Health Matters is a monthly column that features expert advice from doctors and medical specialists in Singapore. Have a burning health question? Email us at firstname.lastname@example.org with “Health Matters” in your subject header and we’ll get back to you.
Over 2,000 women are estimated to be diagnosed with breast cancer in Singapore every year, it being one of the most commonly occurring cancers among women here. According to the World Cancer Research Fund, breast cancer is also the most prevalent overall worldwide – more than 2.26 million new cases were detected in women in 2020.
While it usually occurs in women above the age of 40, about 10 per cent of women with newly diagnosed breast cancers fall below this age bracket, according to Dr Lee Wai Peng, senior consultant and breast cancer surgeon at Solis Breast Care and Surgery Centre.
With positive breast cancer diagnosis among younger women on the rise, how can we take better care of our breast health? And why is a mammogram recommended for women above the age of 40 – but not for younger women? Here, Dr Lee answers our questions.
Why is it recommended that women in their twenties and thirties opt for an ultrasound instead of a mammogram?
Younger women in their 20s and 30s, and even women in their 40s may have very dense breasts. Hence, interpretations of mammograms can be exceptionally challenging in such instances. Occasionally, extremely small or early lesions may be missed on the standard 2D mammograms. Introduction of 3D mammograms has allowed some of these subtle or minute lesions to be picked up especially in ladies with dense breasts.
Ultrasound is not a routine screening modality for women in their 20s and 30s, especially if they do not have any symptoms. Instead, women in this age group are encouraged to perform breast self-examination on a monthly basis, seven to 10 days after the onset of their menstruation. If they have any symptoms or concerns, they should seek a consultation with a breast specialist. Ultrasound may then be performed to evaluate their symptoms.
The prevalence of breast cancer is higher from age 40 onwards, which is why older women are advised to go for regular mammograms. Women who are aged between 40 to 49 and do not have any symptoms are advised to consider a yearly mammogram after speaking to their doctor on the pros and cons of the procedure. Asymptomatic women above the age of 50 are recommended to have a mammogram done once every two years.
While it’s said that the likelihood of developing breast cancer for women who are 40 and above is higher, it is a fact that breast cancer can occur in women at any age. How can younger women prevent breast cancer from occurring?
Unfortunately, there has not been any effective prevention measure for young women against breast cancer. However, certain lifestyle modifications may reduce the risk for developing the disease. This includes:
- To stop smoking
- Moderate our alcohol consumption
- Exercise regularly
- Maintain a healthy body mass index
Women can also consider discussing the following with their doctors:
- Alternative measures of contraception
- Pros and cons, as well as alternatives for hormone replacement therapy (HRT)
And for young women with a strong family history of breast cancer, they may wish to speak to their doctor about genetic counselling, and to seek further advice on how to screen their breast.
I have seen instances where a mastectomy was being recommended to a patient with Stage 0 breast cancer. What is your take on this? Does age play a part in terms of treatment options?
Mastectomy is one of the two methods of surgical treatment that can be offered to ladies diagnosed with breast cancer, including Stage 0. The other method is breast conserving surgery (BCS), also known as lumpectomy. Age does not play a part in the choice of treatment though the choice for mastectomy may be noticeably more popular among the older aged women. The choice of surgery advised depends largely on the extent of the cancer and the volume of unaffected breast tissue.
A variety of reconstruction options are now made available for ladies opting for mastectomy, such as silicone implant or autologous flap (using their own body tissue for reconstruction). Sometimes, a combination of both may be utilised. Surgery to reconstruct the breast can be done at the same time of the mastectomy or it can be done at a later time when the breast cancer treatment is completed (i.e. months to years after the mastectomy).
Oncoplastic breast surgery has been gaining popularity and this allows more women to have the option of conserving their breast, doing away the need for mastectomy. This may be suitable for women with larger sized tumours where previously mastectomy was the only possible option. This involves repositioning or rearranging the local surrounding tissue into the breast cavity where the tumour was previously located to allow the lady to retain the shape of her breast after surgery.
What are some misconceptions about breast cancer that most people have, even today?
Some of the common misconceptions that still exist include the perception that breast cancer only occurs in older women, such as those above the age of 60, or that it will only happen in women who have a family history of breast cancer.
There are also other falsehoods, such as:
- Cancerous lumps are painful
- All lumps in the breast must be due to breast cancer
- Using deodorants and antiperspirants, and wearing wired bras can lead to breast cancer
Finally, another common misbelief is that only women can get breast cancer. The truth is, although it’s much less common, men can develop breast cancer as well. Men diagnosed with breast cancer make up one per cent of all breast cancers.