George Practice

3 Trefoil Square, Gloucester Ln, George Central, 6529

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Friday: 8am - 3pm
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24 Dec - 2 Jan: CLOSED


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Mammograms – the why, when and how often’s

Breast cancer is the most frequent type of non-skin cancer and the most frequent cause of cancer death in women worldwide

The majority of breast cancers are diagnosed as a result of an abnormal screening study, although a significant number are first brought to attention by a patient. Findings suggest that screening mammography both reduces the odds of dying of breast cancer and facilitates the use of early treatment

What is a mammogram?

Mammography is the process of using low-energy X-rays(usually around 30 kVp) to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through the detection of characteristic masses or microcalcifications.

What are the benefits and potential harms of screening mammograms?

Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread. Results from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50. However, studies to date have not shown a benefit from regular screening mammography in women under age 40 or from baseline screening mammograms (mammograms used for comparison) taken before age 40.

The benefits of screening mammography need to be balanced against its harms, which include:

False-positive results. False-positive results occur when radiologists see an abnormality (that is, a potential “positive”) on a mammogram but no cancer is actually present.

False-positive mammogram results can lead to anxiety and other forms of psychological distress in affected women. The additional testing required to rule out cancer can also be costly and time-consuming and can cause physical discomfort.

False-positive results are more common for younger women, women with dense breasts, women who have had previous breast biopsies, women with a family history of breast cancer, and women who are taking estrogen (for example, menopausal hormone therapy


Overdiagnosis and overtreatment. Screening mammograms can find cancers and cases of ductal carcinoma in situ(DCIS, a noninvasive tumor in which abnormal cells that may become cancerous build up in the lining of breast ducts) that need to be treated. However, they can also find cases of DCIS and small cancers that would never cause symptoms or threaten a woman’s life. This phenomenon is called “overdiagnosis.” Treatment of overdiagnosed cancers and overdiagnosed cases of DCIS is not needed and results in “overtreatment.”

Because doctors cannot easily distinguish cancers and cases of DCIS that need to be treated from those that do not, they are all treated.

False-negative results. In cancer screening, a negative result means no abnormality is present. False-negative results occur when mammograms appear normal even though breast cancer is present. Overall, screening mammograms miss about 20% of breast cancers that are present at the time of screening. False-negative results can lead to delays in treatment and a false sense of security for affected women.

One cause of false-negative results is high breast density. Breasts contain both dense tissue (i.e., glandular tissue and connective tissue, together known as fibroglandular tissue) and fatty tissue.

False-negative results occur more often among younger women than among older women because younger women are more likely to have dense breasts. As a woman ages, her breasts usually become fattier, and false-negative results become less likely.

Some breast cancers grow so quickly that they appear within months of a normal (negative) screening mammogram. This situation does not represent a false-negative result, because the negative result of the screening was correct. But it means that a negative result can give a false sense of security. Some of the cancers missed by screening mammograms can be detected by clinical breast exams (physical exams of the breast done by a health care provider).

Finding breast cancer early may not reduce a woman’s chance of dying from the disease. Even though mammograms can detect malignant tumors that cannot be felt, treating a small tumor does not always mean that the woman will not die from cancer. A fast-growing or aggressive cancer may have already spread to other parts of the body before it is detected. Instead, women with such tumors live a longer period of time knowing that they likely have a potentially fatal disease.

In addition, finding breast cancer early may not help prolong the life of a woman who is suffering from other, more life-threatening health conditions.

Radiation exposure. Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is low, but repeated x-rays have the potential to cause cancer. Although the potential benefits of mammography nearly always outweigh the potential harm from radiation exposure, women should talk with their health care providers about the need for each x-ray. In addition, they should always let their health care provider and the x-ray technologist know if there is any possibility that they are pregnant because radiation can harm a growing fetus.


When and how often should I have a mammogram?

Current screening protocols for an average-risk woman are similar worldwide. No programs begin screening women before age 50 and few have shorter than 12–18-month screening intervals. Most advocate screening from age 50 and longer screening intervals (24–36 months). The American College of Radiology (ACR) has the longest recommended age range for screening and is the only one recommending annual screening. The UK has the longest recommended screening interval at three years.

The World Health Organization (WHO) recommends two-yearly screening in large, national-based screening programs.

South African recommendations have historically been based on American guidelines, some of which changed in 2009, again in 2016 and most recently April 2019.

© 2019 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Society and expert recommendations for routine mammographic screening in women at average risk

Group (date) Frequency of screening (years) Initiation of screening for women at average risk
40 to 49 years of age 50 to 69 years of age ≥70 years of age
Government-sponsored groups
US Preventive Services Task Force (2016)[1] Two Individualize* Yes Yes, to age 74
Medical societies
American College of Obstetricians and Gynecologists (2017) One to two* Individualize* Yes Yes, to at least age 75
American College of Physicians (2019) Two Individualize* Yes Yes, to age 74
American Academy of Family Physicians (2019) Two Individualize* Yes Yes, to age 74
American Cancer Society (2015) One year age 45 to 54 Individualize* through age 44

Yes, start age 45

Yes Yes
One to two years age ≥55
American College of Radiology (2017) One Yes Yes Yes


No matter who you are or what your risk factors are, the best option is to have an open discussion with your family doctor about any questions or concerns you might have.

Sore Throat

Your throat aches and burns. It’s painful to swallow. You know something is wrong, but how bad is it? Will it get better without antibiotics? Or will you need to visit the doctor?

Pain in the throat is one of the most common symptoms seen in healthcare. It accounts for more than 13 million visits to doctor’s offices each year worldwide.

Causes include:

  1. Colds, the flu, and other viral infections

Viruses cause about 90 percent of sore throats

  1. Strep throat and other bacterial infections

Bacterial infections can also cause sore throats. The most common one is strep throat, an infection of the throat and tonsils caused by group A Streptococcus bacteria.

  1. Allergies

When the immune system reacts to allergy triggers like pollen, grass, and pet dander, it releases chemicals that cause symptoms like nasal congestion, watery eyes, sneezing, and throat irritation.

Excess mucus in the nose can drip down the back of the throat. This is called a postnasal drip and can irritate the throat.

  1. Dry air

Dry air can suck moisture from the mouth and throat, and leave them feeling dry and scratchy. The air is most likely dry in the winter months when the heater is running.

  1. Smoke, chemicals, and other irritants

Many different chemicals and other substances in the environment irritate the throat, including:

  • cigarette and other tobacco smoke
  • air pollution
  • cleaning products and other chemicals
  1. Injury

Any injury, such as a hit or cut to the neck, can cause pain in the throat. Getting a piece of food stuck in your throat can also irritate it.

  1. Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD)is a condition in which acid from the stomach backs up into the esophagus — the tube that carries food from the mouth to the stomach.

The acid burns the esophagus and throat, causing symptoms like heartburn and acid reflux — the regurgitation of acid into your throat.

How can I tell if it is a viral or bacterial infection?

It is hard to tell the difference. But there are some clues to look for.

People who have a sore throat caused by a virus usually have other symptoms, such as:

  • A runny nose
  • A stuffed-up chest
  • Itchy or red eyes
  • Cough

People who have a sore throat caused by strep throat do not usually have a cough, runny nose, or itchy or red eyes. They might have been in close contact with another person who has strep throat. They might also have:

  • Severe throat pain
  • Fever (temperature higher than 100.4°F or 38°C)
  • Swollen glands in the neck
  • A rash

Do I need antibiotics?

If you have an infection caused by a virus, you do not need antibiotics. But if you have strep throat, you should get antibiotics. Most people with strep throat get better without antibiotics, but doctors often prescribe them anyway. That’s because antibiotics can prevent problems sometimes caused by strep throat. Plus, antibiotics can reduce the symptoms of strep throat and prevent its spread to other people.

What can I do to feel better?

If you want some relief from the pain of the sore throat, you can take pain medicine that you can get without a prescription like ibuprofen or paracetamol.  Throat sprays are no better at soothing pain than sucking on cough drops. Some people feel relief if they gargle with salt water.

When can I go back to school/work?

If you have strep throat, wait 1 day after starting antibiotics. By then you will be a lot less likely to spread the infection. If you do not have strep throat, you can go back as soon as you feel well.

How can I prevent getting a sore throat?

Wash your hands often with soap and water. It is one of the best ways to prevent the spread of infection. You can use an alcohol rub instead, but make sure the hand rub gets everywhere on your hands.

The bottom line

Viral and bacterial infections, as well as irritants and injuries, cause the majority of sore throats. Most sore throats get better in a few days without treatment.

Rest, warm liquids, saltwater gargles, and over-the-counter pain relievers can help soothe the pain of a sore throat at home.

Strep throat and other bacterial infections are treated with antibiotics. Your doctor can use a swab test to find out if you have strep.

See a doctor for more severe symptoms, like trouble breathing or swallowing, a high fever, or a stiff neck.



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  • 24 Dec - 2 JanClosed

Welcome! We are two dedicated doctors offering a full-service family practice situated in the centre of George on the beautiful Garden Route. We are eager to optimize the health of patients in and around George, as well as the surrounding area. Our doctors collaborate in order to meet the health needs of the whole family, from baby-care to care of the elderly, in a friendly relaxed atmosphere. We regard our role as being family doctors, concerned with care and support to each member of the family. Being familiar with the personal and family history of each patient, ensures that we will be able to give high quality care and service.

Drs. van der Spuy © 2019 All Rights Reserved