Breast Cancer

What Is Breast Cancer?

Breast cancer occurs when cells in the breast replicate uncontrollably. It can form in the lobules, the glands that produce milk, or the ducts, the tubes that carry milk to the nipples. These cancerous cells can spread to the connective tissue that forms most of the breast. 

 

Although cancer of the lobules and the ducts are the most common types of breast cancer, there are other rarer breast cancers. These include inflammatory breast cancer, mucinous cancer, medullary cancer and Paget’s disease.

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Symptoms Of Breast Cancer

The symptoms of breast cancer include but are not limited to:

 

• Changes in the size and shape of one or both breasts 

• White, grey or bloody discharge from one or both nipples

• Hard lumps or swollen areas in the armpits or breasts 

• Dimpling or indentations on the surface of the breasts 

• Rashes on or around the nipple

• A sudden change in the appearance of the nipple, such as changes in colour or a sunken appearance 

 

While most women may understandably be concerned about breast pain, it is important to note that breast pain is typically not a symptom of breast cancer. Instead, it often arises from benign conditions such as hormonal changes, cysts, or mastitis.

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Causes And Risk Factors Of Breast Cancer 

The causes and risk factors of breast cancer include:

 

Age - Breast cancer most commonly occurs in women over the age of 50. In Singapore, peak incidences occur between the ages of 40-60. It is recommended that women above 40 are regularly screened for signs of breast cancer. 

 

Hormonal Imbalance - Being exposed to abnormal amounts of oestrogen can increase the risk of breast cancer. Beginning ovulation earlier than normal or going through menopause later than normal can increase oestrogen exposure and up the risk of breast cancer. Similarly, not having children or having children at an above-average age can lengthen periods of oestrogen exposure and increase the risk of breast cancer.  

 

Contraceptive Methods - Some studies have shown that there is a link between the contraceptive pill and a heightened risk of breast cancer. However, the risk of breast cancer returns to normal 2 years after stopping the pill.  

 

Weight - Those who have gone through menopause and are overweight or obese are more likely to develop breast cancer. 

 

Genetic Risk - Genes known as BRCA1 and BRCA2 are passed down through family members and increase the risk of breast cancer. Having a family member who has suffered from breast or ovarian cancer also increases the risk of breast cancer. 

 

Alcohol Consumption - Drinking alcohol on a regular basis can increase the chance of breast cancer. 

Previous Cancers - A previous instance of non-invasive or benign breast lumps can up the chance of subsequent tumours forming. Similarly, receiving radiation therapy in the upper torso area for another cancer can increase the risk of breast cancer.

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Breast Cancer Screening

Breast cancer screening is the best way to identify symptoms of breast cancer in their early stages. There are two types of breast cancer screening. These are:

 

• Self-examination - Many women opt to examine their own breasts for signs of cancer. This involves checking for common symptoms, checking for nipple discharge, and feeling for lumps in the breast tissue while lying down. 

 

• Mammogram - Screening mammograms involve taking X-ray images of one or both breasts. They are most commonly used to screen for breast cancer in women who have no symptoms. 

 

• Breast ultrasound - In women with dense breast tissue on mammogram, it is advisable to add on an ultrasound screening to increase the accuracy of mammogram.

 

• MRI - Some patients with high risk or strong family history may need to start screening at an earlier age and with the aid of an MRI.

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It is best to consult your doctor to decide on which is the best screening modality for you. Screening frequency and modality should be tailored to the individual depending on their breast health and risk profile.

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Breast Cancer Diagnosis

If abnormalities are found during a screening or physical examination, there are many ways breast cancer can be officially diagnosed. These include: 

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Imaging Tests

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Mammogram - Diagnostic mammograms involve taking more in-depth X-ray images of the breast tissue. 

 

Ultrasound - Ultrasounds use sound waves to create images of breast tissue. These images show abnormalities such as lumps and their characteristics.

 

MRI - Magnetic resonance imaging machines take multiple pictures of the breasts in short succession. These are overlaid to create detailed images of breast tissue. 

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Biopsy 

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Core needle biopsy - This biopsy uses a hollow needle which moves quickly in and out of the breast tissue. A small ‘core’ of tissue is then removed and analysed. 

 

Vacuum-assisted core needle breast biopsy - This biopsy follows the same procedure as the core needle biopsy, but the needle is equipped with a vacuum to suck breast tissue samples. 

 

Fine needle aspiration - This biopsy uses very thin needles which can be inserted directly into cysts or enlarged lymph nodes to collect cell samples. 

 

Excision biopsy - This is a type of surgical biopsy that involves removing the entire lump or affected area. This is then sent for testing. 

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Breast Cancer Treatments

Doctors may recommend different treatments depending on the type and stage of the breast cancer diagnosis. The most common treatments are:  

 

Surgery - Surgery to treat breast cancer will either remove the affected area, or remove part or all of the breast. If the cancer has spread to the lymph nodes these will also need to be removed. 

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Radiation Therapy - Radiation treatments use high-energy beams to kill abnormal cells. This is usually performed after surgery to reduce the risk of cancer recurrence. 

 

Chemotherapy - Anticancer drugs are injected into the bloodstream. As they circulate through the body they disrupt the growth of cancer cells. 

 

Targeted Therapy - Using medicines, targeted therapy either destroys cancer cells or slows their growth. These medicines can be administered in pills, through injection or an IV. 

Endocrine Therapy - If a tumour is hormone-sensitive, endocrine therapy can stop the body from producing those hormones. This is usually given as a tablet which is taken every morning for 5-10 years after cancer surgery to reduce the risk of cancer recurrence.