Breast Cancer

Breast cancer is one of the most common cancers that affect 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.

Obesity

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.

Prevention

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.

Surgery

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

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.