PLEASE NOTE: Do not refer patients with an abnormal examination for routine mammograms. Patients sent for a routine mammogram must have a normal clinical examination. Patients with an abnormal clinical examination must be referred to the Breast Clinic.

The maximum wait for routine mammograms is 12 weeks. The current capacity only allows for 15 patients per week for routine mammograms. If no dates are available, all the available slots have been used. 5 New slots should become available on Mondays, Tuesdays and Wednesdays. 

 

ROUTINE MAMMOGRAMS

Please Note:

• “Screening mammograms” are not offered to asymptomatic individuals without a specific indication.
• Mammograms are only done on patients over 40 years unless there is a history of previous breast cancer, or other family members had their cancers at a very young age.
• There is no indication to repeat a routine mammogram if the patient had a normal mammogram in the last year, unless there are new concerning symptoms.
• Routine mammograms are not done on patients with symptoms of breast cancer; these patients need to be referred to a diagnostic breast clinic. There are 2 clinics in metro West at Groote Schuur Hospital and Mitchells Plain Hospital.
• Routine mammograms are not indicated in patients older than 70 years with a normal breast examination

INDICATIONS FOR ROUTINE MAMMOGRAMS

Patients with no previous breast cancer

•  Hormone Replacement Therapy (HRT), these patients should have a mammogram before starting and every 2-3 years while on treatment.
• Please note mastalgia as an isolated symptom is not an indication for mammography - Link to more information

Patients with previous breast cancer

Breast-conserving treatment initially

• Mammogram yearly for 5 years in all patients
• Stop after 5 years if there is no family history of breast cancer, or the patient is older than 70 years.
• Continue 2 yearly if there is a first-degree (mother, sister, daughter) family member with breast cancer. Up to the age of 70 
• In young patients, especially if they had their first cancer before 40 years, continue with 2 yearly mammograms until 70, even if there is no family history.
   

Mastectomy initially

• There is no reason to do a mammogram of the contralateral breast unless the patient is young or has a strong family history of breast cancer. Remember, contralateral breast cancer is rare. The rate of contralateral breast cancer is low, < 5% in patients that is of average risk.

 

• A Mammogram of the contralateral breast is not indicated unless the following is present.
  • The patient has frst-degree (mother, sister, daughter) family members with breast cancer, then 2 yearly mammograms need to be done up to the age of 70.
  • The patient is young, especially if she had her first cancer before 40 years, continue with 2 yearly mammograms until 70, even if there is no family history.

 

 

Remember, there are only a limited number of slots available for mammograms. Groote Schuur has the only mammogram machine to serve the whole of the Western Cape Town Metro as well as the West Coast Region. The more inappropriate referrals, the longer the waiting time for patients that would benefit the most. 

Referring Health Care Worker Information

Patient Information

Mastalgia is not an indication for a routine mammogram. 

 

Please see indications for routine mammography below

 

Breast Pain (Mastalgia) 

Patients with breast pain as their only symptom are not seen at a specialist Breast Clinic. They can be treated by their primary healthcare provider. The treatment is not complex, and these patients do not require any special investigations. Mastalgia on its own is not a symptom of breast cancer. Mastalgia is not an indication for a mammogram.

Most women (up to 7 in 10 women) develop breast pain at some stage in life develop breast pain at some stage in their life.

In about 2 in 3 women the pain develops in the days just before a period - cyclical breast pain.

In the remainder, the pain is not related to periods - non-cyclical.

 

What are the treatment options for breast pain?

The value of reassurance cannot be overstated. Patients are worried that they have breast cancer. This is not the case in patients with isolated mastalgia, and they should be reassured. This is often all that is needed. Breast pain is as common as a headache, and just as not every headache needs to be seen by a neurologsist, not every mastalgia needs to be seen by a breast specialist. If there are no "red flag" symptoms of breast cancer the patient can be managed in the primary healthcare environment.

No treatment may be needed if the symptoms are mild. 

If the pain is more severe, or for the times when it may flare up worse than usual, treatment options include the following:

• Support the breasts. A well-supporting bra should be worn. Some women find that wearing a supporting bra 24 hours a day for the week before a period is helpful. It is best to avoid underwired bras. Wear a sports bra during exercise.
• Painkillers such as paracetamol or ibuprofen. Take regularly on the days when the breasts are painful.
• Topical ('rub-on') anti-inflammatory cream. For example, topical diclofenac or topical ibuprofen (Voltaren Gel).
• Evening primrose oil is often recommended as a treatment for breast pain. A dose of 1-3gms (2-6 tablets) of Evening Primrose oil each day for a period of 6 weeks is required before the benefit can be assessed. Improvement in the severity of cyclical and non-cyclical mastalgia is 58% and 38%, respectively. If symptoms improve, continue these tablets.

 

 

ROUTINE MAMMOGRAMS AT GROOTE SCHUUR HOSPITAL

Please Note:

• “Screening mammograms” are not offered to asymptomatic individuals without a specific indication.
• Mammograms are only done on patients over 40 years unless there is a history of previous breast cancer, or other family members had their cancers at a very young age.
• There is no indication to repeat a routine mammogram if the patient had a normal mammogram in the last year, unless there are new concerning symptoms.
• Routine mammograms are not done on patients with symptoms of breast cancer; these patients need to be referred to a diagnostic breast clinic. There are 2 clinics in metro West at Groote Schuur Hospital and Mitchells Plain Hospital.

INDICATIONS FOR ROUTINE MAMMOGRAMS

Patients with no previous breast cancer

• Hormone Replacement Therapy (HRT), these patients should have a mammogram before starting and every 2-3 years while on treatment.
• Please note mastalgia as an isolated symptom is not an indication for mammography - Link to more information

Patients with previous breast cancer

Breast-conserving treatment initially

• Mammogram yearly for 5 years in all patients
• Stop after 5 years 
  
  

Mastectomy initially

• There is no reason to do a mammogram of the contralateral breast unless the patient is young or has a strong family history of breast cancer. Remember, contralateral breast cancer is rare. The rate of contralateral breast cancer is low, < 5% in patients that is of average risk.

Remember, there are only a limited number of slots available for mammograms. Groote Schuur has the only mammogram machine to serve the whole of the Western Cape Town Metro as well as the West Coast Region. The more inappropriate referrals, the longer the waiting time for patients that would benefit the most.

 Please make sure your patient meets the criteria for a mammogram

• She must be over 40 years of age unless a mammogram is done for previous breast cancer OR she has a family history of breast cancer with a family member under 40 with breast cancer (Please note: No patients under the age of 35 will receive a mammogram unless the patient personally had breast cancer)
• She should not have had a recent normal mammogram (within the last year) 

 Please follow the instructions below for routine mammogram bookings

1. Please complete an X-ray request form or referral letter with details of the indication for the mammogram.
2. Send your patient directly to C16 in the new hospital for their mammogram on the date and time you selected.
3. The mammogram result will be reviewed, and the patient will be contacted by phone with a result and follow-up plan. 
4. The patient is usually contacted on a Thursday, two weeks after the mammogram, but please note that this process can take longer.
5. Please provide a contact number your patient can answer when we call with results.

Please note: The maximum wait for routine mammograms is 12 weeks. The current capacity only allows for 15 patients per week. If no dates are available, all the available slots have been used. New slots may become available the next week, so you might need to check daily to see if slots are available. 

 

PLEASE NOTE 

Please make sure you click Submit after selecting a date and time. 

Please note

Your patient is younger than 40 years and does not qualify for a mammogram. Patients receiving a mammogram need to be older than 40 years, with the only exception being a personal history of breast cancer or multiple family members with breast cancer at a young age.

If your patient is younger than 40 and has an indication for a mammogram, please contact us at breastsurgendo@gmail.com  and motivate why your patient should have a mammogram.

Please provide the patient name, DOB, and hospital number of patients in all correspondence.

PLEASE NOTE, if your patient has an abnormal clinical examination she needs to be referred to our diagnostic breast clinic. Routine mammograms are only for patients with a normal clinical examination.

You can make a referral to our diagnostic breast clinic by using the following link:

Metro West Diagnostic Breast Clinic Referral