Breast cancer is the abnormal growth of cancer cells in the breast. These cancerous cells can develop and mutate rapidly, potentially spreading to other parts of your body.
According to the Singapore Cancer Society, breast cancer is the most common cancer among Singaporean women, with around 1,000 women diagnosed annually. Furthermore, approximately 1 in 13 Singaporean women will be diagnosed with breast cancer throughout their lifetime.
Types of Breast Cancer
There are various types of breast cancer, and they can be categorised into two main types: Invasive and non-invasive (in situ).
For invasive cancers, the cancerous cells (malignant) have the ability to spread to adjacent breast tissue and other organs, whereas for non-invasive cancers, the cells do not have this ability.
Some of the most common types of breast cancer include:
Invasive Ductal Carcinoma (IDC). IDC is the most common type of breast cancer. It originates from the breast’s milk ducts and slowly invades nearby breast tissues. IDC can also spread to other parts of the body.
Invasive Lobular Carcinoma (ILC). ILC begins in the milk glands (lobules) instead of originating from the milk ducts like IDC and slowly invades the other areas of the breast. Similar to IDC, ILC can also spread to other parts of your body.
Ductal Carcinoma In Situ (DCIS). DCIS is non-invasive, meaning that the abnormal cells are confined to the breast’s milk ducts and have not spread to nearby breast tissues.
Inflammatory Breast Cancer (IBC). IBC is a rare but aggressive form of breast cancer, making up around 1 to 5% of all breast cancer cases. It is classified as Stage 3 breast cancer, where the cancer cells infiltrate the skin and lymph vessels of the breast, blocking the lymph nodes. Apart from developing a lump, IBC can also cause your breasts to swell, turn red and feel very warm.
Metastatic Breast Cancer (MBC). MBC is classified as Stage 4 breast cancer, and the cancer cells have spread to other parts of the body such as the lungs, liver, brain or bones.
Triple-Negative Breast Cancer (TNBC). TNBC is another uncommon form of breast cancer, affecting only about 10 to 15% of breast cancer patients. For TNBC to be diagnosed, the two hormone receptors (Estrogen and progesterone receptors) and the Her2 receptor are absent from the cancer cells. This type of cancer is more aggressive than the hormone receptor positive breast cancer.
Risk Factors for Breast Cancer
As with any other type of cancer, breast cancer also has its associated risks. However, possessing risk factors does not imply that you will develop breast cancer. Some women may still get breast cancer even though they do not fall under any of the risk categories. Having a risk factor simply means that you have a higher chance of developing breast cancer in your lifetime.
Some of these risk factors include:
Gender. Women have a much higher risk of getting breast cancer as compared to men. However, women are not the only ones who can be diagnosed with breast cancer. Men are also susceptible to the disease, with about less than 1% occurrence.
Age. The risk of breast cancer increases as you age. Women above 40 years old should have regular breast screening.
Family history. Having a first- or second-degree family or relative who has or had breast cancer increases the risk of developing breast cancer.
Genetic mutations. Women who have inherited mutated genes such as BRCA1 and BRCA2 have a higher chance of getting breast cancer.
Hormones. Women who menstruate early (before 12), menopause late (after 55), have their first pregnancy after age 30 or have not been pregnant before are at a higher risk of developing breast cancer. These examples are linked to the female hormone oestrogen, which is known to affect breast tissues.
Lifestyle factors. Women who are physically inactive, consume a high-fat diet or indulge in alcohol excessively also have an increased risk of developing breast cancer due to alterations in oestrogen levels. Older women who are obese also have a much higher chance of getting breast cancer. Women who are on Hormone Replacement Therapy (HRT) are also at an increased risk of developing breast cancer.
Previous history. Women who have had breast cancer or non-cancerous breast disease are also at a much higher risk of being diagnosed with breast cancer.
Early Signs of Breast Cancer
In most cases, early breast cancer does not produce any noticeable symptoms. However, there are still several tell-tale indicators of potential breast cancer.
The common symptoms and early signs of breast cancer may include:
A lump in the breast or underarm area
Changes in the size or shape of the breast or nipple (thickening/swelling)
Nipple discharge (clear or bloody)
Irritation or redness in the breast or nipple area
Dimpling of breast skin
Pain in the breast or nipple area
Without screening, you are unlikely to realise if you have breast cancer until there is a significant lump in your breast area that is large enough to be felt or seen. Even so, a lump may not necessarily indicate that you have breast cancer. Breast cancer is often not noticeable, therefore it is important to undergo breast cancer screening as early detection of cancer cells means simpler treatment and less chance of dying from breast cancer.
How Is Breast Cancer Diagnosed?
Mammography. Mammography uses low-dose x-rays to examine and detect abnormalities in the breast. It allows the detection of abnormalities that may suggest the presence of cancerous tumours or lumps that cannot be easily seen or felt. During a mammogram, both your breasts will be gently compressed between two transparent plates. X-ray images of each breast will then be taken from different angles.
Ultrasound. A breast ultrasound scan uses penetrating sound waves to determine whether a lump is solid or filled with liquid. This is usually done with mammography to increase the detection rate for any abnormalities or unusual lumps in the breast.
Magnetic Resonance Imaging (MRI). An MRI scan uses magnetic waves to produce detailed images of the interior of your breasts. This method is usually used to detect breast lumps that are not visible with mammography or ultrasound. It may be recommended if you are under 40 years old and belong to the high-risk group (family history or presence of BRCA 1 or 2 genes). However, this method is generally not recommended for routine breast screening for normal-risk women.
Breast Biopsy. A breast biopsy is a test usually done when your doctor suspects a significant chance of the presence of abnormal cells in your breast after having done the standard screening tests. Your doctor will use surgical procedures to remove sample tissues from suspicious areas, and these tissue cells will undergo further examination to determine if they are cancerous.
Breast cancer may be the most common cancer among Singaporean women, but it can be treated when detected early. Early warning signs and symptoms may indicate a more serious issue and could lead to breast cancer. However, these tell-tale signs are often unnoticeable and may not even be present at all.
As such, early detection through the various screening options is the key to simpler treatment and increasing the chance of surviving breast cancer.
As a supporter of personalised surgical care, I understand that no two patients are the same. I believe in tailoring management for each patient to meet each individual’s needs and expectations. A patient’s journey can be difficult and frustrating at times, so I strive to make this experience as pleasant and seamless as possible.
Dr. Tan Chuan Chien
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Dr. Tan is a Fellow of the Royal Australasian College of Surgeons (FRACS). He is also accredited to practice as a Specialist in both Singapore and Australia.
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Dr. Tan Chuan Chien
Consultant General Surgeon Breast & Thyroid Surgery
Bachelor of Medicine & Bachelor of Surgery (MBBS)- The University of Adelaide, Australia
Fellow of the Royal Australasian College of Surgeons (FRACS)
Full Registration, Singapore Medical Council (SMC) and Specialist Accreditation Board, Singapore (General Surgery)
Full General & Specialist Registration (General Surgery), Australian Health Practitioner Regulation Agency (AHPRA)
Completed Breast Surgery training through the BreastSurgANZ Fellowship programme
Dr. Tan Chuan Chien is a Fellowship-trained Breast and Endocrine Surgeon practicing as a Consultant General Surgeon at Gleneagles Hospital, Singapore. He also sees patients at Mount Elizabeth Novena Specialist Centre and Parkway East Medical Centre. Dr. Tan is a registered Specialist Surgeon (General Surgery) in both Singapore and Australia.