Breast Cancer & your PMB entitlements
Breast Cancer Awareness Month
October has been recognised as Breast Cancer Awareness Month since the 1980s. It is often called “Pink October” because people wear pink and display the pink ribbon to highlight the importance of prevention, routine screening, and early diagnosis of breast cancer.
Breast cancer remains the most diagnosed cancer worldwide, with 2.26 million new cases reported in 2020. In South Africa, it accounts for 14.3% of all new cancer cases, making it the leading cause of cancer in both women and men.
While breast cancer is usually associated with women, men also have breast tissue and can develop the disease. In South Africa, male breast cancer makes up about 1.8% of all cases, compared to less than 1% globally.
Know the Risk Factors
Although anyone can develop breast cancer, certain factors increase the risk:
For women and men:
- Age (previously common after 50 for women, but this is changing earlier presentation is becoming common, and between 40–80 for men).
- Inherited changes (mutations) in certain genes, such as BRCA1 and BRCA2.
- Family history of breast cancer.
- Previous radiation therapy to the chest
- Lifestyle factors such as inactivity, obesity or alcohol use
Additional male-specific risks:
- Klinefelter’s syndrome, which is a genetic condition that occurs when a boy is born with more than one copy of the X chromosome and produces lower levels of certain male hormones, androgens and more female hormones (oestrogens).
- Hormone therapy treatment, such as oestrogen-containing medications used to treat prostate cancer.
Signs and Symptoms
Being alert to changes is critical for early detection. Look out for:
- A lump or swelling in the breast or underarm.
- Changes in breast size or shape.
- Redness, dimpling, or scaling of the skin.
- Nipple inversion, discharge, or bleeding.
- Breast discomfort or pulling sensation.
Regular screening and awareness of symptoms greatly improve outcomes.
- Women: Clinical breast exams and mammograms (check with your scheme if covered).
- Men: Prompt medical attention for unusual breast changes.
When detected early, many breast cancer cases can be effectively treated with surgery, chemotherapy, radiation, or hormonal therapy.
PMB level of care
Treatable breast cancer is included in the Prescribed Minimum Benefit (PMB) regulations under Diagnosis and Treatment and Pair (DTP) code 950J.
This means that when cancer meets the criteria for being treatable, your medical scheme must cover the diagnosis, treatment, and follow-up care, regardless of your benefit option.
This includes:
- Screening through physical breast exams and consultations.
- Surgery (including reconstruction).
- Radiology and pathology.
- Chemotherapy and radiation therapy.
- Certain biologic medicines and genetic referrals where clinically indicated.
For women with cancer in one breast, with confirmed BRAC1 or 2 genetic mutation, or family history a preventative mastectomy and reconstruction of the unaffected breast is also PMB level of care.
Not covered as PMB (but may be funded at your scheme’s discretion):
- Preventive mastectomy in women without breast cancer.
- Screening mammograms (schemes often fund annually for certain options).
- Some biologics are not included in PMB.
Awareness matters most when it leads to action.
Learn more about breast cancer and your benefits with our CMScripts.
