Breast Cancer and Your PMB Entitlements
- Tony
- Oct 9
- 3 min read
October: A Month of Awareness and Action
October has been recognised as Breast Cancer Awareness Month since the 1980s — often referred to as “Pink October.” During this time, people across the world wear pink ribbons to raise awareness about prevention, routine screening, and the importance of early detection.
Globally, breast cancer remains the most diagnosed cancer, 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 among both women and men. While breast cancer is more common in women, it’s important to remember that men can also develop the disease — representing around 1.8% of local cases, higher than the global average of less than 1%.
This October, the Council for Medical Schemes (CMS) joins the international movement by highlighting key facts about breast cancer — including risk factors, early warning signs, and the Prescribed Minimum Benefit (PMB) level of care available to medical scheme members.
Know the Risk Factors
Although anyone can develop breast cancer, some individuals are at a higher risk due to genetic, lifestyle, or environmental factors.
For both women and men:
Age: Risk increases after age 50 for women and between 40–80 for men.
Genetic mutations: Inherited changes in genes such as BRCA1 and BRCA2.
Family history of breast cancer.
Previous radiation therapy to the chest.
Lifestyle factors: Physical inactivity, obesity, and alcohol use can all contribute.
Additional male-specific risks:
Klinefelter’s syndrome: A genetic condition causing higher oestrogen and lower androgen levels.
Hormone therapy treatments: Especially oestrogen-containing medications used in prostate cancer management.
Recognising the Signs and Symptoms
Early detection saves lives. Regular self-examinations and awareness of changes are crucial for prompt diagnosis and treatment.
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 a pulling sensation.
Screening recommendations:
Women: Clinical breast exams and mammograms — check with your medical scheme for coverage.
Men: Seek medical advice immediately if any unusual breast changes occur.
When detected early, breast cancer can be effectively treated through surgery, chemotherapy, radiation, or hormonal therapy.
PMB Level of Care for Breast Cancer
Treatable breast cancer falls under the Prescribed Minimum Benefit (PMB) regulations, specifically Diagnosis and Treatment Pair (DTP) code 950J.This means that once breast cancer is confirmed as treatable, your medical scheme must cover the diagnosis, treatment, and follow-up care — regardless of your benefit plan.
PMB Level of Care Includes:
Screening and physical breast examinations.
Specialist consultations.
Surgery (including reconstruction).
Radiology and pathology services.
Chemotherapy and radiation therapy.
Certain biologic medicines and genetic testing when clinically necessary.
For women with confirmed BRCA1 or BRCA2 mutations, or a strong family history of breast cancer, preventive mastectomy and reconstruction of the unaffected breast are also covered at the PMB level.
Not covered under PMB (but may be funded at your scheme’s discretion):
Preventive mastectomy in women without breast cancer.
Screening mammograms (though many schemes provide this annually).
Certain advanced biologic treatments.
Taking Action This October
Awareness is only powerful when it leads to action.Know your risk, get screened, and understand your medical benefits.If you are a member of a medical scheme, you are entitled to care for treatable breast cancer under PMB — ensuring access to essential diagnostic and treatment services.
Key Takeaway
Early detection, awareness, and understanding your entitlements can make a life-saving difference. This Pink October, let’s stand together in spreading knowledge, supporting those affected, and promoting access to quality care for all.
Source Acknowledgement
This article has been adapted and summarised using information published by the Council for Medical Schemes (CMS), including their official CMScript documents which can be viewed for further detail:
The CMS is the regulatory authority overseeing medical schemes in South Africa, ensuring members’ rights and benefits are protected.
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