The impact of Measurement Accuracy in the fight against breast cancer

In 2018, it was estimated that 627,000 women died from breast cancer – that is approximately 15% of all cancer deaths among women. South Africa is no different as the Cancer Association of South Africa (CANSA) also mentions that breast cancer is the leading cancer affecting women in the country.

According to the National Cancer Registry, the probability is that 1 in 27 women are at high risk of being diagnosed with breast cancer in their lifetime and the risk is higher for women over the age of 55. To improve breast cancer outcomes and reduce mortality rate, early detection is critical.

There are two early detection strategies for breast cancer: early diagnosis and screening.

Early diagnosis strategies focus on providing timely access to cancer treatment by reducing barriers to care and/or improving access to effective diagnosis services. The goal is to increase the proportion of breast cancers identified at an early stage, allowing for more effective treatment to be used and reducing the risks of death from breast cancer.

Screening consists of testing women to identify cancers before any symptoms appear. Various methods have been evaluated as breast cancer screening tools, including mammography, which uses low-energy x-rays to identify abnormalities in the breast.

Radiation technologies play a critical part in the diagnosis and treatment of breast cancer (and other cancers) in South Africa, from imaging using mammography, to treatment with external beam radiotherapy. As important a role as these radiation technologies play, they could also be detrimental to the patients and other health workers, if not correctly calibrated using instruments that have valid calibrations traceable to the international measurement standards.

The National Metrology Iinstitute of South Africa (NMISA) was established under the Measurement Units and Measurement Standards Act, No.18 of 2006, to provide for the use of measurement units of the International System of Units (SI) and to provide for the keeping and maintenance of the national measurement standards.

The dosimetry standards section at NMISA, first accredited for ISO 17025 in 2003, provides traceability to the health sector amongst many other industries, through the calibration of radiation detectors used to ensure safe use of the mentioned radiation technologies, and calibration of personal monitoring devices used to ensure safety of health workers.

NMISA plays an important role in ensuring the optimization of protection and safety in medical radiation exposure. This is because, calibration is the cornerstone for accurate radiation dose measurement in hospitals using ionising radiation technologies for diagnostic and/or treatment of cancer.

Without the calibration of devices, it is impossible to know with certainty how much radiation has been administered to a patient, leading to either overdosing or underdosing which could both be detrimental to the patient care.

The institute also provides these services to the Southern African Development Community (SADC) countries and the rest of the region. The dosimetry section has also been declared by AFRA/IAEA as a regional training centre for the English-speaking African countries.

NMISA is part of the Department of Trade, Industry and Competition’s (dtic), family of the Technical Infrastructure (TI) Institutes, which also include the South African Bureau of Standards (SABS), National Regulator for Compulsory Specification (NRCS) and the South African National Accreditation System (SANAS), that together provides for confidence in local goods and products and allows for successful prosecution in cases of non-compliance