Breast cancer is a common type of cancer that starts in the cells of the breast. Many cases are diagnosed in Singapore each year, with 12,735 cases of breast cancer diagnosed between 2017 and 2021. If not detected early, it can spread to other parts of the body, including bones, liver, lungs, and brain.

The disease is caused by abnormal cells growing uncontrollably in breast tissue. Other factors may contribute to breast cancer, such as long-term exposure to estrogen, genetic predisposition, and age.

Breast Cancer Risk Factors

Knowing the risk factors for breast cancer can help you take steps to lower your risk. Common risk factors include being female, getting older, having a personal or family history of breast cancer, inherited genes that heighten your risk of breast cancer, radiation exposure to your chest area, obesity, starting your period early, starting menopause late, not having children or having them later in life, postmenopausal hormone therapy and drinking alcohol.

Symptoms of Breast Cancer

Breast cancer can have a combination of symptoms—some more visible than others—and it's important to be aware of them. Symptoms may include:

• Lumps or thickening in the breast that feels different from the surrounding tissue
• Changes in the size, shape, or appearance of the breast
• Changes to the skin over the breast, such as dimpling
• Newly-inverted nipples
• Peeling, scaling, crusting, or flaking of the pigmented area of skin around the nipple or breast
• Skin on the breast that looks like an orange peel with pits or redness
• Abnormal fluid discharge coming from the nipple

OncoCare understands that not all breast cancer symptoms are readily noticeable. That's why they have a team of dedicated breast cancer specialists who can provide comprehensive evaluation and investigation, even if you haven't experienced symptoms.

Early detection is critical in the fight against breast cancer. Even if you haven't experienced any concerning symptoms, OncoCare's team of breast cancer specialists in Singapore can help to provide comprehensive evaluation and guidance. They can leverage diagnostic tools and their expertise to better investigate any potential concerns you may have.

This proactive approach, combined with regular self-examinations and doctor-recommended screenings, empowers you to stay on top of your breast health. Here are some examples of recommended screenings:

• Clinical breast exam: A physical examination by a doctor to check for lumps or abnormalities.
• Mammography: An X-ray of the breast tissue to detect abnormalities.
• Ultrasound: Utilises sound waves to create images of breast tissue, often used to further investigate abnormalities detected during a mammogram.

Common Spread Sites for Breast Cancer

Despite its name, breast cancer can affect other parts of the body. This is why it is essential to detect it early by going for scheduled cancer screenings with a breast cancer specialist in Singapore. The most frequent sites of metastasis include:

• Bones: A common site for breast cancer metastasis. Back pain, bone fractures, and weakness can be signs of spread.
• Lungs: Cancer cells can travel through the bloodstream and settle in the lungs, causing coughing, shortness of breath, and chest pain.
• Liver: Spread to the liver can lead to fatigue, nausea, and abdominal pain.
• Brain: Less frequent, but breast cancer can metastasise to the brain, causing headaches, seizures, and vision problems.

While early detection is ideal, if breast cancer has spread to other organs, doctors rely on a combination of tests to diagnose and determine the best course of treatment.

Blood tests can assess overall health and check for tumour markers that might indicate cancer spread. Imaging tests like CT scans, MRIs, and bone scans provide detailed pictures of internal organs to pinpoint the location and extent of metastases. To definitively confirm cancer, a tissue biopsy, where a small sample is extracted for microscopic examination, may be necessary.

Treatment options for metastatic breast cancer depend on the affected organ and the cancer's specific characteristics. These may include surgery, radiation therapy, hormone therapy, chemotherapy, or targeted drug therapy.

How is Breast Cancer Diagnosed?

Early detection and diagnosis of breast cancer significantly increase your chances of survival. Women aged 20 and above are encouraged to perform a breast self-examination at least once a month. This involves physically checking your breasts for any changes in shape, the presence of lumps, or any discharge from your nipples.

To detect the presence of cancerous lumps with more accuracy than a physical examination alone, a mammogram screening is highly recommended. A mammogram is an X-ray imaging technique specifically designed for the breast. During a mammogram, a technologist will position your breast between two plates to spread out the tissue and capture clear images. These images are then examined by a radiologist for any abnormalities that may indicate cancer.

For women aged 40 to 49, it is advisable to make this screening an annual affair to catch any abnormalities as early as possible.

Treatment Methods for Breast Cancer

There are several breast cancer treatments in Singapore, including chemotherapy, immunotherapy, and radiation therapy.

1. Surgery

Breast cancer surgery is a common treatment option for breast cancer. The goal of surgery is to remove the cancerous tissue from the breast. The type of surgery recommended will depend on the size and stage of the tumour, as well as other factors such as the patient's age and overall health.

Some of the surgical options for the breast include lumpectomy, where only the cancerous lump and surrounding tissue are removed, and mastectomy, which involves the removal of the entire breast. In some cases, breast reconstruction may be performed after a mastectomy to restore the breast’s appearance. It's important to discuss the surgical options with a cancer doctor in Singapore to determine which option is best for you.

2. Chemotherapy

Chemotherapy drugs are used to kill breast cancer cells. These drugs target the vulnerabilities of tumour cells compared to normal cells. Cancer cells need different mechanisms to grow faster, repair themselves, use certain nutritional pathways, increase blood flow, reduce cell death signals, and evade immunity.

Chemotherapy and other anti-cancer therapies rely on these mechanisms to attack and kill cancer cells.

3. Immunotherapy

Immunotherapy drugs use the body's immune system to identify and kill cancer cells. When used with chemotherapy, this drug class has been most effective in treating triple-negative breast cancers.

4. Hormone Therapy

Hormone therapy is a type of breast cancer treatment that uses drugs to target the hormones that stimulate the growth and spread of hormone-sensitive breast cancer cells. This type of cancer grows in response to hormones like oestrogen, which can cause cancer cells to multiply and spread rapidly. Hormone therapy works by blocking or reducing the production of oestrogen in the body, which starves the cancer cells and slows down their growth.

Hormone therapy drugs are typically used in women with hormone receptor-positive breast cancer, which means the cancer cells have receptors that bind to oestrogen and/or progesterone. By targeting these receptors, hormone therapy can stop the cancer cells from dividing and growing, and can even shrink the tumour.

Hormonal therapy may be used alone or in combination with other treatments such as chemotherapy or radiation therapy, depending on the stage and type of breast cancer.

5. Radiation Therapy

Radiation therapy (or radiotherapy) is a treatment that uses high-energy X-rays to treat breast cancer. It can also be used in advanced cancer to treat certain conditions such as bone pains or nerve compression in the spinal cord. Brain metastases from breast cancer may also need radiotherapy. The treatment is given over several weeks and avoids the main organs as far as possible. Focal radiation to selected tumour sites, called stereotactic radiotherapy, may be used in some situations to minimise side effects.

How to Prevent Breast Cancer

Like most cancer diagnoses, avoiding breast cancer is never foolproof; however, you can take steps to help prevent its occurrence. One crucial factor, especially after menopause, is maintaining a healthy weight. Obesity can increase your risk of breast cancer. A study in 2021 found that overweight or obese women after menopause have a 20-60% higher risk compared to lean women.

Here are some ways to reduce the chances of developing breast cancer:

• Active Lifestyle: Regular physical activity can help regulate hormones and boost the immune system, both of which can possibly lower the risk of breast cancer.
• Limit Alcohol Consumption: Alcohol increases estrogen levels and other hormones associated with hormone-receptor-positive breast cancer. Reducing your alcohol intake can potentially decrease these hormone levels.
• Avoid Smoking: Smoking is linked to a higher risk of several cancers, including breast cancer. Quitting smoking can significantly reduce your risk of developing cancer.
• Pick Up a Healthy Diet: A diet rich in vegetables, fruit, and whole grains, and low in processed foods and saturated fats, can possibly reduce the risk of cancer by maintaining healthy body weight and providing antioxidants.
• Breastfeeding (where possible): For mothers, breastfeeding for at least 12 months can potentially lower the risk of both pre- and postmenopausal breast cancer, likely due to hormonal changes during lactation that delay how menstrual cycles pan out.
• Birth Control: Using hormonal birth control pills or patches for an extended period, especially before your first full-term pregnancy, may slightly reduce your risk of breast cancer. However, it's important to discuss the benefits and risks of hormonal birth control with your doctor, as it may not be suitable for everyone.

Why Go to a Breast Cancer Specialist for Screenings

If you are experiencing any breast cancer symptoms or have any risk factors, it is important to seek medical attention and get screened regularly. Early detection of cancer leads to a higher chance of successful treatment. A breast cancer specialist in Singapore like OncoCare can provide you with the best care and advice.

OncoCare is a leading cancer specialist in Singapore, providing comprehensive and compassionate care to patients with breast cancer. At OncoCare, we offer a range of screening tests and diagnostic services to detect breast cancer at an early stage. These tests include mammography, ultrasound, and breast MRI. We also have a team of experienced oncologists, surgeons, and other healthcare professionals who work together to provide personalised consultation and treatment plans for each patient.

If you or a family member has been diagnosed with breast cancer, OncoCare offers a range of treatment options, including chemotherapy, immunotherapy, radiation therapy, hormone therapy, and surgery. Our goal is to provide the best possible care and support to our patients, from diagnosis to survivorship. Contact us today to learn more about our services and how we can help you.

“Expert knowledge means better care for cancer”

Written by:

Dr Peter Ang

MBBS (Singapore)

M.Med (Singapore)

MRCP (United Kingdom)

FAMS (Medical Oncology)