Breast cancer is still the most common cancer among Singaporean women, but compared to decades ago, it is no longer necessarily a death sentence. Famous breast cancer survivors include local actress Pan Ling Ling, Hong Kong singer Frances Yip, Australian musician Kylie Minogue and American actress Julia Louis-Dreyfus.
While certain hereditary genetic mutations, such as a BRCA1 or BRCA2 mutation, increase one’s risk of breast cancer, many women receive a diagnosis without having a family history of the disease at all. Hence, it is recommended that all women perform self-examinations monthly, while women between the ages of 40 and 50 should go for a yearly mammogram screening, as breast cancer that occurs below the age of 50 tends to be more aggressive. Once a woman turns 50, her screening frequency drops to once every two years.
DEFINING BREAST CANCER
Simply put, breast cancer occurs when breast lobules or ducts transform into cancerous cells. Once they do so, a lump forms, which then spreads to the lymph nodes in the armpit and then to the rest of the patient’s body. Thus, self-examinations are crucial in order to detect abnormal lumps early.
Dr Khoo Kei Siong, deputy medical director and senior consultant in medical oncology at Parkway Cancer Centre, lists the risk factors for breast cancer: Increasing age, a personal or family history of breast cancer, obesity in post-menopausal women, excessive alcohol intake, and a history of exposure to ionizing radiation to the chest.
Additional risk factors include late or no pregnancy, early onset of menstruation, late onset of menopause and use of hormone replacement therapy.
TRUTHS AND MYTHS
Breast cancer is not limited to women. Around one out of every 1,000 men will get breast cancer, though Dr Khoo points out that such cases are rare.
“However, the risk of men developing breast cancer increases if there are many cases of breast or ovarian cancers among female family members. The increased risk is primarily due to the inheritance of mutated cancer predisposing genes,” he said.
There are many old wives’ tales swirling around breast cancer, including uniquely Asian ones such as the myth that consuming soy products will cause breast cancer. Dr Khoo said that “On the contrary, there is evidence that among Asian women, a higher intake of isoflavones (the estrogen-like substance in soy products) is associated with a reduced risk of breast cancer.”
BETTER SURVIVAL OUTCOMES
The latest Singapore Cancer Registry report (June 2017) showed that a majority of local women diagnosed with breast cancer had a good chance of surviving the disease. The five-year survival rate for women diagnosed in Stage II – who formed 39 per cent of all breast cancer cases – was 80 per cent. Those who were diagnosed in Stage I (33 per cent) had a five-year survival rate of 90 per cent.
According to Dr Khoo, treatment for breast cancer consists of surgery, radiotherapy as well as systemic drug treatments like chemotherapy, hormonal (also known as endocrine) therapy and targeted therapy that are used after surgery to lower the risk of relapses and improve the cure rate.
Said Dr Khoo: “They shrink large localised breast tumours so that they can be operated on, or reduce and contain advanced breast cancer so that patients can live longer and better. Some of the new drug treatments include agents that target HER2 receptors and CDK 4/6, which both play a critical role in the growth and proliferation of breast cancer cells.”
While it is important to remove the primary tumour in the breast, not every patient will face a full breast removal – known as a mastectomy.
Explained Dr Khoo: “If the tumour is relatively small, not too close to the nipple or areola, and has not invaded the skin or the underlying muscle of the chest, a lumpectomy – meaning removal of the tumour with a surrounding rim of normal breast tissue – will achieve the same long-term cure rate as a mastectomy.”
He added: “As awareness about this disease increases and more women are going for screening, most breast cancers are now diagnosed at an early stage and many patients will be eligible for breast conservation.”
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