Breast cancer is the most common cancer among women in Singapore. Data from the Ministry of Health (MOH), Singapore shows that close to 1,000 women in Singapore are diagnosed with breast cancer each year. Most undergo treatment, but there are some who delay seeking medical attention for months, or even years.
When detected early, breast cancer is highly curable and patients can remain well for 5, 10, even 20 years after. The earlier it is detected through screening, the higher the chance one can overcome breast cancer.
The recommended method to detect early signs of breast cancer is through a mammogram. A supplementary breast ultrasound may also be ordered by your doctor as well. In this article, we will learn why these are done.
What You Need to Know About Breast Screening
Mammogram is an x-ray of the breasts and is one of the proven ways to screen for early breast cancer. Screening refers a process to check for early disease, when there is no sign or symptom yet. A mammogram is able to detect calcium spots in the breasts, which may be a sign of early cancer, or caused by non-cancerous reasons.
During the x-ray, a female radiographer will place your breast between two flat plastic plates and compress for a few seconds. This is performed on one breast at a time. There may be some discomfort but it is important for the breast tissue to be compressed for a clearer image. Additional views may be needed for closer examination.
The patient is exposed to a low dose of radiation during the procedure (equivalent to being exposed to environmental background radiation for 2 months), so the overall radiation risk is low, and the potential benefits outweigh the risk.
- Breast Ultrasound
Ultrasound of the breasts is safe, non-invasive, painless, and is the same technology used to monitor a baby during pregnancy. It is useful in detecting lumps and for checking if a lump is solid or cystic.
However, an ultrasound cannot detect calcium spots. Your doctor may order an ultrasound – not for screening, but for diagnosis to confirm what type of lump it is. An ultrasound may also be used to supplement a mammogram for ladies with dense breasts.
If you have breast implants or family history of breast cancer, talk to your doctor to ask about MRI screening.
For patients where screening picks up an abnormality, consult your doctor and he/she will advise if you need a biopsy.
Who Should Get Screened for Breast Cancer?
Women aged 40 to 49 are recommended to go for a mammogram every year. For those above age 50, this should be reduced to once every 2 years.
For younger women below the age of 40, a screening mammogram is not recommended. If you have a high risk of breast cancer due to family history or hereditary genetic mutations, you should speak to a breast specialist early.
In addition to screening, all women aged 18 and above should do monthly breast self-examination (BSE) to help you be familiarized with the feeling and look of your breasts. This will enable you to detect any changes and abnormalities more easily.
If you notice a change in your breasts that seem abnormal or if one breast is different from the other while doing BSE, you should seek immediate medical advice from your doctor.
Do Mammograms Hurt?
Mammograms do not necessarily hurt but may be uncomfortable due to the compression of the breasts between two plates. If it gets too uncomfortable for you, please do not hesitate to inform your radiographer.
Risk Factors for Breast Cancer
Some women are at higher risk of developing breast cancer as compared to others. Here are some risk factors for you to take note of:
- Having one or more close relatives with breast cancer
- Personal history of breast cancer
- Age – breast cancer risk increases as one gets older, especially after menopause;
- Being overweight;
- Being physically inactive;
- Drinking alcohol regularly; or
- Long-term use of combined hormone replacement therapy (of more than 5 years)
Regular screening is important, even more so for women with any of these risk factors.
What Happens After the Diagnosis of Breast Cancer?
Once your doctor confirms the diagnosis of breast cancer, the first process involved is staging. This will help determine the extent of the disease and prognosis. Staging is also used to plan treatment options.
Breast cancer is typically classified into Stage 0, I, II, III, or IV, based on the tumor size, the involvement of lymph nodes, and whether it has spread to other body parts.
The presence of tumor markers like estrogen/ progesterone receptors and proliferation factors (HER2) and are also analysed during the staging process, as they may affect the sequence of treatment for surgery versus systemic treatment.
Once staging is done, your doctor will advise on the ideal treatment options. The course of treatment will highly depend on your overall health, breast cancer type, stage, grade, size, sensitivity to hormones, and your personal preference.
The most common treatment options are Surgery (Lumpectomy or Mastectomy), Chemotherapy, Radiation Therapy, and Hormonal Therapy.
Here’s what you need to know about the treatments for breast cancer:
- Lumpectomy: This procedure is a form of “breast preservation” or “breast-conserving” surgery. In this surgery, only the tumor and a small portion of healthy tissues surrounding the tumor are removed. Following this surgery, changes in breast shape and size, as well as a scar, may be expected.
To further eliminate cancer cells that may remain after lumpectomy, most patients go through radiation therapy for a week, after the surgery wounds have healed.
- Mastectomy: This procedure is the surgical removal of the whole breast to completely take out the breast tissues. If patients opt for reconstruction surgery, this may be performed and we will preserve the skin in the breast region, or maybe even the nipple if suitable.
Reconstruction of the breast is done with tissue taken from another part of the body. Skin-saving and nipple-sparing mastectomy can only be performed when the breast under the skin or nipple is free from tumor cells.
- Radiation Therapy: With the use of high-powered protons and x-rays, this procedure is used to kill the cancer cells by focusing on the part of your body where the malignant tumour is located and making it shrink. This type of treatment may last between one to three weeks.
- Chemotherapy: This is the administration of cancer drugs intravenously (IV) to reduce the risk of cancer coming back. The risk of recurrence is linked to the stage of your cancer. Chemotherapy has side effects and most commonly nausea, rash, fever and hair loss; but the frequency and severity vary from patient to patient.
- Hormone-Blocking Therapy: There are breast cancers that are progesterone (PR positive) or estrogen receptor-positive (ER-positive). Such hormone-sensitive cancers are suitable for such treatment, in the form of a daily tablet. It also helps decrease the chances of breast cancer from recurring.
- Targeted Therapy Drugs: Some cancers have overexpression of HER2 (Human Epidermal Growth Factor 2). This is a receptor (sensor) that make a cell grow very fast. Targeted therapy is also given intravenously (IV). In targeted therapy, only HER2 cells are attacked, and healthy cells are spared; as compared to chemotherapy wherein both cancer cells and healthy cells are attacked.
- Immunotherapy: Immunotherapy uses your body’s own immune system to fight off the cancer cells. It is not first line treatment for breast cancers. For the rare cancers that do not respond to usual chemo/targeted treatment or in cases of cancer recurrences, the doctor may recommend immunotherapy. It is one of the most expensive treatment options for any kind of cancer.
- Sentinel lymph node biopsy: This is done during the operation to check the first few “guarding” lymph nodes. If breast cancer spreads, it usually spreads to the lymph nodes in the axilla (armpit) first since it is closest to the breast. If the sentinel lymph node biopsy is normal, then nothing further is done. If the sentinel lymph node biopsy shows cancer spread, then your doctor will proceed with axillary lymph node dissection.
- Axillary lymph node dissection: This is a procedure done to remove all visible fat (which contains the lymph nodes) in the axilla.
- Palliative or Supportive Care: For patients with stage 4 cancer, the aim of palliative care is to improve the quality of life of the cancer patient. In combination with other treatment options, palliative care focuses on alleviating the symptoms experienced by the cancer patient.
Get Screened Today!
The patient, and her loved ones may also undergo a lot of emotional and mental stress. We strongly advise to empower yourself with facts and knowledge, and have a routine health check-up. Talk to your healthcare provider to schedule a mammogram if you are aged 40 and above. If you detect abnormal changes to your breasts, speak to a breast specialist early and don’t delay treatment.
For a detailed review and consultation with a breast specialist, you can book a consultation with Dr Tan Yia Swam, Clinical Director of Thomson Breast Centre. Take action today and live life to the fullest.