. Our mission is to drive healthcare advancement by advocating for policies that improve patient access to safe, high-quality, and affordable medicines.
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