A doctor's thoughts on breast health in Breast Cancer Awareness Month

By Dr Ezlyn Izharuddin, DTAP Clinic

Breast cancer is the most common cancer diagnosed in women worldwide. Since 2003, breast cancer is the leading cause of cancer deaths for females in Singapore.

October is Breast Cancer Awareness Month, an annual campaign to highlight the importance of breast health and breast cancer research. While we cannot prevent cancer, we can be proactive and take charge of our health.

Rise in breast cancer in Singapore

Invasive breast cancer was consistently ranked as the most frequent cancer among women in Singapore for the past 50 years. Approximately 1 in 16 of all women will be diagnosed with an invasive disease in their lifetime. In 2013 to 2017, there were 10,824 new cases of invasive breast cancer diagnosed, or nearly six cases per day and 2,180 deaths.

This rise is likely attributable to several factors such as changes in the reproductive pattern in Singapore including delayed childbearing, having fewer children, reduced prevalence and duration of breastfeeding, as well as changes in other risk factors such as use of hormone replacement therapy (HRT), use of oral contraceptives, and an increase in the prevalence of obesity.

While the age-standardised incidence ratio of invasive breast cancer in Singapore was much lower than those in western countries such as the UK, Australia, and USA, it was the highest among the Asian countries including Malaysia, Japan, South Korea, and China.

Importance of early detection with screening

Breast cancer screening is done to look for signs of breast cancer in all women, even in those without any symptoms. The goal of screening is to detect cancers early before symptoms occur. Early-stage cancers are easier to treat than later-stage cancers, with a higher chance of survival. An American study showed that when breast cancer is detected early and is in the localised stage, the 5-year relative survival rate is 99%.

The guidelines on breast screening are as follows:

• 39 years and below - Monthly breast self-examination

• 40 to 49 years - Monthly breast self-examination and annual screening mammography

• 50 years and above - Monthly breast self-examination and 2-yearly screening mammography

Risk factors

There are known risk factors that may lead to the development of breast cancer, such as risks that cannot be changed (non-modifiable), and those that can be changed (modifiable).

Non-modifiable risk factors:

• Age – the risk of breast cancer increases with increasing age

• Family history – especially in a first-degree relative (mother, sister or daughter)

• Personal history of breast cancer – a previous breast cancer increases risk of cancer in the other breast

• Genetic mutations – these inherited genetic mutations are called BRCA1 and BRCA2

• Early menarche (onset of menstruation – before age 12) and/or late menopause (after age 55)

• Dense breast tissue – the presence of dense breasts makes detection of lumps more difficult and increases the risk of breast cancer

Modifiable risk factors:

• Overweight or obese – including excessive weight gain in post-menopausal women

• Use of hormone replacement therapy for long periods

• Reproductive history - history of never having had children, having the first pregnancy after age 30 and not breastfeeding

• Drinking alcohol excessively over a long period of time

Common signs and symptoms

There may be no symptoms or pain if the breast cancer is at its early stages. Therefore, one should keep a lookout for changes in the breast during self-examination, using the acronym, FAD:

• A change in how the breast or nipple FEELS – watch out for a change in the skin texture, a lump in the breast or underarm area, as well as tenderness of the nipple.

• A change in the breast or nipple APPEARANCE - Any unexplained change in size or shape of the breast, dimpling, inverted nipple, redness or pitting (resembling an orange skin) or the skin of the breast, areola or nipple.

• Any nipple DISCHARGE - In particular clear or bloody discharge

Treatment option

Breast cancer treatment depends in part on the stage of the cancer, or how far the cancer has spread. Most people with breast cancer have one or more of the following treatments:

• Surgery – either by mastectomy (removal of the whole breast with or without reconstruction) or breast-conserving therapy (also called lumpectomy which is surgery to remove the cancer and a section of healthy tissue around it; usually followed by radiation therapy)

• Radiation therapy – the use of radiation to kill cancer cells

• Chemotherapy – the use of medicines to kill cancer cells and stop them from further growth. This can be given before surgery to decrease the size of the cancer to ease removal. This also may be given after surgery to kill any remaining cancer cells.

• Hormone therapy – Certain forms of breast cancer grow in response to hormones. Hormone therapy blocks the production of these hormones.

• Targeted therapy – This involves the use of antibodies to bind to specific cancer cell sites to prevent its growth.

Show support for someone with breast cancer

There are a number of ways to show support to someone close to you who has been diagnosed with breast cancer. Most women would be shocked and experience different emotions after such a diagnosis, such as anger, fear, sadness, and even depression. Giving emotional support to them in the form of being present and listening to them talk about their feelings can help them cope with their distress and be a source of comfort that they need.

Support can also be offered in a practical way. This can be through offering them a helping hand around the house – cleaning, washing, cooking, looking after the kids, driving them to hospitals or clinics for appointments. As it may not be as easy for them to carry out daily tasks at home possibly from side effects of treatment, post-surgery or from a low mood, patients who are loved ones will always appreciate you helping to relieve the burden of household chores.