Nicola Mawson
If you have a look around at all the people you know, regardless of where you met them, one in 26 of the women will get breast cancer, and about one in a thousand men. For women, the risks increase with age, but that doesn’t eliminate the chances that it will not happen to you.
The Cancer Association of South Africa, on its website, has anecdotes from women who have survived breast cancer:
Melissa Willemse: “When it comes to breast cancer age is not a factor. The first doctor I saw immediately dismissed my question about the painful lump under my arm because I was too young for breast cancer…. My advice is if you feel something is wrong don’t hesitate to get a second opinion. Cancer doesn’t care how old you are.”
All women, the association states, are at risk, especially those with a family history of breast cancer. “Being overweight, inactive, consuming alcohol, poor dietary habits, smoking and exposure to chemicals also increase risk.”
One would imagine that this also applies to men, but the focus locally seems to be on women, probably because it is also the most common cancer among women in South Africa. According to Breast Cancer Research, it accounts for 22.6% of all female cancers and 16% of cancer deaths among women.
As with any other disease, the earlier it’s diagnosed, the better. On the Cansa website, Cynthia Erasmus said: “Looking back now I realise that if I had acted sooner, perhaps I could just have had a lumpectomy instead of a double mastectomy.”
Yet, Momentum Life Insurance's claims statistics show that early detection has worsened, with only 56% of cases detected at stage 1 in 2023, down from 67% in 2022.
A Health Quality Assessment annual Industry Report on the quality of healthcare in South Africa, released just two months ago, found that there has been little progress in encouraging more women between 50 and 74 to access mammography services.
“This has sparked some schemes to take proactive steps to estimate the risk of developing breast cancer. For those at higher risk, additional screenings such as MRI scans are available,” it said in a statement at the time.
However, Richard Clemitson, Specialist Health and Gap Cover Advisor at Atacus Financial Services told Personal Finance: “I will be contacted quite often by clients asking if they still have a mammogram benefit that Discovery will cover that is available”.
Medical aids, he said, have a duty to provide a level of care when it comes to breast cancer under prescribed minimum benefits.
Helfin Financial Services has a neat explanation:
Treatable cancers are defined in the PMB regulations as solid organ malignant tumours where:
- They involve only the organ of origin and have not spread to adjacent organs.
- There is no evidence of distant metastatic spread.
- They have not, using compression, infarction, or other means, brought about irreversible and irreparable damage to the organ within which they originated (for example brain stem compression caused by a cerebral tumour) or another vital organ.
- Or, if points 1 to 3 do not apply, there is a well-demonstrated five-year survival rate of greater than 10% for the given therapy for the condition concerned.
“Regardless of which benefit option a member or beneficiary is on, the medical scheme must pay for the diagnosis, treatment, and care costs of treatable breast cancer,” it said. Other aspects that must be covered include screening through a physical breast examination, consultations with doctors and other health professionals, surgery, radiology, pathology, chemotherapy, radiation therapy, and breast reconstruction, it stated.
Discovery, South Africa’s largest medical aid by numbers, covers the cost of mammograms under its preventative screening benefit once every two years. “However, if a person is deemed as high-risk Discovery will cover the mammogram every year,” Clemitson said. High risk, he explained, would include those with a history of breast cancer in their direct families.
However, it seems that it’s not always easy for people to get the proper treatment under their medical aid.
Over the past decade, Campaigning for Cancer NPC and Rare Diseases South Africa NPC has successfully secured treatment access for many patients who were previously denied care. They have guided and equipped patients, medical practices, and authorisation staff to navigate challenges related to treatment motivations, authorisations, and disputes over treatment plans rejected by patients' medical schemes, a statement stated.
The two organisations have banded together to form ASK Now Patient Services, which seeks to provide comprehensive navigation support to all patients seeking timely access to the treatment they need at no cost as it is a non-profit.
"The dispute escalation process can be complex, time-consuming, and administratively burdensome. ASK Now Patient Services aims to alleviate these challenges for patients and medical practices. As an NPC, we offer these services to patients, doctors, and their practice staff free of charge," said Comfort Maluleke, Senior Case Manager at Campaigning for Cancer and Executive Director for ASK Now Patient Services.
However, dealing with cancer goes beyond just the medical aspect.
Joretha Bothma, Head of Product Development, Underwriting, and Claims at Momentum Life Insurance, added that the financial strain associated with breast cancer extends beyond medical treatments and includes the cost of lost income due to missed work or reduced hours. For this situation, she recommends critical illness cover.
Moreover, check with your scheme for counselling benefits.
PERSONAL FINANCE