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Breast cancer in Singapore: Risks, symptoms and preventive steps

By: Amy Greenburg

In honour of Breast Cancer Awareness Month, we asked gynaecologist and obstetrician, Dr Christopher Ng of GynaeMD Women’s and Rejuvenation Clinic, to educate us on the terrible disease and how we can detect it as early as possible.

Totally not awkward for the model involved at all....
Totally not awkward for the model involved at all….

What are the risk factors for breast cancer?
They include family history (inherited mutated genes), personal history, increasing age, obesity, alcohol consumption, radiation exposure, early menarche and late menopause, having your first child after the age of 35, having never been pregnant, and excessive hormonal exposure – especially women who undergo hormone replacement therapy (HRT) for longer than five years after menopause. Any woman is at risk of developing breast cancer, but those with these risk factors are in greater danger.

What are the symptoms that women should look out for?
Breast lumps, skin changes, including pitting and dimpling, change in breast shape, bloody nipple discharge and nipple inversion.

What forms of screening are used to diagnose breast cancer?
The most effective and proven method to detect breast cancer early is an X-ray of the breasts, or mammogram, and this can be combined with an ultrasound scan of the breast in some cases. Women are also encouraged to examine their own breasts on a monthly basis, after their periods have ended – although this is not considered as accurate as mammography.

So, how often should women undergo mammograms, and at what age should they start?
Women aged 40 and above should go for a screening mammogram once a year until  they reach menopause, after which screening mammograms are recommended every two years.

What preventative steps, if any, can be taken?
Maintain a healthy weight and lifestyle, limit alcohol consumption and avoid overexposure to long-term hormonal therapies; women can go on HRT to relieve their menopausal symptoms, as long as it’s for less than five years. Those women with a very strong family history of breast cancer who have tested positive for the breast cancer gene mutation may choose to undergo a prophylactic mastectomy; they may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast and ovarian cancers once they have reached menopause.

All the discomfort is worth it for health's sake
All the discomfort is worth it for health’s sake

What’s a mammogram?
During a mammogram, each breast is compressed between two plates to flatten and spread the tissue for a few seconds. Though it can be uncomfortable for a moment, it’s necessary in order to produce a good quality, readable mammogram.

The goal of mammography is to detect breast cancer, and in the earliest stage possible; when caught early, localised cancers can be removed without resorting to mastectomy (breast removal).

The age quandary
In recent years, there has been controversy over when and how often women should go for mammograms – while some cancer doctors argue that yearly mammograms are only necessary for women above 50, other experts maintain that mammograms should be performed from the age of 40.

Nevertheless, the majority of doctors agree that women under 40 do not need yearly mammograms unless they’re at high risk, with strong family histories of breast or ovarian cancers. In fact, according to Cancer Research UK, mammograms are more difficult to read in younger women because their breast tissue is denser. There’s also little evidence that regular mammograms for most women under 40 reduces deaths from breast cancer.

The doctor’s advice
Dr Ng recommends that, in addition to breast screenings, women should have a general screening once a year for peace of mind, and for the early prevention or detection of any diseases. His clinic offers a GynaeMD Pelvis, Breast and Bone Package for women 40 and above, and for those who are menopausal; the package involves a pelvis ultrasound, mammogram and blood cancer markers, and an evaluation of bone mass density. According to Dr Ng, this examination is very beneficial in that it allows for any benign breast lumps or cysts to be observed; if they appear suspicious, they can be removed or the patient can be referred to a breast surgeon for a second opinion; similarly, any fibroids and cysts that are discovered can be monitored.

It's easy to tell if something's amiss once you get to know your jubblies
It’s easy to tell if something’s amiss once you get to know your jubblies

Check yourself
Whether or not women should do breast self-exams has become a subject of debate in recent years, as the issue of accuracy has been called into question. However, one thing’s for sure: the more aware of your body you are, the more likely you are to notice if something’s out of the ordinary, and potentially harmful. It’s important to know how your breasts normally look and feel, and being in the habit of checking for any abnormalities can be a valuable means of keeping tabs on your breast health, even if you do visit the doctor for regular exams. According to John Hopkins Medicine, 40 percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam routine is crucial. For a step-by-step guide to conducting a breast self-exam, visit breastcancer.org.

Some vital stats about breast cancer…

  • According to World Cancer Research Fund International, breast cancer is the most common cause of cancer-related deaths among women globally, with more than 450,000 deaths each year, and accounting for about 14 percent of all female cancer deaths.
  • According to the Health Promotion Board, breast cancer is the most common cancer among Singaporean women.
  • Breast cancer is the most commonly diagnosed cancer among Australian women, according to the National Breast Cancer Foundation in Australia. It’s estimated that, in 2014 alone, 15,270 women in Australia will be diagnosed with the disease.
  • According to Cancer Research UK, the lifetime risk of being diagnosed with breast cancer is one in eight for women in the UK, where it’s the most common form of cancer. The same goes for women in the US, says the American Cancer Society (ACS).
  • The ACS projects that around 232,670 new cases of invasive breast cancer will be diagnosed in the US this year, and about 62,570 new cases of carcinoma in situ (the earliest form of breast cancer) will be detected; sadly, an estimated 40,000 women will die this year from the disease in the US.
  • Although breast cancer is often thought to be a disease of the developed world, almost 50 percent of breast cancer cases and 58 percent of deaths occur in less developed countries, according to the World Health Organisation (WHO).
  • In 2012, Belgium had the highest incidence of breast cancer, followed by Denmark, France and The Netherlands, according to World Cancer Research Fund International.
  • According to WHO, breast cancer survival rates vary greatly worldwide, ranging from 80 percent or more in North America, Sweden and Japan, to around 60 percent in middle-income countries and below 40 percent in low-income countries, mainly due to a lack of early detection programmes in less advanced countries.