Every woman frets at the thought of contracting breast cancer. Early detection can however, go a long way in arresting the disease.
Breast cancer is the most common cancer among women worldwide and also in Singapore.
About 1,200 new cases of breast cancer are diagnosed each year in Singapore and about 270 women in Singapore die annually from this disease.
The aim of understanding breast health for women is to detect breast cancer early when
treatment is more successful and chances of surviving the disease are better. This is done through
the following three methods – monthly breast self-examination(BSE), regular screening mammography and clinical breast checks by the doctor.
Most breast lumps or changes are found by a woman herself through regular checks. It is important to get used to how your breasts feel at different times of the menstrual cycle and to know when there is a change.
Furthermore, BSE is quick, free and requires no help. It should be done once a month, about one week after the menstrual period as this is when your breasts are least lumpy from hormonal influences. Women as early as in their 20s can start examining their own breasts.
The things to look out for are breast lumps, breast pain, breast asymmetry, nipple discharge, nipple retraction, nipple rash, skin changes and axillary lumps. Not all breast lumps are cancerous. Eight out
of ten lumps felt by a woman are benign. That includes fibroadenoma in women in their 20s, and
fibrocystic disease affecting women in the 30s and 40s. Breast abscesses commonly occur in women
who are breastfeeding. Regardless of the woman’s age, a painless lump which is hard, irregular and has
changed to the overlying skin or nipple, should not be ignored. Breast pain or mastalgia is a fairly common symptom experienced by most women, about a week before the menstrual period. This is due to the hormonal influence on the breast tissue, causing breast swelling. This form of mastalgia tends to be cyclical and involves both breasts. However, if the mastalgia persists after the end of the menstrual period or affects only one breast, medical advice needs to be sought. The most common cause of mastalgia is the fibrocystic disease and this benign condition is common in women in their mid thirties. Only 10 percent of breast cancer presents as mastalgia. Another sympton to look out for is nipple discharge.
During the monthly breast self-examination, the nipples should be lightly pressed to elicit for any
discharge. Any nipple discharge that is bloody, persistent, affects only one nipple and is associated
with a breast lump should be brought to the attention of your doctor.
Regular screening mammography
Mammography is the best tool in screening breast cancer because it improves the ability to detect breast
abnormalities even when they are very small. In fact, regular mammograms have been shown to confer a 15 percent reduction in breast cancer mortality in women above 50 years old. Recent advances in mammography include full field digital imaging, which minimizses the amount of radiation exposure to the patient. The recommendations are for women between the age of 40 to 49 to undergo regular screening mammograms once a year and for women 50 years old and above, to be screened once every two years.
The benefit of the mammogram is less pronounced in women aged 40 years and below because younger
women tend to have denser breasts. For younger women, who detect a lump during BSE, a breast
ultrasound with elastography is useful in determining if the lump is suspicious or not. There is no radiation involved in a breast ultrasound.
Clinical examination by a doctor
Regular breast examinations by the doctor are important during routine health physical check-ups.
It is recommended that this is done once every three years for women above 20 years of age and every year for women aged 40 years and above. However, this may need to be done more frequently if there is a
strong family history of breast cancer. During the consultation, a detailed medical history for menstrual cycles, pregnancies and breastfeeding is taken, followed by a thorough breast and axillary examination.
In essence, breast self-examination and the doctor’s clinical examination are important methods of breast
cancer detection and these should be performed with regular mammography. Together, these three methods provide complete breast cancer screening. Remember, early detection gives you the best chances of cure.
Dr Georgette Chan SW
Consultant Breast and General Surgeon
MBBS (Singapore), M.Med (Surgery), MRCS
(Edinburgh), FRCSEd (General Surgery), FAMS.
Dr Georgette Chan is a female breast and general surgeon who
obtained her post-graduate degrees in general surgery from both
the National University of Singapore and the Royal College of
Surgeons of Edinburgh.