Breast Cancer Screening

Overview

Screening for illness refers to the process of identifying a very early stage of the disease process, such that the disease may be prevented or cured. Tests that are used for screening have been rigorously studied to make sure that they are user-friendly, accurate, and cost effective.

For women, there are effective screening tests for breast and cervical cancers.

For breast cancer screening, most countries, including Singapore, recommend mammogram (MMG) screening from age 50 onwards. For ladies who are at higher risk, or wish to start earlier, mammogram screening may start at 40. Some specialists will recommend a supplementary ultrasound (US) as well.

What is a mammogram?: A MMG uses X-rays to detect calcium spots in the breasts- which may be a sign of early cancer. Calcium spots may also be due to many other non-cancerous causes. This should not be done during pregnancy or breastfeeding.

During the X-ray, a 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 close examination. Talk to your breast specialist at the clinic review to understand the findings.

What is an ultrasound?:

Ultrasound is the same technology used to monitor the baby during pregnancy, it is

safe for use. It is useful in detecting lumps, and for checking if a lump is solid or

cystic (“water”).

Most specialists do not use US as a screening, as most of such lumps detected are not cancerous; while a lump that is cancerous may be at an advanced stage, as compared to cancer detected by the MMG method.

Symptoms

Women who have no symptoms and feel well may actually have minor abnormalities, or very early cancer changes.

Screening should be done, even when a person feels completely well, as the disease may be in such an early state that there is no sign or symptom at all. This doesn’t apply only for breast cancer, but for conditions such as high blood pressure, diabetes, high cholesterol, colon cancer etc.

Who should undergo Mammogram Screening?

If pregnant/breastfeeding: Cannot do MMG. Do frequent breast self exam– if a lump is felt, see a doctor for an ultrasound.

If age less than 40: no routine screening advised. Please consult a specialist to discuss other modes of screening if you are at high risk of breast cancer.

If age 40 or more, consider yearly MMG screening, with a supplementary US

If age 50: strongly encouraged for 2-yearly MMG screening, with a supplementary US. For some patients, your doctor may recommend keeping to a yearly schedule, if your MMG shows dense breasts, or there are some minor abnormalities detected.

Diagnosis

The test(s) you need will depend on your mammogram result. Dr Tan Yia Swam will recommend suitable tests for you, such as:

  • A repeat mammogram where different views of the breasts are taken
  • An ultrasound
  • A biopsy of the abnormal area may be necessary, to get samples for looking under the microscope

If you had one of the above symptoms, Dr Tan Yia Swam will access and arrange for the relevant radiology (mammogram, ultrasound, whole-body scan), and biopsies of abnormal areas as indicated.

What happens when there is an abnormal screening

Screening may be done by your family doctor, general practitioner, polyclinic, or any health screening services. When there is an abnormality, that is when you will be referred to a breast specialist (such as Dr Tan Yia Swam) for an in-depth discussion of

  • What the abnormality is
  • How serious is it
  • What needs to be done to confirm the abnormality

A breast specialist will be able to evaluate your condition, and guide you on the next steps of treatment.

Causes, and Prevention of Breast Cancer

Dr Tan Yia Swam believes that a healthy lifestyle is the best medicine. A holistic approach, encompassing all aspects of wellness is the key to good health. Eat whole foods, exercise, look after the mental and emotional health, develop strong bonds with family and friends to have good social support.

All of the above will reduce the chance of almost all illnesses. Even when a critical illness strikes, being strong and fit- physically and mentally- will help you get well faster.

For breast cancer prevention, general tips include keeping an average weight, don’t smoke, don’t drink alcohol. If you enjoy alcohol, to keep drinking to no more than 2 drinks a day.

Sometimes, even with best efforts at prevention, cancer cells can still grow. Then the best protection we have is for early detection.

The good news is, early detection can increase your chances of survival. Hence, every woman aged 40 and above should be screened regularly for breast cancer.

These are the methods for early detection:

  • Do regular monthly breast self examination
  • Go for regular screening mammograms
    • 40-50: once a year, consider supplementary US
    • >50: once every two years, however,
    • If dense breasts: consider yearly MMG/US
  • See a doctor once a year, for a physical examination and additional tests as necessary
    • Ultrasound breasts
    • MRI breasts (for selected high risk individuals)
    • Biopsy (for abnormal findings on radiology)
    • Genetic screening (for selected individuals)

For a personal assessment, tailored to your individual medical and family history, speak to a breast specialist to understand more; and learn about what method of early detection is most suitable for you.

Risk Factors

Everyone, both men and women are at risk of breast cancer. A person has an increased risk of cancer if she has the following:

  • Being 50 years of age or older; and/or
  • Having a first-degree relative with breast cancer: mother, sister or daughter

Having a male relative with breast cancer

  • Having a personal history of breast cancer, or an abnormal breast biopsy (please bring previous result to the consultation)
  • A history of ovarian cancers

Some other milder risk factors are as below:

  • Early onset of menstruation
  • Late menopause
  • Having your first child after the age of 30
  • Having fewer children or never having children
  • Being on hormone replacement therapy
  • Weight gain, especially after the menopause

However, the absence of these risk factors does not mean protection against breast cancer. Regular screening, including performing regular breast self-examinations, is important for the early detection of breast cancer, as early stages of the disease may not have any symptoms.

Consult Our Doctor

Dr Tan Yia Swam Breast & General Surgeon

MBBS (Singapore), M.Med (Surgery), FRCS (Edin), FAMS (Surgery)

FAQs

Avoiding standing still for long periods will reduce the pressure in the veins in the legs. For people who need to stand for long periods at work, wearing compression stockings will reduce the pressure build up in the legs.

The ultrasound will be done of the legs from the thigh to the calves. Please wear or bring along a pair of shorts to change into for the scan.

Have a question or need a second opinion?

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