Melrose Arch Mammography, known to its patients as MAMI, has marked the start of spring by reminding women in Johannesburg that a breast check at its Melrose Boulevard rooms is never a single test. Every patient seen at the practice has both a mammogram and a breast ultrasound in the same appointment, reviewed by the same radiologist, because each of the two tests picks up something the other can miss.

The practice describes mammography as the gold standard test for breast cancer screening. It also accepts the well documented limitation of that test, which is that dense breast tissue can hide small cancers on a mammogram image. Ultrasound looks through that dense tissue. Rather than leaving the second test to a follow up visit, or to a referral somewhere else, MAMI performs it on every patient as a matter of routine. For the woman in the chair it means one appointment, one set of images, and one radiologist who has seen both.

September is a sensible month to get that appointment into the diary. Screening rooms across the country grow busier as the awareness campaigns of the final quarter get under way, and a booking made now is usually easier to place at a convenient time than one made in the rush later in the year. For women who have let a year or two slip since their last check, the start of a new season is a reasonable prompt.

What happens in the appointment

Mammograms at MAMI are taken on 3D machines using tomosynthesis, which builds a detailed picture of the breast from a series of thin image slices. The practice notes that this modern generation of equipment delivers a very low dose of radiation, low enough that annual imaging is considered safe, and that the scan itself is quick.

Mammogram compression is far lighter than it was on the older analogue machines, which the practice says means the examination is not painful and will not damage breast tissue or implants. Any discomfort is brief because the scan is fast. Women who have avoided screening because of what they remember of an appointment years ago are often surprised by how different the current process is.

The ultrasound that follows is performed by the radiologist rather than handed to a technician, so the person interpreting the images is also the person holding the probe. MAMI uses ultra high frequency probes, with high resolution imaging, harmonics, doppler and elastography as additional tools. For patients under 35, whose breast tissue is typically denser, ultrasound is used as the primary test in place of mammography.

A woman who has found a lump, noticed a change she cannot explain, or simply wants a starting point rather than a full screening programme can book a Breast Examination and talk it through with the team before anything else is arranged. The practice takes the same approach whether the visit is routine screening or the result of something a patient has felt herself.

When a biopsy is the next step

Imaging can show that an area of the breast looks abnormal. It cannot, on its own, say what that area is. MAMI is direct about this point on its own material: mammograms and ultrasounds are excellent at picking up abnormalities, but only a biopsy can confirm or exclude a cancer, and only a biopsy sample lets a pathologist establish what type of cancer is present.

Biopsies are performed in the mammography department itself, under either ultrasound or stereotactic guidance. Ultrasound guidance means the radiologist watches the area on screen and places the needle accordingly. Stereotactic guidance targets the area using the mammogram machine. Most ultrasound guided procedures use a core needle, a thin hollow needle fired several times into the area in question. Stereotactic procedures generally use a vacuum assisted device, which takes a slightly larger sample. A small metallic clip is always left at the site as a marker for future imaging.

Local anaesthetic is used throughout. The practice states that the procedure is not painful beyond the anaesthetic injection itself, that it takes roughly 20 to 30 minutes, and that patients go home afterwards. A small amount of bruising is normal and generally settles within about a week. Results are usually available within two to three days, which matters a great deal to anyone waiting on them.

Accreditation and the team behind the images

MAMI is the new face of Parklane Women's Imaging Centre, carrying across the same staff, the same radiologists and the same equipment into a larger and more accessible department at Melrose Arch. The Parklane practice was the first internationally accredited breast imaging unit in Africa.

The American College of Radiology has accredited the unit for mammography, stereotactic biopsy, breast ultrasound and breast MRI, and has recognised it as a Breast Imaging Centre of Excellence. The practice states that it is the only unit in South Africa to hold that centre of excellence accreditation, and the first in Africa to receive it. Accreditation of this kind is about process and quality control rather than any promise about an individual result, which is precisely why it is worth asking about when choosing where to be scanned.

Dr Peter Schoub, diagnostic radiologist and managing director of the practice, qualified as a doctor in 1998 and as a radiologist in 2007. He has focused on breast radiology for more than 15 years, holds the European Diploma of Breast Imaging awarded in 2018, and is an honorary lecturer in the Radiology Department at the University of the Witwatersrand.

The unit does not work in isolation. It forms part of a multidisciplinary breast cancer team made up of breast surgeons, reconstructive surgeons, oncologists, pathologists and radiologists. A patient diagnosed at MAMI is referred directly to that team, which evaluates the case and recommends treatment. Through treatment the imaging unit continues to assist with staging, localisation, monitoring of chemotherapy and follow up, so a patient is not repeatedly starting again with a new set of strangers.

Medical aid, cost and booking

Cost is one of the most common reasons a screening appointment gets postponed, and it is often based on an assumption rather than a check. MAMI points out that most medical aids pay for mammograms from screening benefits rather than from medical savings, which applies even to members on a basic hospital plan. Patients are invited to phone the rooms with their medical aid number so the practice can confirm cover, or quote a cash price for anyone paying out of pocket.

Bookings run through 011 484 3149 or [email protected], and the practice also takes enquiries by WhatsApp from its website. General questions go to [email protected]. The rooms are on the first floor at 10 Melrose Boulevard in Melrose Arch, Johannesburg, with parking and access that the practice designed to be easier than a hospital radiology department.

What else the practice offers

Breast imaging sits at the centre of the offering, but it is not the whole of it. MAMI is the only practice in the country offering cryoablation for breast lesions. It also provides bone density and body composition scans, and scar management massage for patients recovering from surgery. Alongside the clinical services the practice runs Wellness Within, a set of programmes, podcasts and modules covering areas such as nutrition, the mind and body connection, and life after a diagnosis.

That range reflects a view of breast health that extends past the day of the scan. A screening appointment is a single morning. Recovery, follow up and the ordinary business of staying well run for far longer, and a practice that keeps its own patients through those stages tends to know their history better than one that sees them once.

Why the annual interval matters

Guidance on when to start screening varies between countries and organisations. MAMI's stated position is that annual imaging from the age of 40 allows the earliest possible detection. The reasoning it gives is practical rather than promotional: the peak age for breast cancer sits between 55 and 60, but the practice is seeing an increasing trend of breast cancer in younger women, and cancers in younger patients are more likely to be aggressive and fast growing. Women in their 40s also tend to have denser breast tissue, which is the case where the paired ultrasound earns its place.

There is a second argument for keeping to a yearly rhythm. Regular imaging lets the radiologist compare this year's pictures against last year's, and it is often that comparison, rather than any single image, that reveals a subtle change in breast tissue worth investigating. A one off scan has no baseline behind it.

Full details of the practice, its services and its accreditations are on the MAMI website at https://mammogram.co.za/.

About MAMI (Melrose Arch Mammography)

MAMI, or Melrose Arch Mammography Inc., is a breast imaging practice on the first floor at 10 Melrose Boulevard, Melrose Arch, Johannesburg. It is the new face of Parklane Women's Imaging Centre, which was the first internationally accredited breast imaging unit in Africa. The practice provides mammography on 3D tomosynthesis equipment, breast ultrasound performed by a radiologist, and ultrasound and stereotactic guided breast biopsies, together with cryoablation, bone density and body composition scans, and scar management massage. It is accredited by the American College of Radiology for mammography, stereotactic biopsy, breast ultrasound and breast MRI, and is recognised as a Breast Imaging Centre of Excellence. The unit forms part of a multidisciplinary breast cancer team of surgeons, oncologists, pathologists and radiologists, and is led by diagnostic radiologist Dr Peter Schoub.

Media Contact
MAMI (Melrose Arch Mammography)
Email: [email protected]
Phone: +27 11 484 3149
Website: https://mammogram.co.za/