Female Forward: Real conversations. Trusted experts. Better health.
Female Forward: Real conversations. Trusted experts. Better health.
Female Forward: Real conversations. Trusted experts. Better health.
Gary Oberholzer
Female Forward: Real conversations. Trusted experts. Better health.
When it comes to their health, women are often everyone else’s biggest supporter—but far too often, their own needs come last.
Between careers, families, businesses and the demands of everyday life, it’s easy to ignore a symptom, postpone a check-up or convince yourself you’ll “get around to it later”. Yet many of South Africa’s leading healthcare professionals agree that some of the biggest health challenges facing women today aren’t caused by a lack of treatment—they’re caused by delayed conversations, missed warning signs and the belief that feeling exhausted, overwhelmed or unwell is simply part of life.
Female Forward brings together leading doctors and healthcare professionals to answer one simple question:
What do you wish every woman knew before she became your patient?
Their answers are practical, honest and, in many cases, life-changing.
From heart health and hormones to mental wellbeing, nutrition, sleep, cancer screening and preventative care, these expert insights are designed to help women better understand their bodies, ask the right questions and make informed decisions about their health at every stage of life.
Whether you’re looking for answers to a specific concern or simply want to take better care of yourself, we invite you to explore the conversations below – either in audio or text format.
Click on the themes below to reveal insights from our specialist panel of guests:
I'm always looking after everyone else. What about me?
Women are often expected to carry the emotional, practical and mental load of family life while meeting the demands of work and modern living. Our experts explain why constantly putting yourself last is neither healthy nor sustainable.
It can look like competence from the outside. The lunches are packed, the deadlines are met, appointments are remembered and everyone gets where they need to be. Yet the woman holding it all together may be exhausted, anxious and gradually losing touch with the things that once made her feel like herself.
That tension surfaced repeatedly during Tara Penny's Female Forward conversations. Across psychiatry, psychology and general practice, the message was remarkably consistent: women have become very good at functioning while depleted.
The pressure to do everything perfectly
Psychiatrist Dr Feroza Arbee describes modern women as “overproductive human beings” who expect an enormous amount of themselves. Many are earning an income and building careers while still feeling responsible for maintaining the home, raising children and ensuring that everyone else's needs are met.
“We have evolved into these overproductive human beings that expect so much of ourselves.”
— Dr Feroza ArbeeThe pressure does not come only from men, workplaces or society. Women can be unforgiving critics of themselves and one another. The school fundraiser, homemade costume, tidy home and carefully curated family life all become quiet tests of whether a woman is coping well enough.
At the same time, many women have lost the village that once made family life more manageable. Extended families may live far apart. Neighbours barely know one another. New mothers are expected to recover, bond, breastfeed, keep the household moving and return to work without the network of support earlier generations may have relied on.
“If you don't feed the mom, you can't feed the baby.”
— A principle shared during Dr Feroza Arbee's conversationIt applies far beyond infancy. When a woman is emotionally and physically depleted, her ability to care for everyone else is eventually affected too.
When being busy becomes burnout
Burnout does not always look like a dramatic breakdown. Women may continue working, parenting and meeting obligations while feeling increasingly detached from their own lives.
Dr Arbee says leisure and self-care are often the first things to disappear. Exercise is cancelled. The coffee date is postponed. Work follows women home through their phones, creating an always-on culture in which there is no clear point at which the day ends.
The warning signs can be subtle: reduced concentration, unread messages, forgetfulness, irritability, persistent tension and the sense that activities that once brought pleasure have become chores.
“If there's a lack of pleasure in your life, where everything begins to feel like a chore, you may well be suffering from burnout.”
— Dr Feroza ArbeeClinical psychologist Dimakatso Motiang sees a similar pattern in women who arrive in therapy feeling empty and unheard. They are mothers, partners, professionals and caregivers who have spent so long filling everyone else's cup that they no longer have the energy to care for themselves.
Changes in energy, social connection and motivation can be important clues. A woman who once exercised, enjoyed hobbies, attended church or spent time with friends may begin withdrawing because everything feels exhausting.
Registered counsellor Dr Tricia Moodley adds that anxiety can follow women through every part of the day. It may appear in the classroom, the boardroom, the car and eventually the bedroom, affecting sleep and the ability to feel present.
Looking highly functional does not mean somebody is not struggling. Anxiety, trauma, self-doubt and imposter syndrome can all exist behind a carefully managed exterior.
You cannot live on the dregs at the bottom of the cup
Psychiatrist Dr Yumna Minty says mental illness does not discriminate. In her rooms, she sees teenagers, university students, professionals, stay-at-home mothers and grandmothers. Anxiety and depression can affect women across every age, income group and background.
Yet women often treat their own mental wellbeing as an afterthought. They focus on children, partners, parents, careers and extended family—and accept whatever energy is left over for themselves.
“You can't always be giving of yourself to the point that there's nothing left to give.”
— Dr Yumna MintyDr Minty suggests shifting the conversation away from guilt and towards responsibility. Women frequently think about their responsibilities to everyone else, but rarely ask what responsibilities they have towards themselves.
Rest, treatment, therapy and emotional support are not rewards to be earned after every task has been completed. They are part of maintaining the resilience needed to meet life's responsibilities in the first place.
Good enough is healthier than perfect
Dr Arbee's own experience of postnatal depression demonstrates how difficult it can be to recognise mental distress from the inside—even when you are medically trained.
She recalls being sleep-deprived, anxious and irritable after the birth of her first child. She loved her baby, but did not enjoy being a mother at that time. The gap between what motherhood was supposed to feel like and what she was actually experiencing made it harder to recognise that she needed help.
Eventually, therapy helped her understand that she had experienced significant postnatal depression. Her advice to other women is clear: it is real, help is available and asking for support does not mean you will automatically be medicated or judged.
“Our kids don't need perfect moms. They need good enough moms.”
— Dr Feroza ArbeeA fed child, a present parent and a home that feels emotionally safe matter more than whether everything is immaculate. There will always be clutter and another unfinished item on the to-do list. The pursuit of perfection can rob families of the connection women are working so hard to create.
Ask for what you need—and share the load
Women are accustomed to being asked for things. They are less accustomed to doing the asking.
Dr Arbee encourages women to communicate their needs instead of hoping a partner or family member will notice. She also challenges the idea that a partner is “helping” with parenting or household responsibilities. Help suggests that the work fundamentally belongs to the woman. Shared responsibility recognises that both adults are part of the same household and family.
Boundaries do not have to be dramatic. Dr Arbee protects small moments in her day, including ten quiet minutes with a cup of tea and a point in the evening when she has “clocked out” of practical mothering duties.
By expressing those needs, she has also shown her children that they are allowed to ask for time and space to regulate themselves.
Be careful when coping becomes self-medication
Women may reach for alcohol, cannabis, energy drinks or prescription medication to calm down, stay awake or get through the day. The substance itself is not always the first warning sign. The sense that you cannot cope without it is.
“If you're needing it—if you say, ‘I can't get through the afternoon or the evening without my whatever’—that's a problem.”
— Dr Feroza ArbeeDr Minty similarly encourages people to look beyond judgement and ask why the dependence developed. What conflict, crisis or emotional need is the substance or medication attempting to manage? Lasting recovery requires addressing that underlying need and building healthier ways to cope.
Consider speaking to a healthcare professional if:
- You feel tense, anxious or emotionally flat most of the time.
- The things you once enjoyed now feel like obligations.
- You are withdrawing from friends, exercise, hobbies or spiritual life.
- You rely on alcohol, stimulants, cannabis or medication to function or unwind.
- You feel persistently low, irritable, overwhelmed or unable to cope.
- You have thoughts of harming yourself or feel that those around you would be better off without you.
The central message from the mental-health professionals in Female Forward is one of hope. Burnout, anxiety, depression and postnatal mental-health difficulties are treatable. Reaching out does not mean that you have failed.
“You're not alone.”
— Dr Feroza ArbeeFemale Forward takeaway
- Stop treating exhaustion as proof that you are doing enough.
- Notice when joy, motivation or connection begin disappearing.
- Put rest, therapy, exercise or personal time into the diary before the gaps fill up.
- Ask clearly for what you need and share responsibility at home.
- Do not wait for a crisis before seeking professional support.
- Remember that “good enough” is healthier than an impossible version of perfect.
Is what I'm feeling actually normal?
Painful periods, brain fog, poor sleep, incontinence, exhaustion, anxiety and changes in sexual health are often dismissed as the price of being a woman. Our experts explain why “common” and “normal” are not always the same thing.
Women become skilled at adapting. They plan around their periods, carry spare clothing, work through exhaustion, tolerate disrupted sleep and quietly adjust to changes in their bodies.
But adapting to a symptom does not necessarily make it normal.
Throughout the Female Forward interviews, doctors repeatedly described women who had lived with treatable symptoms for months or years because they assumed there was nothing to be done—or felt too embarrassed to raise the subject.
Pain should not take over your life
General practitioner Dr Chantel de Pinheiro says the line between expected menstrual cramping and pain that requires investigation can become blurred.
Some discomfort may occur during a period. However, pain that disrupts school, work, exercise or normal daily activity should not simply be accepted.
“You may have some cramps, but if that's disrupting your day-to-day life, that's not considered normal anymore.”
— Dr Chantel de PinheiroConditions such as endometriosis can take years to diagnose partly because women have been told that severe period pain is simply something they must tolerate. Keeping a record of symptoms, their timing and their impact on daily life can help a doctor build a clearer picture.
Dr de Pinheiro also encourages women to discuss painful sex, changes in libido and other intimate symptoms. Doctors are not asking these questions out of curiosity. Sexual health can provide important clues about hormones, physical discomfort, medication, stress and wider wellbeing.
Perimenopause can begin before you expect it
Gynaecologist Dr Kalliopi Kyriazis says women may begin noticing changes in their early forties. Breast tenderness, anxiety, poor concentration, disrupted sleep and changes to the menstrual cycle may all form part of the perimenopausal picture.
Brain fog can be particularly unsettling for capable women who suddenly struggle to retrieve words, spell familiar terms or complete tasks that once felt easy.
“Things that were easy to do are now difficult to do.”
— Dr Kalliopi KyriazisThese changes are not a personal failure, a loss of intelligence or proof that a woman is no longer coping. They may have a biological explanation—and support is available.
Dr Kyriazis also warns against assuming that incontinence after childbirth or during midlife is unavoidable. Pelvic-floor weakness, birth trauma and falling oestrogen levels can contribute, but pelvic-floor exercises, core strengthening and appropriate medical treatment may improve symptoms.
“No, it's not normal.”
— Dr Kalliopi Kyriazis, on women accepting urinary leakage as inevitableMenopause is a transition—not a disappearance
Functional medicine practitioner Dr Ashika Pillay focuses on menopause care and midlife women's health. She encourages women to see menopause as a transition rather than the beginning of decline.
Midlife often brings several major pressures at once: children are becoming more independent, parents may require care and professional responsibilities may be increasing. When sleep, concentration and emotional resilience also change, women may assume they are simply burnt out or “going crazy”.
Looking at the complete picture can be transformative. Instead of treating each symptom separately—with a sleeping tablet for insomnia, an anti-anxiety medication for anxiety and general advice to relax—a clinician can consider hormonal change alongside mental health, lifestyle and medical history.
Dr Pillay's approach centres on awareness, choice and responsibility. Once a woman understands what may be happening, she can explore treatment options with an appropriate practitioner and make informed choices about her health.
“We really want to hand back the power of women's health to women.”
— Dr Ashika PillayHormone therapy may be appropriate for some women, but it is not the only part of menopause care. Sleep, movement, nutrition, stress, family history and ongoing screening remain important throughout the transition.
Sleep is not dead time
Clinician and sleep specialist Dr Allison Bentley says women are being squeezed at both ends of the night. They stay awake late to complete work and household responsibilities, then wake early to prepare children and households for the day.
Hormonal changes across menstruation, pregnancy and menopause can further affect the quality of women's sleep.
“We're not getting enough sleep. We're not getting enough quality sleep.”
— Dr Allison BentleySleep is when the body and brain undergo essential maintenance. Regularly cutting it short can affect attention, concentration, memory, mood and irritability in the short term. Over time, chronic sleep disruption is associated with serious health consequences.
Dr Bentley does not consider sleep merely one pillar of health. In her view, it is the central pillar because sleep influences how well people eat, move and cope.
“I don't believe sleep is a pillar of health. I believe it's the pillar of health.”
— Dr Allison BentleyPractical improvement begins with understanding your natural sleep pattern and protecting a consistent routine. A calming wind-down period, reduced evening stimulation and keeping bright screens away from the face before bed can all help.
Persistent insomnia, loud snoring, waking unrefreshed or excessive daytime sleepiness should be discussed with a healthcare professional rather than managed indefinitely with caffeine or sleeping tablets.
A woman's heart may not follow the textbook
Cardiologist Dr Adriano Dello Iacono cautions that women do not always experience the classic crushing chest pain associated with a heart attack.
Symptoms may include indigestion, nausea, sweating, fainting, unusual shortness of breath or a sudden reduction in the amount of activity a woman can comfortably manage.
The pattern matters. Symptoms linked to exertion that improve with rest deserve particular attention, as do recurrent or unexplained changes.
“Diseases don't read the textbooks.”
— Dr Adriano Dello IaconoA woman who previously walked comfortably but suddenly becomes breathless with minimal effort may assume she is simply unfit. Recurrent indigestion during exercise may be blamed on food. Fainting may be dismissed as stress. These symptoms do not always indicate heart disease, but they should not automatically be ignored.
“Anything that is weird, that's persistent, always get checked out.”
— Dr Adriano Dello IaconoRisk factors also matter. Diabetes, high blood pressure, high cholesterol, smoking, vaping, sleep apnoea and a family history of early heart attack or stroke increase the importance of screening and timely assessment.
Do not dismiss symptoms that:
- Repeatedly disrupt work, sleep, exercise or normal daily life.
- Are new, worsening or distinctly different from your usual pattern.
- Include severe menstrual or pelvic pain.
- Include bleeding after menopause.
- Include persistent insomnia, loud snoring or daytime sleepiness.
- Include exertion-related indigestion, nausea, sweating or breathlessness.
- Include fainting, particularly with palpitations or during physical activity.
- Include painful sex, urinary leakage or other intimate symptoms you have been too embarrassed to discuss.
The goal is not to make women anxious about every small change. It is to help them distinguish between a passing symptom and a pattern that deserves attention.
Dr de Pinheiro says women frequently defer annual checks until they are already unwell. Routine appointments create space to discuss changes before they become emergencies and allow screening to detect conditions that may not yet be causing symptoms.
Female Forward takeaway
- Know your own normal—and pay attention when it changes.
- Common symptoms are not automatically harmless or untreatable.
- Pain that disrupts daily life deserves investigation.
- Talk openly about periods, sexual health, incontinence and menopause.
- Protect sleep as an essential part of your health.
- Remember that heart symptoms in women may look different from the textbook version.
- Trust your instincts and seek advice when something feels persistently wrong.
Is what I'm feeling actually normal?
Painful periods, brain fog, poor sleep, incontinence, exhaustion, anxiety and changes in sexual health are often dismissed as the price of being a woman. Our experts explain why “common” and “normal” are not always the same thing.
Women become skilled at adapting. They plan around their periods, carry spare clothing, work through exhaustion, tolerate disrupted sleep and quietly adjust to changes in their bodies.
But adapting to a symptom does not necessarily make it normal.
Throughout the Female Forward interviews, doctors repeatedly described women who had lived with treatable symptoms for months or years because they assumed there was nothing to be done—or felt too embarrassed to raise the subject.
Pain should not take over your life
General practitioner Dr Chantel de Pinheiro says the line between expected menstrual cramping and pain that requires investigation can become blurred.
Some discomfort may occur during a period. However, pain that disrupts school, work, exercise or normal daily activity should not simply be accepted.
“You may have some cramps, but if that's disrupting your day-to-day life, that's not considered normal anymore.”
— Dr Chantel de PinheiroConditions such as endometriosis can take years to diagnose partly because women have been told that severe period pain is simply something they must tolerate. Keeping a record of symptoms, their timing and their impact on daily life can help a doctor build a clearer picture.
Dr de Pinheiro also encourages women to discuss painful sex, changes in libido and other intimate symptoms. Doctors are not asking these questions out of curiosity. Sexual health can provide important clues about hormones, physical discomfort, medication, stress and wider wellbeing.
Perimenopause can begin before you expect it
Gynaecologist Dr Kalliopi Kyriazis says women may begin noticing changes in their early forties. Breast tenderness, anxiety, poor concentration, disrupted sleep and changes to the menstrual cycle may all form part of the perimenopausal picture.
Brain fog can be particularly unsettling for capable women who suddenly struggle to retrieve words, spell familiar terms or complete tasks that once felt easy.
“Things that were easy to do are now difficult to do.”
— Dr Kalliopi KyriazisThese changes are not a personal failure, a loss of intelligence or proof that a woman is no longer coping. They may have a biological explanation—and support is available.
Dr Kyriazis also warns against assuming that incontinence after childbirth or during midlife is unavoidable. Pelvic-floor weakness, birth trauma and falling oestrogen levels can contribute, but pelvic-floor exercises, core strengthening and appropriate medical treatment may improve symptoms.
“No, it's not normal.”
— Dr Kalliopi Kyriazis, on women accepting urinary leakage as inevitableMenopause is a transition—not a disappearance
Functional medicine practitioner Dr Ashika Pillay focuses on menopause care and midlife women's health. She encourages women to see menopause as a transition rather than the beginning of decline.
Midlife often brings several major pressures at once: children are becoming more independent, parents may require care and professional responsibilities may be increasing. When sleep, concentration and emotional resilience also change, women may assume they are simply burnt out or “going crazy”.
Looking at the complete picture can be transformative. Instead of treating each symptom separately—with a sleeping tablet for insomnia, an anti-anxiety medication for anxiety and general advice to relax—a clinician can consider hormonal change alongside mental health, lifestyle and medical history.
Dr Pillay's approach centres on awareness, choice and responsibility. Once a woman understands what may be happening, she can explore treatment options with an appropriate practitioner and make informed choices about her health.
“We really want to hand back the power of women's health to women.”
— Dr Ashika PillayHormone therapy may be appropriate for some women, but it is not the only part of menopause care. Sleep, movement, nutrition, stress, family history and ongoing screening remain important throughout the transition.
Sleep is not dead time
Clinician and sleep specialist Dr Allison Bentley says women are being squeezed at both ends of the night. They stay awake late to complete work and household responsibilities, then wake early to prepare children and households for the day.
Hormonal changes across menstruation, pregnancy and menopause can further affect the quality of women's sleep.
“We're not getting enough sleep. We're not getting enough quality sleep.”
— Dr Allison BentleySleep is when the body and brain undergo essential maintenance. Regularly cutting it short can affect attention, concentration, memory, mood and irritability in the short term. Over time, chronic sleep disruption is associated with serious health consequences.
Dr Bentley does not consider sleep merely one pillar of health. In her view, it is the central pillar because sleep influences how well people eat, move and cope.
“I don't believe sleep is a pillar of health. I believe it's the pillar of health.”
— Dr Allison BentleyPractical improvement begins with understanding your natural sleep pattern and protecting a consistent routine. A calming wind-down period, reduced evening stimulation and keeping bright screens away from the face before bed can all help.
Persistent insomnia, loud snoring, waking unrefreshed or excessive daytime sleepiness should be discussed with a healthcare professional rather than managed indefinitely with caffeine or sleeping tablets.
A woman's heart may not follow the textbook
Cardiologist Dr Adriano Dello Iacono cautions that women do not always experience the classic crushing chest pain associated with a heart attack.
Symptoms may include indigestion, nausea, sweating, fainting, unusual shortness of breath or a sudden reduction in the amount of activity a woman can comfortably manage.
The pattern matters. Symptoms linked to exertion that improve with rest deserve particular attention, as do recurrent or unexplained changes.
“Diseases don't read the textbooks.”
— Dr Adriano Dello IaconoA woman who previously walked comfortably but suddenly becomes breathless with minimal effort may assume she is simply unfit. Recurrent indigestion during exercise may be blamed on food. Fainting may be dismissed as stress. These symptoms do not always indicate heart disease, but they should not automatically be ignored.
“Anything that is weird, that's persistent, always get checked out.”
— Dr Adriano Dello IaconoRisk factors also matter. Diabetes, high blood pressure, high cholesterol, smoking, vaping, sleep apnoea and a family history of early heart attack or stroke increase the importance of screening and timely assessment.
Do not dismiss symptoms that:
- Repeatedly disrupt work, sleep, exercise or normal daily life.
- Are new, worsening or distinctly different from your usual pattern.
- Include severe menstrual or pelvic pain.
- Include bleeding after menopause.
- Include persistent insomnia, loud snoring or daytime sleepiness.
- Include exertion-related indigestion, nausea, sweating or breathlessness.
- Include fainting, particularly with palpitations or during physical activity.
- Include painful sex, urinary leakage or other intimate symptoms you have been too embarrassed to discuss.
The goal is not to make women anxious about every small change. It is to help them distinguish between a passing symptom and a pattern that deserves attention.
Dr de Pinheiro says women frequently defer annual checks until they are already unwell. Routine appointments create space to discuss changes before they become emergencies and allow screening to detect conditions that may not yet be causing symptoms.
Female Forward takeaway
- Know your own normal—and pay attention when it changes.
- Common symptoms are not automatically harmless or untreatable.
- Pain that disrupts daily life deserves investigation.
- Talk openly about periods, sexual health, incontinence and menopause.
- Protect sleep as an essential part of your health.
- Remember that heart symptoms in women may look different from the textbook version.
- Trust your instincts and seek advice when something feels persistently wrong.
Know your body. Trust your instincts. Never ignore change.
Breast cancer is not automatically a death sentence—and it is not only a disease of older women. Knowing your own normal, understanding your personal risk and acting quickly when something changes can make an enormous difference.
Fear can make women avoid the very information that could protect them. A breast check is postponed. A lump is watched for another month. A mammogram is delayed because it may be uncomfortable—or because finding something feels more frightening than not knowing.
But the breast-health specialists interviewed for Female Forward offer a far more hopeful message: modern treatment has advanced significantly, and breast cancers found early often have excellent outcomes.
Breast cancer can happen without an obvious risk factor
Prof Carol Benn, a surgeon with a special interest in breast health, cautions against assuming that breast cancer only affects women with a strong family history.
Genetics matter, but they are only one part of the picture. Many women diagnosed with breast cancer have no clear risk factor at all. A vague family history may also be more relevant than it first appears, particularly when different cancers occur across the family.
“We want people to know their norm, examine their breasts and go for screening.”
— Prof Carol BennKnowing your normal does not mean becoming anxious about every variation in breast tissue. Breasts naturally change throughout the menstrual cycle, pregnancy, breastfeeding and menopause. The goal is to become familiar enough with your own body to recognise a new or persistent change.
You are never too young to take a change seriously
Dr Peter Schoub explains that routine mammography generally begins from the age of 40 for women at average risk, ideally every year. Women with a higher personal risk may need to begin earlier.
That does not mean younger women should ignore breast health. Breast cancer can occur in women in their twenties and thirties, and cancers diagnosed in younger women can sometimes be more aggressive.
The tragedy is that a lump may be dismissed because the woman—or even a healthcare practitioner—believes she is too young to have breast cancer.
“Anyone can get breast cancer. If a woman or her doctor feels a lump, never hesitate. Always get it checked.”
— Dr Peter SchoubMost lumps in younger women will not be cancer. However, only an appropriate clinical examination and imaging can establish that safely. Reassurance should follow investigation—not replace it.
Women who are pregnant or have recently had a baby should also report persistent breast changes. A lump may easily be attributed to milk production, a blocked duct or hormonal change, but it still deserves assessment if it does not resolve.
The changes you should not ignore
A new lump remains the most common warning sign, but it is not the only change that should prompt a conversation with a healthcare professional.
Arrange a breast assessment if you notice:
- A new lump in the breast or under the arm.
- A persistent area of thickening or breast tissue that feels different.
- A change in the size, shape or appearance of one breast.
- New dimpling, puckering or changes to the skin.
- A nipple that has recently become inverted or changed position.
- A spontaneous nipple discharge, particularly if it is bloody, brown or clear.
- Persistent redness, swelling or an unexplained change that does not settle.
- Any symptom that is new for you and continues despite the menstrual cycle changing.
Dr Schoub emphasises that women are not expected to determine for themselves whether a discharge, lump or visual change is dangerous. That is the healthcare professional’s job.
“If there’s something new, come to us. Let us put your mind at ease—or find out if there’s a problem.”
— Dr Peter SchoubA mammogram should not be something to dread
Many women avoid their first mammogram because of stories about pain. Dr Schoub says modern equipment and well-trained staff should make the procedure manageable, even if it is not necessarily comfortable.
During a mammogram, each breast is positioned and gently compressed so that clear X-ray images can be taken from different angles. Compression is necessary to spread out the tissue and improve the quality of the image, but the examination itself is brief.
Depending on a woman’s age, symptoms and breast density, the assessment may also include an ultrasound. Women with very dense breast tissue may require additional imaging because both dense tissue and cancers appear white on a mammogram.
“It’s like trying to find a polar bear in the snow.”
— Dr Peter Schoub, explaining why dense breast tissue can make cancers harder to seeBreast density is not something a woman can determine by touch or by looking at her breasts. It becomes apparent through imaging. Dense breast tissue can both increase breast-cancer risk and make abnormalities more difficult to detect, which is why ultrasound or, in selected higher-risk cases, MRI may be recommended.
Understand your personal risk
Screening should not always follow a one-size-fits-all timetable. A woman’s personal plan may be influenced by:
- A strong family history of breast, ovarian, prostate or related cancers.
- Family members diagnosed at a young age.
- A known genetic mutation such as BRCA.
- Very dense breast tissue.
- A previous breast cancer or high-risk breast lesion.
- Previous radiation treatment to the chest.
- Other factors identified during a formal risk assessment.
A healthcare practitioner or breast-imaging centre can help calculate personal risk and advise whether screening should begin earlier or include additional imaging.
An early diagnosis changes the conversation
Dr Schoub’s central message is that early detection saves lives. Although no lifestyle change can guarantee that a woman will never develop breast cancer, screening and prompt investigation can identify it at a stage when treatment may be less aggressive and outcomes are significantly better.
“More than 90% of breast cancers caught early are not going to kill that person. That is the hope.”
— Dr Peter SchoubDr Sarah Nietz, a breast surgeon, regularly meets women during the most frightening first days after diagnosis. Her role is not only to help establish the extent of the disease, but to make sure each woman is seen as an individual rather than simply another case.
She says honesty, kindness and clear information matter enormously at this stage. A new diagnosis can feel overwhelming, but early breast cancer often has good treatment options and good outcomes.
“Especially if breast cancer is detected early, we’ve got good outcomes and good treatment options. Treatment has really advanced.”
— Dr Sarah NietzThe first recommendation is not always immediate surgery. Breast cancers differ in their biology, size, stage and response to treatment. The right sequence may involve surgery first, medication before surgery, radiation, targeted therapy, hormone treatment or a combination of approaches.
Choose a team, not a single opinion
Prof Benn, Dr Nietz and Dr Schoub all reinforce the importance of multidisciplinary care. Breast cancer should be considered by a coordinated group that may include a breast surgeon, radiologist, pathologist, medical oncologist, radiation oncologist, reconstructive surgeon and psychological-support professionals.
This collaboration allows the team to review the type and stage of cancer, discuss fertility where relevant, plan treatment in the right sequence and consider the woman’s broader life and health—not only the tumour.
“No breast cancer should be treated outside of a multidisciplinary team.”
— Dr Peter SchoubFor younger women, this coordinated care is particularly important. A diagnosis may affect studies, career plans, relationships, body image, sexuality and future fertility. Those concerns are not secondary to the medical treatment; they are part of caring for the whole woman.
Healthy choices help—but they do not make you immune
Maintaining a healthy weight, exercising, avoiding smoking, limiting excessive alcohol and eating a balanced diet may reduce risk and support overall health. Breastfeeding and pregnancy can also influence risk.
However, none of these factors provides complete protection. Women who exercise, breastfeed, eat well and have no family history can still develop breast cancer. A diagnosis is not evidence that somebody failed to live correctly.
The healthiest response is not blame. It is awareness, appropriate screening and acting promptly when something changes.
Female Forward breast-health checklist
- Become familiar with the normal look and feel of your breasts.
- Never ignore a new lump or persistent change because you think you are too young.
- Discuss your family history with a healthcare professional.
- Ask whether your personal risk means screening should begin earlier.
- Begin routine mammography from the age recommended for your risk profile.
- Ask about breast density and whether ultrasound or MRI is appropriate.
- Seek care from an experienced multidisciplinary breast team if you receive a diagnosis.
- Remember that early detection brings more options and far better outcomes.
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