Radiation Treatment for

Breast Cancer

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What is breast cancer?

Breast cancer is one of the most common cancers that affects women in Singapore. It can begin in different parts of the breast and usually starts in the cells of the lobules (the milk-producing glands) or the ducts (the passages that deliver milk from the lobules to the nipple). Breast cancer can also begin in the stromal tissues, which are the fibrous and fatty connective tissues of the breast. As breast cancer responds well to early detection, patients are highly encouraged to consult a breast cancer doctor early and seek prompt breast cancer treatment if they notice any signs and symptoms of breast cancer.

There are several forms of breast cancer, and it helps to stay aware of each type. They are as followed:

Invasive ductal carcinoma

This cancer starts in the milk ducts of one’s breast before spreading to the surrounding breast tissue. This is the most common type of breast cancer, making up around 80% of cases.

Ductal carcinoma in situ

Referred to as Stage 0 breast cancer, ductal carcinoma in situ is considered by some specialists to be precancerous since the cells have yet to spread beyond the milk ducts. This cancer is still treatable, but prompt breast cancer treatment is essential to prevent it from being invasive and spreading to other tissues.

Invasive lobular carcinoma

This cancer develops in the lobules of one’s breast. It is considered invasive, as the cells have broken out of the lobule and begin spreading to the lymph nodes and other areas of the body. 

Lobular carcinoma in situ

This condition is considered precancerous and not a true form of breast cancer. However, it signifies that there are abnormal cells in the lobules of your breast, indicating the potential for breast cancer later on. Therefore, it is essential for those diagnosed with this condition to undergo regular screenings.

Triple-negative breast cancer (TNBC)

TNBC is one of the most difficult forms of cancer to treat. This is because it does not have three of the hormonal markers commonly associated with other forms of breast cancer, making prognosis and treatment challenging.

Inflammatory breast cancer

Inflammatory breast cancer cases are rare, but this type of breast cancer is aggressive. It resembles an infection, with patients experiencing redness, pitting, dimpling, and swelling of their breast skin. This is caused by obstructive cancer cells in the lymph vessels.

Signs and symptoms of breast cancer

Different people have different symptoms of breast cancer. Some people may not even develop any signs or symptoms at all. Some warning signs of breast cancer are:

  • Breast lump
  • Skin changes 
  • Bloody or unusual nipple discharge 
  • Retracted nipple 
  • Breast pain 
  • Persistent rash around the nipple

If you noticed any of the above symptoms, it is advisable to schedule an appointment with a breast cancer doctor for prompt evaluation. However, some may not notice any signs of breast cancer until it is too late. Therefore, it is crucial for you to undergo routine mammograms to minimise your risks. If cancerous cells are spotted, the doctor can schedule you for breast cancer treatment promptly, which increases the chances of a successful breast cancer treatment.

Causes of breast cancer

Breast cancer develops when one’s breast cells begin to grow abnormally. These cancerous cells divide and multiple quicker than the healthy cells do and continue to accumulate, resulting in a lump or mass forming on one’s breast. These cells may continue to spread through one’s breast to the lymph nodes or other parts of the body. This process is referred to as metastasis. To prevent this from happening, prompt breast cancer treatment is advisable. 

Breast cancer often begins with cancerous cells developing in the milk-producing ducts (invasive ductal carcinoma). However, they can also begin in other cells or tissue within the breast, such as in the glandular tissue called lobules (invasive lobular carcinoma). 

While breast cancer doctors have yet to determine the exact cause that results in the development of these abnormal cells, they have identified that lifestyle, environmental, and hormonal factors can increase one’s risk of contracting breast cancer. Therefore, specialists usually recommend regular breast cancer screening using mammograms to identify these cancerous cells early. Prompt diagnosis can lead to more effective breast cancer treatments.

Risks factors

Breast cancer risks are influenced by a number of factors. However, having one or several risk factors does not mean you will develop breast cancer. Nevertheless, it is vital to identify and understand these factors to decrease one’s overall risk. Here are some of the risks of breast cancer.

Being female

Women are more likely to develop breast cancer compared to men.

Increasing age

As you age, you are more likely to develop breast cancer. Breast cancer is most often diagnosed in adults over the age of 50.

A personal history of breast cancer

If you have been diagnosed with lobular carcinoma in situ or atypical hyperplasia of the breast, you are more likely to develop breast cancer. Likewise, if you have breast cancer in one breast, you have an increased risk of developing cancer in your other breast.

A family history of breast cancer

If your mother, sister, or daughter has been diagnosed with breast cancer, you may be at risk too. This is because certain gene mutations that increase one’s risk of breast cancer can be passed from parents to children.

Radiation exposure

Prolonged exposure to radiation can increase one’s risk of developing breast cancer. If you have undergone radiation treatment before, you may be at risk of developing breast cancer.


Being obese can increase one’s risk of developing breast cancer.

Beginning your period at an early age

Women who begin their period at a younger age – before age 12 – have a greater risk of developing breast cancer.

Beginning menopause at an older age

Women who begin their menopause at an older age are more likely to develop breast cancer.

Having never been pregnant

Women who have never given birth are more likely to develop breast cancer than those who have had one or more pregnancies.

Having one’s first child at an older age

Women who give birth to their first child after age 30 may be at greater risk of breast cancer.

Drinking alcohol

Drinking alcohol can increase one’s risk of developing breast cancer.


External factors – such as lifestyle and environmental factors – can impact one’s risk of developing breast cancer. By making changes in your daily life, you can reduce your risk of breast cancer. 

Consult a doctor about breast cancer screening

Discuss with your doctor when you should undergo breast screening exams. You can also discuss the benefits and risks (if any) of the screening. This way, you can determine what screening strategies are ideal for you. If any cancerous cells are detected early, you can undergo breast cancer treatment promptly.

Become familiar with your breasts through self-examinations

It is advisable to conduct breast self-examination and inspect your breasts regularly. This way, you are aware of the normal changes your breasts undergo and can identify any unusual symptoms. If you notice any new changes, lumps, or unusual signs, you should speak to a breast cancer doctor immediately.

Adopt a healthy diet

People who adopt a Mediterranean diet – a diet focused on plant-based food like fruits and vegetables, legumes, and whole grains – supplemented with mixed nuts and extra-virgin olive oil may have a reduced risk of developing breast cancer. Naturally, you should cut down on alcohol as well since excess consumption can increase one’s risk. 

Maintain a healthy weight

Since obesity increases one’s risk of breast cancer, you should strive to maintain a healthy weight. Reduce your calorie intake and increase the amount of exercise. You can also consult your doctor about healthy strategies to reduce your weight.

Breast cancer treatments

There are several breast cancer treatment options available in Singapore. The ideal breast cancer treatment will depend on various factors, such as the location and size of the tumour and whether the cancer cells have spread to other areas of the body. It is best to discuss your options with your breast cancer doctor, as they can assess your needs and prescribe the proper treatment. Here are the common treatment options.


Breast cancer surgery involves removing the cancerous portion of your breast and an area of normal tissue surrounding the tumour. There are different types of surgery depending on your situation, including:

  • Lumpectomy or Breast Conserving Surgery
  • Mastectomy
  • Sentinel node biopsy
  • Axillary lymph node dissection


Chemotherapy is usually prescribed as a primary treatment if the cancer cells have spread beyond your breast to other organs of your body. It can also be recommended before surgery in an effort to shrink the tumour or after surgery to eliminate any remaining cancer cells and minimise the risk of recurrence.

Radiation therapy

Radiation therapy is typically administered after a mastectomy or lumpectomy to eradicate any remaining cancer cells. It can also be used to treat individual metastatic tumours.

Hormone therapy

Hormones – such as progesterone and estrogen – are used to treat certain forms of breast cancer. In such instances, the therapy can lower the patient’s estrogen levels or stop estrogen from attaching to the cancerous cells. It is most often used after surgery to reduce the risk of recurrence.

Immunotherapy / Targeted drug therapy

Immunotherapy utilises the power of the patient’s own immune system to target and attack breast cancer cells. 

Some drugs – like antibody-drug conjugates, kinase inhibitors, and monoclonal antibodies – can be used to target specific cell characteristics that cause cancer. This breast cancer treatment method is typically recommended when the cancer cells have spread to other parts of the body.

What are the common signs and symptoms?

  • Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all. Some warning signs of breast cancer are:

    • Breast lump
    • Skin changes
    • Bloody or unusual nipple discharge
    • Retracted nipple
    • Breast pain
    • Persistent rash around the nipple

How is breast cancer diagnosed?

  • Breast self-examination
  • Clinical breast examination
  • Mammogram
  • Breast ultrasound
  • Breast MRI
  • Breast biopsy (a sample of cells taken from the tumour)

What are the different types of treatments?

Treatment depends on the type of breast cancer and stage of cancer, as well as the general medical condition of the patient.


Removal of the entire affected breast tissue.


Breast-conserving surgery which involves removal of only the cancerous tissue. This is usually followed by radiation therapy.

During the lumpectomy or mastectomy, the surgeons may perform surgery on the lymph node to test if these lymph nodes have been affected by cancer.

What is Radiation Therapy?

Prostate cancer radiation treatment is an option recommended for patients diagnosed with prostate cancer. It uses high-energy X-rays generated from a radiation therapy machine called a LINAC to destroy cancer cells. Prostate cancer radiation treatment has long been used to kill tumours without the need for surgical operations. It inhibits cancer cells from multiplying by delivering ionising radiation to destroy cancer cells while minimising radiation damage to normal tissues. When these cancer cells die, the body naturally eliminates them. Healthy, normal tissues are then able to repair themselves in a way that cancer cells cannot, leading to a much higher proportion of tumour cell death compared to normal cells.

How is Radiation Therapy done?


The Radiation Oncologist determines the most appropriate method and discusses with you the treatment intent, schedule, risks, and side effects.

Mark-Up and Simulation

A CT scan of the treatment area will be obtained, while three small, full-stop marks are made to ensure accurate positioning during your daily treatment.

Treatment Planning

A multidisciplinary team produces a customised treatment plan for you.


Radiation therapy for breast cancer is delivered daily (Mondays to Fridays) for three to seven weeks. Each treatment session lasts 10 to 15 minutes.


Your first follow-up appointment varies depending on how you do during treatment and is usually about four to six weeks after you have completed the course of radiation therapy.

What are the types of radiation therapy available for breast cancer?

3-Dimensional Conformal Radiation Therapy (3DCRT)

3DCRT delivers very precise doses of radiation to the breast and spares surrounding normal tissue through a machine called a linear accelerator.

Accelerated Partial Breast Irradiation (APBI) – Breast Brachytherapy

APBI is currently recommended for selected patients with early-stage breast cancer. It is an outpatient procedure that involves placing flexible plastic tubes called catheters into the breast around the scar region.

A radioactive source then travels via the catheters to treat the high-risk area surrounding the scar. This technique reduces the overall treatment time from several weeks to four days, as well as the potential long-term side effects on adjacent tissues.

Intensity Modulated Radiation Therapy (IMRT)

IMRT involves varying (or modulating) the intensity of the radiation being delivered during treatment. Compared to 3DCRT, this technique can deliver more tightly focused radiation beams to cancerous tumours while reducing the amount of radiation to surrounding healthy tissues.

Breath Hold Technique (for left-sided breast cancer)

Breath Hold Technique utilises a patient-controlled ventilation control tool that helps the patient hold a deep breath. This allows us to treat the chest wall/breast with the patient in full inspiration (at full inspiration, the chest wall is furthest from the heart), thereby minimising any radiation dosage to the heart.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

What are the potential side effects?

Although the non-surgical nature of radiation breast cancer treatment does away with complications that can arise from surgery, patients may still experience minimal side effects. These include swelling, tender skin, and fatigue in the first one to two weeks following radiation therapy sessions for breast cancer treatment. Fortunately, the majority of side effects improve over time and can be effectively managed with medication. Inform your doctor or nurse if you are experiencing any discomfort, so they can help you manage your symptoms and improve your wellbeing.

  • Skin irritation similar to a sunburn
  • Mild to moderate breast swelling
  • Mild fatigue
  • Mild tenderness in the breast or chest wall
  • Scarring of a small part of the lung just under the breast
  • Ischaemic heart disease for left breast radiation (new techniques have minimised the risk to under 5%)
  • Secondary cancers (rare)
  • Rib fracture (rare)

Caring for yourself during and after Radiation therapy

  • Stop smoking

    Immediate benefits include less airway irritation and less coughing and shortness of breath.

  • Stay active

    Even gentle, short bouts of activity help! Improves mood, reduces fatigue, and helps with appetite.

  • Check your medications

    Inform your doctor if you are taking medications to make sure that they are safe to use during radiation therapy.

  • Be careful caring for the affected area

    Avoid hot or cold packs, and only use lotions and ointments after checking with your doctor or nurse. Clean the affected area with lukewarm water and mild soap.

  • Enlist support

    Mental and emotional health are as important as physical health. It might be helpful to talk to counsellors or join a cancer support group.

  • Have a caregiver who can manage your care

    It is good to have someone who can help keep track of hospital appointments and medications prescribed.

  • Rest well

    Get plenty of rest during treatment.

  • Eat well

    It makes you feel better, has fewer side effects, and allows you to fight infections better.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

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Contact Dr Johann Tang

ME Novena Specialist Group
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Frequently Asked Questions

There are many different types of breast cancer. Breast cancer treatment will depend heavily on the type of breast cancer you have, the stage it is in, and several other factors. For Metastatic Breast Cancer (MBC), there is currently no cure. However, treatment options have vastly improved outcomes for patients in recent years.

Because breast cancer cells are mutated, their cell division and, hence, growth rate, can be difficult to predict. The more advanced the stage of breast cancer, the faster it is likely to grow and spread. Health screenings scheduled with a breast cancer doctor are therefore recommended for patients at high risk for breast cancer.

Many breast cancer treatments, like surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy, are well-established protocols for patients. Some of the newest treatments combine hormone therapy with targeted therapy and use new drugs that can slow tumour growth without affecting normal cell function. Talk to your breast cancer doctor to learn more about these new treatments.

Bone pain, fatigue, pain in the back or neck, nausea, jaundice, cough, and chest pain are just some of the signs that breast cancer has spread. There can be many other symptoms, depending on the location of the cancer cells, so talk to your breast cancer doctor for more information.

A mastectomy is a surgery to remove all breast tissue and is used as a form of breast cancer treatment. Surgery may be a viable option for breast cancers in stages 1, 2, and 3.

While opting for surgery can be a viable breast cancer treatment option, it does not guarantee that your breast cancer will be cured. It is not possible to remove all the cancerous cells, and those that are left behind may still go on to cause cancer.