Breast Cancer

Breast cancer arises from a malignant tumour. It occurs when breast cells become abnormal and divide without control or order. Learn more about breast cancer, its signs and symptoms, diagnosis, stages and treatment.

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What is Breast Cancer?

The female breast is made up mainly of:
Lobules (milk-producing glands)
Ducts (tiny tubes that carry the milk from the lobules to the nipple)
Stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels)

When breast cells divide and grow without control, breast cancer occurs. Breast cancer that is confined to the ducts (ductal carcinoma in situ) is non-invasive breast cancer. If detected at this stage, breast cancer can be treated and the woman stands a very good chance of survival.

Cancer that spreads beyond the ducts or lobules to the surrounding breast tissue enters the invasive stage. Over time, breast cancer in the invasive stage can spread to the lymph nodes and possibly to other areas of the body.


Who is at Risk?

Women who are at risk of breast cancer include women:
Aged 40 years and above. The risk increases with age.
With a family history (mother, sister, aunt or grandmother) of breast cancer.
With a personal history of breast cancer — women who have had breast cancer before. Those who have non-cancerous breast diseases such as ductal carcinoma in situ are considered to be at a higher risk of developing breast cancer. 
Who experience early onset of menstruation (before 11 years old) and late menopause (above 55 years old).
Who have no children or had the first child later (especially above 30 years).
On hormone replacement therapy.
With high BMI (after menopause).
Who consume alcohol regularly.

People who think they may be at risk should discuss this with their doctor.


What Are the Symptoms of Breast Cancer?

In the early stages of breast cancer, there is usually no pain or symptoms. Breast cancer may cause any of the following signs and symptoms:
A lump or thickening in the breast or in the underarm area
Change in the size or shape of the breast
Bloody or unusual nipple discharge
Dimpling or puckering of skin overlying the breast
Itchy rash of the nipple
Scaly, red or swollen skin on the breast, nipple or areola (the dark area of skin that is around the nipple)
Recent history of nipple retraction (a nipple turned inward into the breast)


What Can You Do to Prevent Breast Cancer?

Practise a healthy lifestyle and maintain a healthy weight.
Avoid alcohol intake or limit your intake to one alcoholic drink a day.
Avoid long-term hormone replacement therapy, but if it is needed, ensure it does not last more than five years.
Most importantly, participate in regular mammogram screenings*.

*The chart below states the recommended guidelines for breast screening.

NCIS Screening Chart 


How is Breast Cancer Diagnosed?

Breast cancer is sometimes discovered after symptoms appear, but many women with early-stage breast cancer have no symptoms, which is why getting the recommended screening test is so important.

Breast cancer is detected through: (1) clinical examination and (2) mammography. Mammography is sometimes combined with an (3) ultrasound scan of the breast to determine if the lump is mainly solid or cystic.

If something abnormal is found during a screening exam such as the mammogram, you will be called in for further imaging. To confirm the diagnosis, your doctor will usually perform a breast biopsy where a sample of the "abnormal" area in your breast is removed to be checked under a microscope. A biopsy is the only way to tell if cancer is really present.

Biopsy techniques include:
Fine needle aspiration (FNA) biopsy
Core needle biopsy
Mammotome biopsy

The choice of which biopsy to use will depend on several factors which you can discuss with your doctor. In cases where the lump is very small or cannot be felt, the biopsy will be performed under the guidance of either the ultrasound scan or the mammogram.

Occasionally, biopsy results are not confirmatory and at that time, your doctor will discuss performing a small operation to remove the abnormal area for further checks.


What Are the Treatment Options for Breast Cancer?

Depending on the stage of the breast cancer, there are various treatment options available.

​​Stage
Treatment
0

Treatments differ depending on what kind of stage 0 cancer the patient has.

​Surgery is usually the initial treatment at this stage.

Smaller tumours: lumpectomy (only the abnormal cells and some tissue is removed)
Another option: mastectomy (entire breast is removed)

Radiation therapy is the standard treatment after a lumpectomy. It attacks any abnormal cells that might have been missed during surgery and lowers the chance of breast cancer recurring.

1

Early-stage breast cancer: the cancer has not spread beyond the breast.


​Surgery is the standard treatment.

Small tumour (<2cm): cancer is removed with the safest minimal amount of surrounding tissue (wide excision)
In some cases, a mastectomy will be performed

Some of the lymph glands in the armpits are also removed at the same time.

Radiation therapy is standard after a lumpectomy. Women with stage 1 cancer who get a mastectomy don't usually need radiation.

Hormone therapy is used after surgery in women who have hormone receptor-positive cancer (tumours whose growth seem dependant on oestrogen). Drugs such as tamoxifen, an anti-oestrogen drug, may be administered.

Chemotherapy is a treatment with drugs that attack cancer cells. It is often used after surgery to lower the risk of recurrence. Women who have larger tumours are more likely to need this form of treatment. Chemotherapy is typically not required for stage 1; however, it may still be offered depending on the individual's cancer characteristic(s).
3

Cancer has spread to the breasts and lymph nodes.



​Chemotherapy is a common treatment here.

Surgery, chemotherapy and radiation therapy are usually used to treat stage 3 breast cancer.



4

Cancer has spread elsewhere in the body. Affected areas may include the bones, brain, lungs, liver, or other parts of the body.



​As multiple areas may be involved, treatments such as surgery or radiation alone are not sufficient. The objective is to shrink the cancer to slow down the disease and prolong life. Drug therapy like hormonal therapy, chemotherapy or targeted therapy is the main treatment here.




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