Breast Cancer

What Is Breast Cancer?

Breast Cancer is a disease in which malignant (cancer) cells are detected in the tissues of the breast. These cancer cells can then spread within the tissue or organ and to other parts of the body.

It is the second leading cause of death in women today. In Singapore almost every 1 in 20 women will be diagnosed with breast cancer in her lifetime. Chinese women have a higher risk compared to Malay or Indian by about 10-20%. The highest incidence is in the 55-59 years age group. The risk of breast cancer increases with age. The good news is that more women are surviving the disease as a result of earlier detection and improved treatment.

The triggering factors of this cancer are unknown. It could be attributed to a family history of breast cancer, early menarche or other possible risk factors. As it is difficult to ascertain, any one of us can be at risk, especially when we are aged 40 and above. While the factors are unknown, a complete cure is possible with early detection through regular breast checks.

How Common Is Breast Cancer?

Breast Cancer is the second leading cause of death in women today. In Singapore almost every 1 in 20 women will be diagnosed with breast cancer in her lifetime. Chinese women have a higher risk compared to Malay or Indian by about 10-20%. The highest incidence is in the 55 - 59 years age group. The risk of breast cancer increases with age. The good news is that more women are surviving the disease as a result of earlier detection and improved treatment.

What is Breast Cancer

Breast Cancer is a disease in which malignant (cancer) cells are detected in the tissues of the breast. These cancer cells can then spread within the tissue or organ and to other parts of the body.

Anatomy of the breast

What Causes It?

The triggering factors of this cancer are unknown. It could be attributed to a family history of breast cancer, early menarche or other possible risk factors. As it is difficult to ascertain, any one of us can be at risk, especially when we are aged 40 and above. While the factors are unknown, a complete cure is possible with early detection through regular breast checks.

What are the Warning Signs of Breast Cancer?

• painless lump in the breast
• persistent itch & 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 is pulled in or retracted

What are the Guidelines on Breast Screening?

Table A

How is diagnosis made?

• Through a clinical examination by the doctor especially if a lump or an unusual breast change is detected.
• By a mammogram which may detect changes or abnormalities.
• Based on an ultrasound scan of the breast which again may be suspicious for changes or abnormalities.

To confirm breast cancer a biopsy will have to be performed in which a piece of tissue is removed for examination under a microscope.

What are the common biopsy techniques performed?

• Fine Needle Aspiration (FNA)
• Core Needle or Tru-cut Biopsy
• Excision Biopsy

How is Breast Cancer assessed?

GRADE/ DEGREE OF AGGRESSIVENESS

The grades are G1, G2 & G3. Grade 3 is the most aggressive and has the most unfavourable outcome.

EOSTROGEN RECEPTOR (ER) STATUS

If ER is positive, the cancer cells can respond to hormonal therapy e.g. tamoxifen.

Treatment options and prognosis (chance of recovery) depends on the stage of the cancer (whether it is in the breast only or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells and whether the cancer is found in the other breast. A woman's age, menopausal status (whether a woman still has menstrual periods) and her general health can also affect treatment options and prognosis.

What treatment is offered?

Most have surgery to remove the cancer. Forms of surgery include:

• Breast-conserving Surgery, Lumpectomy – removal of the cancer and a small amount of surrounding tissue
• Mastectomy – removal of the whole breast with or without lymph nodes under the axilla

Is any other treatment required?

Often this is followed by systemic therapy which may include either chemotherapy, radiotherapy and/or hormonal therapy to improve the chances of recovery.

What are the rehabilitation steps?

Physical rehabilitation includes:

• Shoulder exercises after surgery
• Arm care to avoid lymphoedema
• Balanced Nutrition and lifestyle adaptation to enhance recovery

Mental rehabilitation involves:

• Close support of spouse, family, friends & support groups
• A woman may feel reassured by knowing her chances of survival
• Attending doctor reviews regularly

What is the best approach to care?

The development of a treatment plan by a multi-disciplinary team – breast surgeons, pathologists, radiologists, medical & radiation oncologists, radiologists, social workers and breast care nurses to diagnose, treat and manage the condition has shown to improve the outcome for patients with cancer.

What is the support available?

CanHOPE a ParkwayHealth initiative together with the multi-disciplinary team of doctors tries to bring about a holistic approach to cancer care at no extra cost. Counsellors manned its cancer counseling service through a hotline and email to provide emotional and psychosocial support to all patients and caregivers to assist them to cope effectively with cancer. A meet and greet service with face-to-face counselling can also be arranged.

Patients, health care professionals & the general public can also receive up-to-date cancer information, its related screening tests, treatment and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies, diet and nutrition.

CALL our CanHOPE counsellors: +65 67389333 or e-mail: enquiry@canhope.org