What You Need to Know About Breast Cancer

Breast cancer. It’s a scary disease that can affect anyone at any age. And if you’re a woman, it can be really difficult to talk about it sometimes. Here are some facts you should know about the most common cancer among women in Singapore. 

What Is Breast Cancer

Breast cancer is cancer that forms in the cells of the breasts. Cancer usually forms in either the lobules or the ducts of the breast. Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipple. Cancer can also occur in the breast’s fatty tissue or the fibrous connective tissue.

The cancerous cells may then spread throughout the breast, to lymph nodes (glands) in your armpit and to other parts of the body.

It is the most common cancer among Singaporean women, with one in 14 suffering from the condition before age 75. It is also the most lethal cancer among women, with over 400 dying from it every year. All women are at risk of breast cancer, and the chances of developing it increase with age.

Risk Factors for Breast Cancer

Moreover, your possibility of having breast cancer increases if you are:

• Female. Women are much more likely than men to develop breast cancer
• Increasing in age. Your risk for breast cancer increases if you are 50 years of age or older
• Having a family history of breast cancer
• Have a history of malignant or benign (non-cancerous) breast disease
• Have a history of ovarian cancers
• Early onset of menstruation
• Late menopause
• Having your first child after the age of 30
• Having fewer children or never having children
• Being on hormone replacement therapy
• Weight gain, especially after menopause
• Drinking alcohol

What Age Does Breast Cancer Usually Start

Breast cancer doesn’t discriminate by age, but it does have a preferred target: as you age, the risk of developing breast cancer increases. While it can strike at any time, the majority of cases are diagnosed in women aged 50 and older.

However, breast cancer can occur in younger women too. Regular breast self-exams and mammograms are essential, regardless of age, to catch any potential issues early and increase the chances of successful treatment.

Breast Cancer Symptoms

Look out for these warning signs:

• Painless lump in the breast
• Persistent itch and rash around the nipple
• Bleeding or unusual discharge from the nipple
• Skin over the breast is swollen and thickened
• Skin over the breast is dimpled or puckered
• Nipple becomes pulled in or retracted
• Change in the size, shape or appearance of a breast
• Breast pain
• A lump or swelling under your arm

Do note that these symptoms do not necessarily mean that you have breast cancer. However, if you spot any of these symptoms, consult a doctor as soon as possible for further examination and testing.

Breast Cancer Stages

There are five stages of breast cancer: 0, 1, 2, 3 and 4. At the earlier stages (0 and 1), treatment can result in survival rates of over 90 per cent.

Stage 0

Stage 0 means that cancer has been diagnosed early. It started in the breast ducts or milk glands and has stayed there. The words “in situ” are commonly used, which means “in the original place.”

Stage 1 

From Stage 1, breast cancer is invasive, meaning it has broken free to attack healthy tissue.

• Stage 1A: Cancer has spread into the fatty breast tissue. The lymph nodes are not affected.
• Stage 1B: Some cancer cells have been found in a few lymph nodes but in tiny amounts.

Stage 2 

By Stage 2, cancer has grown, spread, or both.

• Stage 2A: This means that the tumour in the breast is still small if there’s one at all. There may be no cancer in the lymph nodes, or it may have spread to as many as three.
• Stage 2B: At this stage, the breast tumour is bigger – it may be the size of a walnut or as big as a lime. It may or may not be in any of the lymph nodes.

Stage 3 

At Stage 3, cancer has not spread to the bones or organs, but it is considered advanced and harder to fight.

• Stage 3A: Cancer has spread to 4–9 axillary lymph nodes or has enlarged the internal mammary lymph nodes, and the primary tumour can be any size. In some cases, there is a large tumour in the breast, but other times there’s no tumour.
• Stage 3B: A tumour has invaded the chest wall or skin and may or may not have invaded up to 9 lymph nodes.
• Stage 3C: Cancer is found in 10 or more axillary lymph nodes, lymph nodes near the collarbone, or internal mammary nodes.

Stage4 

By Stage 4, breast cancer cells have spread far away from the breast to nearby and distant lymph nodes and to distant organs.

The most common sites are the bones, lungs, liver, and brain. This stage is described as “metastatic,” meaning it has spread beyond the region of the body where it was first found.

Asian doctor woman examining mammography young woman for breast cancer at hospital

What Causes Breast Cancer

Many factors cause breast cancer. Here are some of the most common:

• Genetics

If you have a family history of breast cancer, your risk is higher than if you don’t. This is because certain genes can make it more likely for cells to become cancerous.

• Age

The older you get, the higher your risk of developing breast cancer. As you age, more cells are produced in your body, and some new cells may be mutated or damaged and eventually become cancerous.

• Hormones

Certain hormones can increase your risk of breast cancer. These include estrogen and testosterone—both naturally occurring in women—and synthetic hormones like birth control pills, hormone replacement therapy (HRT), and anabolic steroids used by athletes or bodybuilders to build muscle mass (they’ve been linked with increased risk).

• Diet

Eating more fruits and vegetables than meat has been linked with lower breast cancer rates; however, research on this link is still being done, so we can’t say whether diet affects risk.

• Reproductive history

Women who have never given birth or gone through menopause have a lower risk than those who did have children or go through menopause after age 40; however, this varies widely depending on race or ethnicity.

How to Check for Breast Cancer

Image Source: iStock

Three types of screenings are involved in detecting breast cancer: self-examination, clinical examination, and mammography.

It is recommended that women above 20 carry out breast self-examination once a month, a week after menses. If the patient no longer has menses, she should perform a breast self-examination on the same day of each month, for example, the first of every month.

Here is what you need to look out for during self-examination:

1. A lump, swelling, or thickening in the breast or underarm area

2. Changes in the size or shape of one breast

3. Puckering or dimpling of the skin of the breast or nipple

4. Persistent rash or change in the skin around the nipple

5. Recent changes in the nipple, eg. inversion, retraction

6. Any bleeding or unusual discharge from the nipple

7. Skin redness or soreness of the breast

8. Accentuated veins on the surface of the breast

9. Unusual swelling of one upper arm

10. Any enlarged lymph nodes in the armpit and collarbone areas

Apart from breast self-examination, it is advised for women above 40 to go for a clinical breast examination once a year.

It is also recommended that women aged 40 to 49 go for a mammogram once a year, while those aged 50 and above go for it once every two years.

A mammogram is a screening procedure that uses a special machine to take X-ray pictures of the breast. The X-ray pictures make it possible to detect cancerous tumours that cannot be felt by hand or lumps in the breast that are not yet cancerous but may grow into cancerous tumours. 

Click here on where you can get a mammogram done in Singapore. Do note that, for those above 50, a mammogram is Medisave-claimable.

A needle biopsy is necessary in case of a suspicious lump, apart from a mammogram. Even if the mammogram returns negative, a biopsy may be needed.

A biopsy involves the removal of tissue from the breast lump using either a core or skinny needle and syringe. The tissue is processed and sent to the pathologist, who will be able to tell if the tissue is cancerous.

If cancer is diagnosed, other tests such as chest X-ray, liver ultrasound, and bone scan may be required to determine if cancer has spread to other parts of the body.

Breast Cancer Treatments

Treatment for breast cancer usually depends on the stage of cancer, the size of the tumour and the extent of spread. One or a combination of therapies may be recommended by the doctor.

• Surgery

This is the most common treatment for breast cancer and involves two types:

Lumpectomy: The breast lump and some normal tissue around it are removed, with the breast being preserved. Some lymph nodes may be removed as well. This is usually done for early breast cancer.

Quadrantectomy: This involves the removal of ¼ of the breast that contains the lump and surrounding tissue.

Mastectomy removes the entire breast, often including the lymph nodes in the armpit and sometimes the chest wall muscles. It is required when the cancer is found in numerous parts of the breast or the cancerous area is large.

• Chemotherapy

Drugs, usually in combination, are given orally or by injection to kill cancer cells.

The drugs enter the bloodstream and travel through the body. There may be mild nausea or vomiting, hair loss, lethargy or tiredness, and loss of appetite.

Chemotherapy is given in cycles – a treatment period, a recovery period, and then treatment again.

• Hormonal Therapy

Normal female hormones like oestrogen may promote normal healthy breast tissue growth but may also accelerate the development and recurrence of certain breast cancers. Hormone therapy can prevent your body’s natural hormones from activating the growth or spread of cancer cells.

Hormonal therapy could involve drugs to change the way hormones work or surgery to remove the ovaries that produce female hormones, which can affect cancer cells. 

The most common drug used for hormone therapy is the oral tablet tamoxifen, which stops the action of oestrogen.

Side effects can occur. These depend on the type of drug used and vary among individuals. They include hot flushes/sweats, vaginal irritation, irregular menstrual periods, depression, mood swings and a slightly increased chance of developing cancer of the uterus and deep vein thrombosis. Regular gynaecological checkups are recommended.

• Radiation Therapy or Radiotherapy

High-energy X-rays are directed at the breast to damage cancer cells and stop them from growing. Radiotherapy of the chest usually takes place over 5 weeks.

Radiotherapy can be vital after a breast-conserving surgery like a lumpectomy since much of the breast tissue is left intact. Most women who have a mastectomy do not need radiotherapy.

• Rehabilitation

Physical rehabilitation includes:

• Shoulder exercises after the surgery
• Arm care to avoid the beginning of lymphoedema (swelling of the arm(s) due to fluid retention)
• Balanced nutrition and lifestyle changes to improve recovery

Mental rehabilitation involves:

• Close support from your spouse, family and friends, as well as support groups
• Reassurance through a better understanding of the chances of survival
• Regular reviews with the doctor

How to Prevent Breast Cancer

As mentioned above, the best way to protect yourself from breast cancer is through regular self-examination, clinical breast examination and mammograms. A monthly breast self-examination also keeps you aware of changes to your breasts.

Image Source: iStock

It is advised for women above 40 to go for a clinical breast examination once a year.

It is also recommended that women aged 40 to 49 go for a mammogram once a year, while those aged 50 and above go for it once every two years.

In addition to this, maintain a healthy and active lifestyle:

• Maintain a healthy weight
• Stay physically active
• Eat a diet rich in fruits, vegetables and whole grains and low in fats
• Avoid alcohol or reduce its consumption

Breast Cancer Foundation in Singapore

The Breast Cancer Foundation (BCF) is a social service agency that supports women and their families affected by breast cancer. The BCF advocates for the early detection of breast cancer and supports the breast cancer community in Singapore.

The BCFS was established in 1997 to help women and their families cope with breast cancer. They provide emotional and practical support through their centres and online portals, including information about treatments, support groups and counselling sessions for patients and their loved ones.

The BCF’s mission is to improve the quality of life for women with breast cancer, promote awareness of early detection techniques and other relevant issues, and raise funds to support research into better treatments and cures for this devastating disease.

For more information about the Breast Cancer Foundation, click here.

Here at theAsianparent Singapore, it’s important for us to give information that is correct, significant, and timely. But this doesn’t serve as an alternative for medical advice or medical treatment. theAsianparent Singapore is not responsible for those that would choose to drink medicines based on information from our website. If you have any doubts, we recommend consulting your doctor for clearer information.