Breast cancer is the most common cancer in women in Singapore and is also the commonest cause of cancer deaths in women.1 in 14 women in Singapore are at risk for breast cancer. The incidence has been on the rising trend among all three ethnic groups in the last forty years.
Fortunately, the treatment of breast cancer has improved over the years mainly due to the advances in chemotherapy developments.
Prognosis is better if the disease is picked up in the early stages. Hence screening is advocated. Early breast cancer is not present with any signs and symptoms and hence screening is advised.
A lot of myths prevail in the community about breast cancer such as “I don’t have pain “so it cannot be cancer. However, 90% of breast cancers are painless. “My parents do not have cancer, so I am not at risk”. Almost 80% of breast cancers are not hereditary, again indicating that only a minority are affected due to the cancer genes (BRCA 1 &2) in the family.
Once an abnormality is detected on imaging and if it is suspicious enough, the doctor will advise for a biopsy, which refers to removing a sample of tissue from the lump using a needle. This is done in the clinic setting or the radiology suite as an outpatient procedure.
The result of the tissue samples confirms the diagnosis of cancer. At times advanced imaging such as MRI of breasts may be suggested before surgery is planned in order to have precise surgical planning.
There are multiple varieties of surgical techniques available as every woman is different and the techniques can be suited to the body type of the patient. Surgical options are available for women with small cup size to allow for lumpectomy and at the same time, the defect can be filled with tissue from elsewhere in the body to minimise the deformity seen after radiation therapy. This is referred to as partial breast reconstruction and Dr Radhika being an oncoplastic surgeon performs this frequently as it results in a superior aesthetic result compared to standard cancer surgery. Sometimes lumpectomy may not be the best surgical option, in which case mastectomy is offered. This refers to the removal of the whole breast. Whole breast reconstruction can be done at the same setting as the cancer operation. Dr Radhika works with her trusted plastic surgery colleagues to provide the ideal reconstructive option for the patient.
Treatment of breast cancer is multidisciplinary. And treatment is personalised as every individual’s needs are taken into consideration and also the tumour biology which differs in different patients. Management involves surgery, chemotherapy, radiotherapy and endocrine treatment. The combination of treatment modalities will differ in individuals.
The diagnosis of breast cancer is not easy either for the doctor to convey or nor the patient to accept. We understand that this will be a difficult journey for the patient and relatives. Our aim is to make this path less painful with compassion and care in the medical expertise we provide.