What do PMBs cover for breast cancer?
Breast cancer remains the most diagnosed cancer globally, with 2.26 million new cases reported in 2020 alone. In South Africa, breast cancer accounted for 14.3% of all new cancer cases, making it the leading cause of cancer in both men and women.
Breast cancer is a disease where cells in the breast grow uncontrollably, leading to the development of tumours. It can originate in different parts of the breast, including the ducts, lobules, or connective tissue. The most common form, ductal cancer, begins in the ducts that carry milk to the nipple. Less common forms, such as lobular cancer or Paget’s disease, affect other areas of the breast.
While breast cancer is most commonly associated with women, men can be affected too. In our next issue as part of Breast Cancer Awareness Month, we will spotlight breast cancer in men to raise awareness for both genders.
Causes and risk factors
While anyone can develop breast cancer, certain factors increase the risk:
- Being over the age of 50
- Genetic mutations (BRCA1 and BRCA2)
- Family history
- Personal history of breast cancer or dense breast tissue
- Previous radiation therapy to the chest
Early detection is key
Early detection of breast cancer through regular screenings greatly increases the chances of successful treatment. Regular mammograms, clinical breast exams, and being aware of changes in the breast can help detect cancer early.
Symptoms to look out for include:
- A lump in the breast or underarm
- Changes in breast size or shape
- Redness or dimpling of the breast skin
- Unusual nipple discharge
If detected early, many breast cancer cases can be treated effectively through surgery, chemotherapy, radiation, or hormonal therapy.
PMB level of care
In South Africa, breast cancer treatment is covered under Prescribed Minimum Benefits (PMB) regulations, ensuring that diagnosis, treatment, and follow-up care are accessible for medical scheme members. This includes surgery, chemotherapy, radiation, and breast reconstruction.
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. Screening through a physical breast examination, consultations with doctors and other health professionals, surgery, radiology, pathology, chemotherapy, and radiation therapy and breast reconstruction are included in what the medical scheme must cover.
For more information on your PMB entitlements, download the full CMScript here.
