Breast Cancer

Overview

Breast cancer is known to be the most common cancer affecting women in Singapore. There is much awareness, but some of the facts are shrouded in myths, resulting in a lot of fear and anxiety. Dr Tan Yia Swam believes that knowledge is power, and she wants to empower all women to take charge of their health and wellness.

What is Breast cancer?

Breast cancer is cancer that starts in the breast tissues, and is multifactorial. There is a combination of genetic and environmental triggers for breast cancer.

There are five stages of breast cancer: 0, 1, 2, 3 and 4. At the earlier stages (0 and 1), treatment can result in survival rates of over 90 percent. Patients may have no symptoms and just had an abnormal mammogram in a routine health screen, or they may have symptoms (as below). All such patients should be evaluated by a breast specialist, who will arrange for breast radiology (imaging such as mammogram or ultrasound) and biopsy as necessary. Once cancer is confirmed, your doctor will explain what stage you are at, and what treatments are needed.

Symptoms

Early breast cancer usually does not have any symptoms. This is why regular mammograms are important. If you experience any of the symptoms described below, please see your doctor early for further evaluation.

  • Painless lump
  • Unusual nipple discharge (eg bloody/greenish/yellowish fluid; not milk)
  • Retracted nipple
  • Persistent rash around the nipple
  • Dimpled/puckered skin
  • Swollen/thickened skin

When to Seek Treatment

It is good to see a breast specialist as soon as possible. If ever you receive an abnormal mammogram report, your doctor will ask you to go for further tests. It may be a stressful period, but try not to panic. Nine out of every 10 women who need further tests will have normal results. Having to go for further tests does not mean you have breast cancer- it just means that the screening test picked up something abnormal, that needs more specialised testing.

Lab tests, and specialised scans need time to organise, and to be reported. Frequently, we see women who are very anxious and want an immediate answer. We seek your understanding that these tests need time to process, and we want to give an accurate diagnosis.

Your breast specialist will be able to facilitate the tests in a timely manner. Dr Tan Yia Swam is aware of how stressful and worrying the waiting can be, and our team has always assisted in coordinating appointments for the patients under her care.

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.

Treatment

When breast cancer is confirmed on biopsy, treatment options will depend on the following:

  • Stage of breast cancer (whether early or late)
  • Types of cancer cells (additional receptor status, ER/PR/her2 which your doctor will arrange for)
  • Age and general health of the individual
  • Personal preference and beliefs

Early-stage breast cancer may require only surgery while late-stage breast cancer often will require a combination of the following treatment options:

  • Breast cancer surgery (may be lump removal, or whole breast removal, with lymph node checking and removal)
  • Radiation therapy: this uses high-energy X-rays to kill cancer cells
  • Chemotherapy: this uses drugs (usually injectable) to destroy cancer cells
  • Hormone therapy: this uses anti-hormonal therapy (usually a tablet form) to stop hormone-responsive cancer cells from growing

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)

Breast Cancer Surgery FAQs

Breast cancer treatment needs a combination of surgery, chemotherapy, targeted therapy, radiation therapy and hormonal therapy.

The exact combination depends on your cancer: be it “stage zero” DCIS, or invasive cancer, and what stage you are diagnosed at. The receptors (ER/PR,her2) also affects the type of treatment you will receive, as well as the choice of surgery. It is complex, and personalised. I urge you to peak with your team of doctors to decide what is best for you. The team will be made up of a surgeon, a radiologist, a medical oncologist and a radiation oncologist.

Medical professionals seldom use “cure” when describing cancer. We will say, “in remission”. My analogy is, think of cancer like any other chronic condition- diabetes, or hypertension. We use treatments to keep the condition under control, so that we can continue to enjoy a good quality of life.

This varies from person to person. My assurance to my patients is, a few days, or even 1-2 weeks needed for complete assessment and treatment planning is not going to affect the long term outcome. When a patient self-detected a lump that’s 3cm, the cancer might have been there for months or even years. Conversely, I have had a few patients who rejected treatment for a confirmed cancer, and some progress fast, within 6 months to stage 4; while others might come back again for treatment after 2 years and be at the same stage. 

All cancer starts at the cell level when it cannot repair itself. A normal cell should “grow old” and die- a process called apoptosis. When this natural process is disrupted, due to some gene mutation, then the cell becomes immortal- and that’s a cancer. 

Surgery is broadly divided into 2 types: (1) mastectomy – i.e. whole breast removal vs (2) breast conservation (also called lumpectomy, or wide excision).  Mastectomy has various types as well: simple mastectomy (leaving a flat chest), or skin-sparing/nipple-sparing mastectomy-> this is done together with a reconstruction, so that the lady can have a natural breast shape similar to her original.

Other than removing the cancer in the breast, we will also check the lymph nodes through a process called sentinel lymph node check. 

I usually take around 90 minutes to 3 hours, depending on the complexity of the surgery.

If patients opt for reconstruction, my Plastic Surgeon colleague may take another 4-6H to do the reconstruction

Most patients stay in the hospital one night, then they go back home to rest after that. Daily activities are back to 90% normal; and I see them one week after that to check the wound and explain the final lab report. I teach them arm exercises, and then they should be back to near normal in another month after that.

For patients with reconstruction, the recovery may be a bit longer- again depending on their overall health and fitness level, body conditioning and tone. Some are as fast as 6 weeks; some take 3 months or longer. 

Yes. I always tell my patients, the first one year after diagnosis may be the “hardest”, due to multiple medical appointments to get a full assessment, and treatments. But the following year- life should go back to normal. Do not live in fear of the cancer.

Have a question or need a second opinion?

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