A Comprehensive Guide to Breast Cancer

Breast Cancer Singapore

Breast cancer occurs when abnormal cells in one or both breast tissues grow and multiply uncontrollably, forming a tumour. This tumour can invade nearby tissues and spread to other parts of the body through the lymphatic system or bloodstream, a process known as metastasis. In Singapore, breast cancer is a common disease among women, accounting for approximately 29.7% of all cancers. One in 13 women will develop breast cancer in their lifetime.

With early detection, breast cancer survival rates have improved in recent years. According to the Singapore Cancer Registry, patients with Stage I breast cancer have a 90% 5-year survival rate, while Stage II patients have an 80% 5-year survival rate.

Signs and Symptoms of Breast Cancer

The most commonly reported signs and symptoms of breast cancer include the following:

• New Lump in Breast or Underarm: A painless lump or mass in the breast or underarm area may be present, accompanied by tenderness that persists throughout the menstrual cycle.
• Skin Changes: The skin on the breast may appear dimpled, puckered, scaly, or inflamed. It may also exhibit red, purple, or darker discolouration than other breast areas.
• Nipple Changes: The nipple may be pulled in or retracted, leading to persistent itching and a rash around the area. It may also cause discharge of clear, bloody, or yellowish fluid.
• Overall Breast Changes: Changes in the size or shape of the breast, swelling in the armpit area or near the collarbone.

Stages and Types of Breast Cancer

Doctors employ breast cancer staging systems to assess its severity, plan treatment strategies and set a prognosis. Breast cancer stages are determined by tumour size (T), lymph node involvement (N), and metastasis to other parts of the body (M). These include:

• Stage 0: This stage is non-invasive, with abnormal cells confined to the breast duct and not spread to surrounding tissues (carcinoma in situ).
• Stage I: In this stage, the tumour measures less than 2 cm and has not spread to nearby lymph nodes and tissues.
• Stage II: The tumour is between 2 – 5 cm with the potential to spread to nearby axillary nodes.
• Stage III: During this stage, the tumour exceeds 5 cm in size and/or has spread to axillary lymph nodes. Cancerous cells may also penetrate the chest wall or skin.
• Stage IV: The cancer has spread from the breast and nearby lymph nodes to other parts of the body, such as the bones, liver, lungs, or brain.

Furthermore, there are various types of breast cancer, such as:

• Ductal carcinoma in situ (DCIS): This is a non-invasive form of cancer in which abnormal cells are limited to the milk duct lining and do not spread beyond the duct.
• Invasive ductal carcinoma (IDC): The cancer grows in the cells lining the milk ducts of the breast and later metastasises through the duct wall, surrounding tissue, and other parts of the body.
• Invasive lobular carcinoma (ILC): The cancer begins in the milk-producing glands (lobules) of the breast and invades other areas of the body.
• Lobular carcinoma in situ (LCIS): This is only found in the milk-producing lobules. It is not considered a true cancer but rather an indication that invasive cancer may occur develop.

Causes and Risk Factors of Breast Cancer

Although the exact cause of breast cancer remains unclear, several factors are associated with an increased risk of developing the disease. These include:

• Age and Gender: Breast cancer is more common in women, and the risk of developing the condition increases after reaching the age of 50.
• Early Onset of Menstruation and Late Menopause: Women who start menstruating at a younger age (before the age of 12) or experience late menopause (after the age of 55) are at a higher risk of breast cancer due to prolonged exposure to oestrogen and progesterone hormones.
• Family History: If an individual has one or more first-degree relatives (such as a mother, sister, or daughter) who have been diagnosed with breast cancer, their risk of developing the disease is doubled, primarily due to specific genes, such as BRCA1 and BRCA2.

Treatment Options for Breast Cancer

Breast cancer treatments differ depending on tumour size and location, diagnosis, and disease stage. Some common treatments available include:

• Surgery - This is an effective treatment option for breast cancer, with two main types:
  • Lumpectomy: In cases of early-stage cancer, a surgeon may remove the tumour along with a small portion of surrounding healthy tissue while preserving the rest of the breast tissue.
  • Mastectomy: For more advanced stages, this surgery involves the total removal of the breast tissue, including the nipple, areola, and underlying lymph nodes.
• Therapies - These treatments may be used in combination with surgery or as standalone options, depending on the type and stage of breast cancer. Some breast cancer therapies include:
  • Chemotherapy: This procedure utilises powerful drugs to kill or slow cancer cell growth. Usually, doctors administer it orally as pills or inject it directly into the vein with a needle.
  • Hormone Therapy: This treatment aims to block or impede the effects of oestrogen and progesterone or reduce their levels in the body to halt breast tumour progression.
  • Targeted Therapy: This procedure uses drugs to target molecules or pathways involved in cancer growth in patients with HER2-positive breast cancer.
  • Immunotherapy: This treatment stimulates the immune system to recognise and destroy cancerous cells. It is typically reserved for patients with late-stage breast cancer.

Prevention and Early Detection

While not all cases of breast cancer can be prevented, implementing risk-reduction strategies can help minimise the chances of developing the disease. Lifestyle changes such as adopting a healthy diet, regular exercise, and limiting alcohol consumption can lower the risk of cancer development and support overall breast health.

Moreover, early detection is crucial to improving the breast cancer prognosis. The following methods are typically employed for screening and early detection:

• Visual and Manual Breast Exam: The doctor examines the breasts for any unusual changes, such as lumps, swelling, puckering, or dimpling of the skin, or changes in the nipple.
• Mammogram Screening: This procedure uses low-dose X-rays to detect breast abnormalities, including calcium deposits, asymmetries, or tumours.
• Other Diagnostic Tools: Vacuum-assisted biopsy involves using a specialised needle to extract a tissue sample for further analysis. Breast ultrasound uses sound waves to generate images of the internal breast structure.

Aftercare, Follow-Up, and Monitoring

Following breast cancer treatment, it is crucial to prioritise post-treatment care and monitoring to detect any signs of recurrence. This involves regular check-ups, imaging studies, and blood tests to monitor progress and provide ongoing support. Patients should actively participate in their aftercare plan and communicate any concerns or symptoms to their doctor. Regular follow-up appointments and monitoring also help to maintain overall health and well-being after treatment.

Maven Surgery offers a range of services for breast cancer, including breast screenings, diagnostics, and surgical procedures, all conveniently located under one roof for the comfort and convenience of our patients. To learn more or make an appointment, please contact us at 6355 5285.

Doctor Profile

Dr Chong Chee Keong

Medical Director & Breast Cancer Surgeon MBBS (Singapore), FRCSEd, FRCS (Glas)

With more than 20 years of experience, Dr Chong Chee Keong is a breast cancer surgeon in Singapore dedicated to providing seamless and supportive care to his patients. He holds Fellowships from the Royal College of Surgeons in Edinburgh and Glasgow and has pursued further training in minimally invasive breast cancer surgery and reconstruction techniques in Japan, which allows him to offer faster recovery times and potentially less scarring for his patients.