Breast Cancer Questions Answered By Medical Oncologist

Contributed by: Dr See Hui Ti

Doc, will I get breast cancer?

Dr See Hui Ti from Parkway Cancer Centre answers questions about breast cancer – the most common cancer among women in Singapore.

I have been told that mammograms can screen for breast cancer. Are they always accurate?

No, not always. For younger women, mammograms can be inaccurate if they have dense breasts. If you are under 50 years old, have dense breasts and feel a lump in your breast, I would recommend that you do a mammogram as well as a breast ultrasound. Nevertheless, a mammogram is still a reliable, easy and relatively inexpensive screening tool, as it can detect cancerous lumps before they are felt by hand.

What are the chances of getting breast cancer? I have heard that the bigger your breast, the higher the chance of getting it.

In Singapore, the chance of getting breast cancer is about one in 10 and one in 15 women. It is not true that the bigger your breasts, the higher the chance of getting breast cancer. The risk, however, does increase with age. The highest incidence of cancer is found in women between the ages of 55 and 59. As a general guideline, if you are below 40 years old, you should do regular self-examination. If you are above 40, you should go for an annual mammogram in addition to regular self-examination.

My mum had breast cancer more than seven years ago and had no relapse. What are the chances of me getting it too? Is there any way to prevent it? Does eating well really help?

Breast cancer is so common in Singapore that it does not mean that you will get it only if you have a family history of it. However, it is advisable to get a clinical breast examination done five years before the age at which your mum had cancer. If your mum had breast cancer when she was 42 years old, for example, then you should get a check-up when you turn 37 years old. Eating healthily, cutting down on your intake of fat, keeping your weight down and exercising regularly can also help to reduce the risk of getting cancer.

My right breast usually feels bloated and painful one week before my menstruation and lasts a few days. Is this normal or a sign of cancer?

This is perfectly normal. Pain, soreness or ache in the breasts is a premenstrual symptom which is resolved by the onset of the period. Breast cancer pain does not come and go with cyclical hormonal changes. Look out, however, for any lump that refuses to go away, a change in the shape of your nipple, discharge from the nipple, or an unexplained redness or rashes on your breast. Consult your doctor if you have any of these signs and symptoms. However, try to avoid going for a mammogram or breast ultrasound one week before or during your menstruation, as it affects the accuracy of the tests. You may want to do it at least one week after your period ends.

I had Stage 1B breast cancer in 2011. My recent blood test showed the tumour marker for CA 15-3 at 14.6, a 3-point increase from an earlier test. It seems to be rising steadily. Does this imply a gradual relapse of the cancer?

While the CA 15-3 tumour marker is usually used to track a patient’s response to breast cancer treatment and recurrence, it is not sensitive or specific enough as a screening test, as non-cancerous conditions can also raise the level. There are many other reasons why it can increase, for example, weight gain. Still, I would encourage you to get the blood test done again in about two months’ time, to see if the increase is real. If it is still increasing then, ask your doctor for a scan of the whole body.

When to go for screening

If you are... Over 25 years old:
  • Monthly breast self-examination
40-49 and above: 
  • Monthly breast self-examination
  • Yearly mammogram +/- ultrasound
50 and above:  
  • Monthly breast self-examination
  • 1-2 yearly mammogram +/- ultrasound

Warning signs of breast cancer 

Look out for...
  • Painless lump in the breast
  • Persistent itch and rash around the nipple
  • Bleeding/unusual discharge from the nipple
  • Nipple is pulled in or retracted
  • Skin over the breast is swollen and thickened
  • Skin over the breast is dimpled or puckered
 This article is adapted from Dr See Hui Ti’s online discussion “Ask the expert: Understanding breast cancer” organised by Parkway Cancer Centre.
POSTED IN Cancer Prevention
TAGS cancer lump, cancer relapse, cancer self-examination, cancer ultrasound, common cancer, history of cancer, mammogram