Breast Health

Breast Cancer: Diagnosis, Treatment & Surgery Options

Breast cancer remains the most common type of cancer among women in Singapore, accounting for at least 1 in every 4 reported cancer cases. The condition arises from abnormal growth of mutated cells in your breast tissues.

The risk of developing breast cancer becomes higher as you age, and early diagnosis is critical in improving your chances of survival. When diagnosed in its early stages, breast cancer becomes easier to treat since more treatment options are available.

Breast Cancer Diagnosis

The sooner breast cancer is diagnosed, the better are your chances of going through treatment successfully and achieving a cure. This is the primary reason why regular screening is recommended. You also need to be familiar with how your breasts look and feel like and report any sudden changes to your doctor. 

Tests and procedures used to diagnose breast cancer include the following.

Clinical Breast Examination

A clinical exam will be conducted if a lump, nipple discharge, or unusual breast changes are detected. During the clinical exam, your doctor will carefully check both of your breasts and lymph nodes in your armpits to establish whether there are any abnormalities.

Abnormal changes include a sudden change in the size and shape of your breast, recent retraction of your nipple, or discolouration of the skin around your breast not related to infection or other skin conditions such as eczema.

Mammogram

In simpler terms, a mammogram is a digital X-ray image of your breast. This is the most commonly used way of screening for breast cancer. Once the X-ray image is taken, your doctor will study it to establish if there is any abnormality with the internal appearance of your breast.

If an abnormality is recorded, your physician may recommend a diagnostic mammogram to evaluate that abnormality further. A diagnostic mammogram is a more detailed X-ray image of your breast. One of the top reasons why mammograms are popular is that they can detect breast lumps up to two years before you can start to feel them.

3D mammogram or tomosynthesis is a relatively new type of improved digital mammogram that allows your doctor to capture multiple images of your breasts instead of just one picture. This advanced technology is extremely helpful since it allows your doctor to see finer details and make a sound judgment about your condition.

Breast Magnetic Resonance Imaging (MRI)

An MRI machine makes use of radio and magnetic waves to create detailed images of the internal appearance of your breast. Before an MRI is conducted, you may receive a dye injection to enhance and improve the clarity of the images of your internal body organs. Unlike other imaging techniques, an MRI does not use radiation for imaging.

Breast Biopsy

If your doctor suspects breast cancer, he/she will recommend a breast biopsy to confirm the suspicion. This is the only definitive way to make a breast cancer diagnosis. The process involves the removal of breast tissue for examination under the microscope.

During a biopsy, your doctor will use a specialized needle device that is guided by X-ray or any other imaging test to extract a sample tissue from the suspected area. The biopsy sample is sent to the laboratory where experts examine the cells to establish whether they are cancerous or not.

Breast Cancer Staging

If breast cancer is diagnosed, further tests such as bone scan, computerized tomography scan (CT scan), and blood tests are done to establish the extent (stage) of your breast cancer. The staging of your cancer will help in determining the best treatment options that may increase your survival chances.

• Stage 0: This stage is often referred to as ductal carcinoma in situ (DCIS). During stage 0, the cells are still limited to within a duct and have not yet started spreading to the surrounding tissues.
• Stage I: At the beginning of stage I, the tumour starts to enlarge, and it is up to two centimetres. However, it has not begun to affect the lymph nodes and other surrounding tissues.
• Stage II: The tumour is still relatively small in size, but it has started spreading to nearby lymph nodes. In most cases, the tumour is between two and five centimetres.
• Stage III: During stage III, the tumour has become large and has spread to axillary lymph nodes and surrounding tissues. At stage III, the tumour is greater than five centimetres and has started to spread to the chest wall and nearby mammary nodes.
• Stage IV: Stage OV breast cancer has spread to distant body organs such as the brain, liver, and lungs. The tumour can be of any size, and the symptoms are worse.

Breast Cancer Treatment Methods

Treatment method and your chances for successful recovery depend on whether the cancer is localised in your breast tissue or has already spread to other body parts. 

Other factors such as your age, menopausal status, specific characteristics of your cancer cells, and your general health will also determine the treatment options available for you. Breast cancer treatment broadly consists of locoregional and systemic treatment methods.

Locoregional Treatment

This breast cancer treatment method makes use of both surgery and radiotherapy to treat cancer cells in your breast and lymph nodes. It compromises of the following treatment methods:

• Lumpectomy: Often referred to as breast-conserving surgery, this procedure involves the removal of the tumour and a small margin of the surrounding tissue. This leaves the rest of your breast untouched. A lumpectomy is usually recommended for removing small tumours. 
• Mastectomy: A mastectomy refers to a surgical procedure to remove the whole of your breast, including your nipple, lobules, areola, ducts, and fatty tissue. However, other surgical techniques may be an option in selected cases to improve the overall appearance of your breast. Mastectomy will be recommended if the tumour to breast size ratio is large. Your doctor will discuss the various options of immediate breast reconstruction with you if a mastectomy is required.  
• Sentinel Lymph Node Biopsy (SLNB):  This procedure involves the removal of the first few lymph nodes which the lymph flows to and testing them for cancer intra-operatively. If cancer is not found in the sentinel lymph nodes, the chance of finding it in the remaining lymph nodes will be quite slim; hence, no other nodes will be removed.
• Radiotherapy: Radiation therapy involves treatment with high-energy rays that destroy the cancer cells. Some patients with breast cancer may need radiation in addition to other treatment methods. The need for radiotherapy will largely depend on your age, stage of cancer, and the type of surgery that you had gone through. Large tumours may also need radiotherapy. This breast cancer treatment method can be used after mastectomy or breast-conserving surgery. It may also be used if your cancer cells have spread to other parts of the body, such as the brain or bones.

Systemic Treatment Methods

These breast cancer treatment options utilise chemotherapy or hormonal drugs to manage clumps of breast cancer cells that may be circulating in your body. Systemic breast cancer treatment methods include:

• Chemotherapy: Chemotherapy refers to the use of drugs to destroy fast-growing cells in your body. Chemotherapy is sometimes given before breast cancer surgery in women with larger tumours. The primary goal of chemotherapy in such a situation is to shrink the tumour in size to facilitate easier surgical removal. Your doctor may also recommend chemotherapy after surgery to decrease the risk of your breast cancer recurring.
• Hormone Therapy: 60-70% of breast cancers are estrogen receptor positive (ER positive) or progesterone receptor positive (PR positive). These cancers grow in response to the female hormones in your body. Hormone therapy works by blocking the action of progesterone and estrogen or lowering their levels in your body as a way of treating the cancer. Hormone therapy is usually used as the last part of your treatment to decrease the risk of cancer recurring.

Managing Fear After Breast Cancer Diagnosis

Being diagnosed with breast cancer can be daunting and overwhelming. The best thing to do is to manage your fears and believe that you will go through treatment successfully. Some of your options include:

• Join a breast cancer support group in your neighbourhood
• Find a breast cancer specialist who understands your situation and is willing to communicate with you in a way that is comfortable for you
• Know what to expect from various treatment procedures to minimize surprises
• Do small things that make you feel positive about your life
• Find someone understanding you can talk to about your anxiety and fears. This could be your parent, partner, or best friend.