Let's learn about breast cancer!

 

There are various types of breast cancer and they may manifest in different ways. Click the START button to find out more.

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what is breast cancer ?

Breast cancer occurs when breast cells divide and grow without control, sometimes invading surrounding tissue. In some cases, the cancer may grow very slowly while in others, it develops more rapidly. Most breast cancers start in the ducts while a small number start in the milk sacs or lobes.

TYPES OF BREAST CANCER

Breast cancer can be classified generally as follows:

  • Cancer that is confined to the ducts (Ductal Carcinoma In Situ or DCIS) or lobules (Lobular Carcinoma In Situ or LCIS). DCIS is considered a precancerous condition while LCIS is a risk factor for invasive cancer.

  • Cancer that has spread beyond the ducts or lobes to the surrounding breast tissue. Generally, most treatable in the early stage when the tumour is relatively small and has not spread to the lymph nodes.

  • Cancer that has spread outside the breast
    to other parts of the body. If cancer cells are detected in the lymph nodes under the arm,
    it may mean that it has spread to other
    lymph nodes and organs such as the
    bones, liver or lungs.

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Symptoms of breast cancer

In early stages of breast cancer, there is usually no pain and there may be no symptoms at all. As the cancer grows, the following symptoms could appear:

  • A persistent lump or thickening in the breast or armpit area

  • A newly retracted
    (pulled in) nipple

  • Changes in the colour or skin of the breast, areola or nipple (eg. dimpling, puckering or scaling)

  • Blood or discharge from
    the nipple

  • A change in the size or shape of the breast

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Consult a doctor if you notice any of the above changes

There are other breast conditions that might mimic the symptoms of breast cancer and so require further tests to diagnose. These include:

  • Cysts: Fluid-filled sacs more common in women aged 35 - 50
  • Fibroadenomas: Benign tumours made of glandular and fibrous tissue, common in younger women
  • Hyperplasia: A proliferation of cells in the lobes or ducts
  • Calcifications: Bits of calcium in the breast
  • Papillomas: Small growths that arise from the lining of the breast ducts and are often not more than 0.5-1.0cm in size
  • Phyllodes tumours: Tumours which tend to grow rapidly to a large size, sometimes up to 8-10cm in size
  • Infections of the breast: Lumps due to an infection are usually very painful and there will be skin changes such as redness and swelling over the lump

Of these, hyperplasia is believed to increase risk for breast cancer while clusters of tiny calcifications (microcalcifications) can be indications of pre-cancer or cancer.

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Myth and truth

  • Breast cancer is a death sentence.

    If detected and treated early enough, breast cancer need not result in death. Early detection can help save lives and breasts.

  • Breast cancer is hereditary.

    Breast cancer is not always hereditary. Over 90% of women in Singapore with breast cancer have no known family history of the disease.

  • If I have bigger breasts, I have a higher chance of getting breast cancer.

    This has not been proven by research. Someone who has smaller breasts has an equal chance of getting breast cancer as one who is well-endowed. Being overweight, however, does increase your risk.

  • Breast cancer is contagious.

    You cannot be infected with breast cancer through physical contact (touching, drinking out of the same cup, sharing food, or having sex).

  • Deodorants, anti-perspirants or wearing bras cause cancer.

    To date, there is no scientifically proven data to support these claims.

  • All breast lumps are cancerous.

    Nine out of 10 breast lumps are not cancer. Most lumps detected under the age of 30 are benign.

  • As long as I have had a mammogram that did not show any abnormalities, I am safe from breast cancer.

    Cancer can occur at any time. That’s why mammograms should be done annually or once in two years, along with monthly Breast Self Examination and yearly Clinical Breast Examinations so that any changes or abnormalities can be picked up early and checked by a doctor.

  • An injury to the breast can cause cancer.

    A bruise or hit to the breast won’t cause cancer. If cancer develops in a spot that has been injured, it is just a coincidence.

  • Breast cancer lumps are painful and grow fast.

    Breast cancer lumps tend to be painless, hard, fixed in position and persist even after a few menstrual cycles. They usually grow slowly. If you are diagnosed with breast cancer, take a little time to talk to relevant people or even seek a second opinion before deciding on
    treatment.

  • Mastectomy (removal of the entire breast) is the only way to get rid of breast cancer.

    Mastectomy is not required for all breast cancers. Thanks to new technology, recent research and improved therapies, those diagnosed with breast cancer have a variety of options, depending on the stage and type of breast cancer.

Want to know more? If you wish to find out more, please request for our publication: Breast Book - Myths, Truths and Facts
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Breast Self Examination

Breast Self Examination (BSE) should be done once each month by women 20 years and older.

The best time to do BSE is 7-10 days after the start of menses, when the breasts are least tender. If you no longer menstruate, do BSE on a fixed date every month, for example the first day of each month.

The purpose of BSE is to enable you to become familiar with the normal feel of your breast tissue so that you can recognise any abnormal changes.

3steps

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While doing BSE, you need to look for:

  • A lump that persists
  • A change in the size or shape of one breast
  • A dimpling or puckering of the skin (like orange peel)
  • A retraction (pulling in) of the nipple
  • A discharge (clear or bloody) from the nipple

If any of these changes are felt or seen, you should consult a doctor immediately.

guideline

If you notice a change in your breasts... do not panic!

Most breast changes are not breast cancer but all should be checked by a doctor.

  • See a doctor who will examine your breast, ask questions about your change, and find out about any relevant medical and family history. This will help the doctor determine if your change is normal or if a review at a later date or further tests are required.
  • You may be referred to go for a mammogram and/or ultrasound, which will be reviewed by a radiologist.
  • If abnormalities are detected by the mammogram or ultrasound, a biopsy will be recommended. A fine needle may be used to obtain some cells or a larger needle to remove tissue from the affected area for examination under a microscope by a pathologist.
  • If cancer is detected, you will be referred to a breast surgeon.

If you have concerns or questions about the investigation of the changes in your breasts, talk to your doctor or seek a second opinion.

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Breast Cancer Screening

Depending on your age, the following is recommended.

age 20 - 39 yrs
  • Do breast self-examination (BSE) once every month

 

age 40 - 49 yrs
  • Do breast self-examination (BSE) once every month
  • Go for a clinical breast examination once a year
  • Go for a mammography screening once a year
age 50 yrs & above
  • Do breast self-examination (BSE) once every month
  • Go for a clinical breast examination once a year
  • Go for a mammography screening once in 2 years (unless otherwise recommended by a doctor)

*Note: Age recommendations are only guidelines and may differ for those with a family history of breast cancer or those who have other risk factors. Consult your doctor on our screening schedule.

Clinical Breast Examination:

  • Women 40 years and older should go for a Clinical Breast Examination once every year. This is an examination of the breast tissue by a healthcare professional.
  • Clinical Breast Examinations can be done at your GP clinic or polyclinic, or at a Gynaecological clinic.
  • The healthcare professional, usually a doctor, will palpate (feel) both your breasts and do a visual examination. If he/she finds anything suspicious, you will be referred for further testing (such as a mammogram/ ultrasound/ biopsy) or be given a follow-up appointment.


MAMMOGRAPHY SCREENING

Mammography screening is a low-dose x-ray examination of the breast that can pick up very small breast cancers. During mammography screening, the breast is gently flattened between two plates of the X-ray machine for a few seconds, to spread the tissue apart and get a good image of the breast. Images of the breast are taken and developed by a radiographer (a technician) who then hands the X-ray films to a radiologist (a doctor) to check for abnormalities.

It is recommended that women aged 40 – 49 should go for mammography screening once a year, and women above 50 should go for one once in 2 years.

Why should one go for a mammography?

Mammography is currently the most reliable way to detect breast cancer. It can detect lumps even before they are felt by the hand. Such early detection can greatly increase chances of recovery as well as provide more treatment options.

Will there be pain when one is doing the mammography?

During the procedure, the breast is compressed for a few seconds to spread the tissue apart and get a good image of the breast. Some women may find this uncomfortable or painful, but this is temporary and will last only a few seconds.

Is mammography screening safe?

Yes, mammography screening is safe. Only a very low dose of radiation is used during mammography screening, and the chance of it saving your life, by detecting breast cancer, is much greater than that of it harming you. In addition, the compression of your breast for a few seconds, to ensure that a clear image is obtained, will not harm your breast in any way.

How accurate is mammography?

Mammography is currently the best way to detect early breast cancer as it can detect lumps that are too small to be felt. However, a small percentage (10%) of cancers do not show up on a mammogram; this could be due to the cancer being:

- Located in a part of the breast that is difficult to screen via mammography

- Hidden by normal breast tissue

- Not so visible as it may be growing in a manner that does not alter the surrounding normal breast tissue.

In addition to mammography, it is important that you do a breast self examination once every month and go to a doctor for a clinical breast examination once a year. Doing all these three types of breast checks can help you to detect any changes in the breast.

Will mammography screening tell if a lump is cancerous or not?

While mammography is useful in detecting lumps, it cannot say for sure if a lump is cancer. Tissue must be removed for examination to tell if it is cancer. This can be done with needle biopsy or open surgical biopsy.

When is the best time to go for mammography?

If you have sensitive breasts, go for mammography at a time of the month when your breasts will be least tender. Try to avoid the week right before your period. This will help to lessen discomfort.

Can all women go for mammography screening?

Mammography is usually not recommended for younger women (below 40) whose breasts tend to be more dense, making it difficult for small changes to be detected. Instead, an ultrasound, which uses high-frequency sound waves, is recommended. During an ultrasound, a gel is put on the breast and a small transducer or microphone is moved over the skin.

How do I prepare for mammography?

- Do not wear any deodorant, perfume, powder or cream, under your arms or chest area as it may interfere with the quality of the mammogram. Also avoid wearing any jewellery.

-Wear a comfortable two-piece outfit.

- There is no need to restrict your food or fluid intake.

Where can I go for mammography screening?

Subsidised mammography screening is available to Singaporean women or Permanent Residents aged 40 and above with no known symptoms such as breast lumps or nipple discharge and who have not had a mammogram in the last 12 months, through BreastScreen Singapore, run by the Health Promotion Board in conjunction with several polyclinics. The cost is $50. Appointments must be made through the Breast Screen Singapore Hotline: 1800 333 3030. For more information, email HPB_BreastScreen_Singapore@hpb.gov.sg or visit the HPB website.

Most hospitals and several clinics offer mammography screening at unsubsidised rates. The cost ranges from $80 to $200 depending on the facility. Most of these require a referral by a GP, followed by a call to make an appointment. Click here for a list of screening services and healthcare facilities.

Want to know more? Learn more about BCF Encouragement for Active Mammograms (BEAM15)

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Risk Factors

 

Being female and having breasts is the highest risk factor. However, 1% of breast cancer occurs in males.

 

A woman’s risk of getting breast cancer increases with age. As women get older, it becomes more likely that abnormal changes will take place in their cells. Breast cancer is more common in women aged 40 and above. However, women as young as in their early twenties have been diagnosed with breast cancer in Singapore.

 

If your mother, sister or daughter has or had breast cancer, you are at higher risk for developing it yourself. Family history of breast cancer can be due to factors such as lifestyle or associated with specific genetic mutations. So far, researchers have found two genes – BRCA1 and BRCA2 – that, if defective, can increase susceptibility for the disease.

 

If you begin to menstruate early (before 12), menopause late (after age 55), have your first child after age 30 or have no children at all, you are at higher risk of developing breast cancer. These factors are believed to be linked to the female hormone oestrogen. Breast cancer has also been associated with the prolonged use (5 years or more) of oestrogen replacement therapy after menopause.

 

Several studies have suggested that eating a diet high in fat may increase the risk of breast cancer; while others have not found this to be so. However, it is still best to limit fat intake as a high-fat diet can result in other cancers and heart disease. In addition, chemicals called phytoestrogens (plant hormones), found in a variety of vegetables and soy, may protect against developing breast cancer as well as slow down its growth.

 

Exercise may lower breast cancer risk by delaying the onset of menstruation, reducing the frequency of regular periods and helping to maintain a healthy weight. Each of these can help decrease the total amount of oestrogen a woman is exposed to in her lifetime. Low to moderate levels of physical activity may enhance the immune system’s ability to kill cancer cells or slow their growth rate.

 

Several studies link alcohol intake on a regular basis with an increased risk of breast cancer. Alcohol may increase risk by altering the way a woman’s body metabolises oestrogen. This may cause blood oestrogen levels to rise, which may in turn increase the risk of breast cancer.

 

Women who have had breast cancer or benign breast disease such as hyperplasia have a higher risk of getting breast cancer.

Four in five women diagnosed with breast cancer have no known risk factors. So it is important to know how to protect yourself and reduce your risk of getting the disease.

PROTECT YOURSELF
  1. Practise a healthy lifestyle
    • Be physically active. Exercise 3 - 5 times a week for at least 30 minutes each time.
    • Maintain a healthy weight.
    • Eat a diet that is rich in fruits, vegetables and whole grains and low in fats with an emphasis on good fats (monounsaturated and polyunsaturated fats) over bad fats (saturated and trans fats).
    • Limit alcohol intake to less than one alcoholic drink a day.
    • Breastfeed children instead of formula feeding them (if possible).
  2. Be aware of breast cancer and its symptoms
  3. Screen yourself for breast cancer regularly
    Early detection offers more treatment options and a better chance of survival and recovery. Take charge of your own breast health and detect changes in your breast through:

    Never be afraid to examine your breasts or to have them examined. Finding out that you do not have breast cancer is more important than the time and effort required for an examination, or any discomfort you may feel.

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Breast Cancer Treatment

Everyone's treatment is different. To help doctors decide on the best treatment, the stage of the cancer needs to be determined. A scale is used that takes into account the tumours size, the sort of cells its made from and whether the cancer has spread or not. One or a combination of therapies may be used which should be discussed with the doctor.

If you are diagnosed with breast cancer, take a little time to talk to relevant people or even seek a second opinion before deciding on treatment.

Want to know more?
BCF Support Groups provide a safe, understanding, caring environment for people who have been affected by breast cancer to explore their emotions, ask questions, and share experiences, information and strategies they find useful in learning to cope with the disease. Our trained Volunteer Befrienders, all of whom are breast cancer survivors themselves, provide information and emotional support through telephone counselling and hospital visits. Asking questions about breast cancer can be difficult. BCFs Volunteer Counsellors have experienced the ups and downs of breast cancer and are prepared to answer any question you may have. Give us a call today!

  1. 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. Usually only performed for early breast cancer.
    • Mastectomy: Removal of the entire breast, often including the lymph nodes in the armpit and sometimes the chest wall muscles. Required when the cancer is found in numerous parts of the breast or the cancerous area is large.
  2. Chemotherapy
    Drugs, usually in a combination, are given orally or by injection, to kill cancer cells. The drugs enter the bloodstream and travel through the body, and cause temporary side-effects that can be prevented or reduced with appropriate steps. Hence, chemotherapy is given in cycles - a treatment period followed by a recovery period, then treatment again and so on.
    Want to know more?
    Learn more about BCF Education and Empowerment Programme (BEEP), Positive Appearance Scheme (PAS) and Wig Loan Programme
  3. Radiation Therapy or Radiotherapy
    High-energy x-rays are directed at the breast, to damage cancer cells and stop them from growing. Radiotherapy is almost always recommended with lumpectomy but not always with mastectomy. Temporary side effects can occur which vary from person to person.
  4. Hormonal Therapy
    This is used to deprive cancer cells of the hormones they need to grow. Hormonal therapy could involve drugs to change the way hormones work or surgery to remove the ovaries that produce female hormones which and can affect cancer cells. Side effects can occur. These depend on the type of drug used and vary among individuals.

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