Understanding breast cancer | Interview with Singapore Breast Surgeon, Dr Lee

Is breast cancer common?

Breast cancer is very common in Singapore, in fact, it’s the top cancer amongst ladies in Singapore. 1 in 13 Singaporean women will be diagnosed with breast cancer in their lifetime. An average of 6 women are diagnosed with breast cancer every single day.

The good news is that more ladies are being diagnosed at an earlier stage, which is stage 1 and 2 and it is attributed to increased awareness about breast cancer and the efforts of our primary physicians, health promotion board as well as education on social media

Some of the risk factors for breast cancer includes:

• A positive family history
• Prolonged female hormone exposure due to early age of menses onset, late menopause, never being pregnant and never breast fed     
• The use of oral contraceptives or hormonal replacement therapy during menopause
• Lifestyle factors like smoking, excessive alcohol, sedentary lifestyle and obesity

Age is an important risk factor too. The incidence of breast cancer rises above the age of 40 and tapers off after 69. Thus, the age between 40 and 69 is a risk factor. Medical breast cancer screening should start from age 40 onwards. But self-check breast examination should start from an even earlier age, as early as in your 20’s.

Self-examination

Breast self-examination is important as it allows a woman to detect any breast lump early especially if this lump is due to a cancer. It would be recommend doing it once a month. For ladies who have yet to reach menopause, it is advisable to do it 7-10 days after the start of their menses. Ladies who are menopause can do this any time in the month.

The 3 simple steps of “look, feel and check”

Look – Look into the mirror with their arms raised. Observe for any nipple changes or obvious lumps or skin changes. Then turn from side to side to see if there are any changes at the sides.

Feel – Feel for any lumps in the breast with the tips of the 3 fingers. This should also include the armpits of both sides. This is best performed while lying down.

Check – Last is to squeeze the nipple gently on each side to see if there is any discharge.

Mammogram

Ladies who have no symptoms and between the age of 40-49 can consider doing a mammogram on a yearly basis while ladies who are above the age of 50 should do their mammogram once every 2 years.

Mammogram services are easily accessible at most polyclinics across Singapore. In fact, mammograms can also be arranged by your family physician or as part of health screening packages.

Ultrasound

Ultrasound is a very simple and safe method of examining the breast. There is no radiation and it can even be performed in the clinic.

In general, ladies below the age of 40 are not encouraged to do a mammogram as their breast tissues are more dense and that may make the interpretation challenging. If a young lady in her 30s has any breast issues or lumps, she should seek medical attention and consider a breast specialist review. A bedside ultrasound may be done at the time of the consultation.

In some situations, however, Ultrasound may complement mammogram as breast cancer screening tools.  onsult your family physician or breast doctor for the best screening recommendation.

3-dimensional mammogram

3D mammogram can be said to be an improved version of the current 2D mammogram that we are using.

Unlike a 2D mammogram where only 2 views of the breast are taken, 3D mammogram will allow multiple Xray images of the breast to be taken in various angles and this will be compiled by the computer software to produce the digital images.

Advantages of a 3-dimenstional mammogram

It has been shown to improve the clarity of the scan and avoid the probability of overlapping breast tissue. It has also been shown to improve the cancer detection rate especially so in ladies with dense breast tissue. Most ladies who have experienced 3D mammogram have said that the pain and discomfort is significantly lesser than that of the 2D mammogram. The amount of radiation emitted by both types of mammograms is extremely low and are very safe. 3D mammogram is available at most restructured hospitals and also at selected private hospitals and breast imaging centres. 

Early detection

The reasons why we as doctors would want to recommend breast cancer screening is to detect early-stage cancer. If we can detect breast cancer early, the 5-year survival rate is as high as 70-90% whereas late-stage cancer survival rate is only less than 30%. Therefore, it is important to do regular breast cancer screening.

Final parting message

Despite the improvement in awareness of breast cancer, our screening rates is still one of the lowest amongst the first world countries. Our screening rate is 30%. That of Sweden and UK is as high as 90%!

A research looking into the reasons why Singaporean women are reluctant to go for their mammogram showed the top reason being fear. The fear of radiation, fear of being diagnosed with cancer and also fear of pain from the mammogram. The other reason often quoted was that of inaccessibility and the lack of time for themselves. It is strongly encouraged that all ladies out there to do your own monthly breast examination and those above 40 to go for your regular breast screening examination.

Dr Lee Wai Peng

MBBS (Singapore), MRCS (Edin), M MED(Surgery), FRCS (Edin), FAMS