Breast Cancer Screening: Everything You Need To Know

Medically reviewed by Dr Johann Tang, Senior Consultant Radiation Oncologist

Overview of Breast Cancer

Breast cancer occurs when breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells and continue to accumulate, forming a lump or a mass.

It often begins with cells in the lobules (the milk-producing glands) or ducts (the channels through which milk flows from the lobules to the nipples). The cancer spreads to other parts of the body through the lymph nodes under the arms.

Breast cancer is the most common cancer among women in Singapore.

Breast cancer affects approximately 1 in 8 Singaporean women. It is estimated that about 30% of newly diagnosed cancers in women are breast cancer and over 2,000 cases are being diagnosed annually.

Signs & Symptoms

One of the most common symptoms of breast cancer is a newly formed lump or mass that is painless and hard. In some cases, breast cancers can be soft, tender, or even painful. If you notice any new lumps or masses in your breast, it is important to get it checked by an experienced doctor.

Here are some other possible symptoms of breast cancer: 

• Swelling of all or part of a breast
• Breast dimpling
• Breast or nipple pain
• Nipple retraction
• Nipple or breast skin that is red, dry, flaking or thickened
• Discharge from nipples
• Swollen lymph nodes (Sometimes breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast is large enough to be felt.)

It is important that if you notice any of the following symptoms, you contact an experienced doctor to get your breasts checked. Screening tests can help detect breast cancer early, which gives you a much better chance of successful treatment.

Breast Cancer Risk Factors 

There are certain factors that can put a woman at a higher risk for getting breast cancer. These include:

• Age as the risk of breast cancer increases significantly after 40 years old
• Early menstruation before 12 years old
• Family history of breast cancer
• Body weight
• Smoking
• Use of hormonal pills

Is Breast Cancer Screening Necessary?

Breast cancer screening is crucial because early detection and treatment is proven to significantly increase your chances of recovery.

Over 90% of women who were diagnosed during the early stages of their cancer remain free of the disease after a 5 year period.

Even if you feel fine, breast cancer screening can detect tiny lumps in the breasts even before you can see or feel them with your hands. Your risk of breast cancer also increases as you get older and women between 40 to 59 years old have the highest rate of being diagnosed with breast cancer.

Breast cancer screening guidelines in Singapore:

• Women between the age of 40-49: Screening should be done every year.
• Women between the ages of 50-69: Screening should be done once every two years 

Women with a family history of breast cancer should also consult their doctor with regards to regular screening as they have a higher risk of getting breast cancer. 

What is a Mammogram? 

A mammogram is an x-ray of the breast that allows doctors to identify changes in the breast tissue. Digital mammograms provide electronic images of the breasts that doctors use to look for areas of abnormal density, lumps or calcified areas. 

If a doctor detects an abnormal area that could be cancer, they will often take a biopsy for further analysis to determine if it is indeed cancer. 

During a mammogram, the breast is positioned and compressed between two plates to reduce the breast’s thickness and decrease overlapping shadows to produce a clearer image. You may feel some discomfort or pressure but this is often temporary.

The risk of radiation from a mammogram is negligible due to advancements in technology that have improved the mammogram technique. 

There are two main types of mammograms – screening mammograms and diagnostic mammograms.

Screening Mammogram

A screening mammogram is used for women who do not display any symptoms of breast cancer. X-rays are taken from 2 different angles to detect a tumour that cannot be felt. 

Routine breast cancer screenings often use a screening mammogram.

Diagnostic Mammogram

A diagnostic mammogram is used for closer analysis of abnormal areas detected on a screening mammogram. 

Breast Mammogram vs Ultrasound 

Mammograms are an effective screening test, offering the most information for women who do not have any symptoms of breast cancer. It has been shown to decrease the number of deaths due to breast cancer. 

However, an ultrasound may be used in conjunction with a mammogram for women who have dense breasts. This is because dense breasts make it more difficult for a mammogram to detect small abnormalities. Hence, an ultrasound is used in order to differentiate between a cancerous solid lump and a non-cancerous cyst that is filled with fluid.  

An ultrasound sends high frequency sound waves through the tissues in the body and converts them into images. A doctor typically applies a gel and moves a probe across the breasts to send the sound waves. 

However, an ultrasound alone cannot be used to detect small calcifications in the early stages of breast cancer. Your doctor will advise you on whether you need breast ultrasound screening in addition to your mammogram.

How To Do A Breast Self-Examination

Regular self-examinations can increase the chances of early detection and treatment especially since routine mammogram screenings are typically only done once a year or once every two years. It can often detect signs early which can trigger a visit to the doctor for further tests and a diagnosis.

Here are the steps you should follow during a self-examination:

Firstly, look in the mirror with your shoulders straight and put your hands on your hips. Look for any changes in the shape, colour and size of your breasts. Signs of breast cancer include inverted nipples, rashes, swelling, redness, soreness, or any dimpling or puckering of the skin. You should also look out for any discharge from the nipples which could be red, yellow, brown or clear.

Raise your arms next and look for the same changes or signs of breast cancer.

Next, lie down and use your hands to feel your breasts. You can use your left hand to feel your right breast and your right hand to feel your left breast. Keep your fingers together and firmly use the pads of your fingers to make small circular motions. 

Make sure you do this motion from side to side including your armpit and cleavage, and from your collarbone to the top of your abdomen. 

You may want to follow a pattern to ensure that you cover the entire breast area. Some people move up and down in rows or make circles around their nipples that get larger until they reach the outer edge of their breast. 

You can use lighter pressure for the tissues at the bottom of the breasts, medium pressure for the tissues in the middle and more pressure for the tissues in the back of your breasts.

Finally, stand up or sit up and feel your breasts. Some people prefer to do this in the shower because the water can decrease the friction. Use the same hand movements to cover the entire area of your breast during your self-examination.

Breast Cancer Treatment In Singapore

Breast cancer is a highly treatable disease, which has a good prognosis if detected early. 

Depending on the stage that breast cancer is detected, there is a wide variety of treatment options available. Have a clear discussion with your doctor to determine the best treatment options for you.

Surgery 

Surgery remains the main and primary treatment options for breast cancer. Systemic or radiation therapy may be used before and/or after surgery to shrink the tumour or remove the amount of cancer. 

Mastectomy 

A mastectomy removes the whole breast, and not the chest muscle. 

In order to have reconstruction, a skin sparing mastectomy, a technique that preserves as much of the breast as possible, and generally performed as a “simple” or “total” mastectomy, is done. 

Lumpectomy

Also known as breast conserving therapy, a lumpectomy removes abnormal cells or tumours, but the rest of your breast is left alone. Only the tumour area and extra tissue around it is removed. A lumpectomy may be followed with radiation therapy.

Radiation Therapy

Radiation therapy utilizes x-rays, gamma rays, protons, and other sources of high energy radiation to kill cancer cells and shrink tumours. Generally given over a period of time, radiation therapy may be administered alone, or before/after surgery to treat or slow the cancer cell growth. In some cases, radiation therapy is given along with other systemic therapies.

Types Of Radiation Therapy

1. Whole breast radiation therapy (WBRT): Radiation of the whole breast
2. Accelerated Partial Breast Irradiation (APBI): Radiation targeted to the area where the tumour was removed 
3. Lymph node radiation therapy: Radiation of the lymph nodes.

Chemotherapy

Chemotherapy is used to treat cancer by killing fast growing cells throughout the body, including cancerous cells and normal cells, by affecting the DNA. Chemotherapy aims to disrupt the life cycle of cancer cells. There are different types of chemotherapy used to treat breast cancer, and not everyone will respond to treatment in the same way. Speak to your oncologist about your treatment goals and to better understand the treatment plans available for you. 

Conclusion

Breast cancer is the most common cancer among Singaporean women. However, early detection and treatment can greatly increase a woman’s chances of survival and recovery.  

Regular breast cancer screening is recommended for women over the age of 40. 

It is highly recommended that all women between the ages of 40 – 69 years old go for regular breast cancer screening. 

However, If you suspect that you are showing symptoms & signs of breast cancer, please consult your doctor immediately.