Medically Reviewed by M Thiviya, R.N.
Cancer occurs when cells start to multiply uncontrollably, often forming tumours. In breast cancer, uncontrolled cell growth begins in the breast and may eventually spread to the rest of the body if left untreated. It is important to note that not all breast tumours are cancerous. In fact, more than 80% of lumps found in the breast are non-cancerous. However, if you notice a lump, do get it checked by a healthcare professional as soon as possible to ensure it does not pose a health risk.
Breast Cancer Symptoms
Oftentimes, breast cancer is discovered when someone notices a lump in their breast. While 8 out of 10 breast lumps are actually benign or non-cancerous, it is best to have them checked as soon as possible as a precaution. Here are some of the symptoms you should take note of:
- Lumps in the breast or underarm
- Unusual or bloody nipple discharge
- Irritation or dimpling of breast skin
- Breast or nipple pain
- Inversion of the nipple
- Redness or flaky skin in the nipple area or the breast
- Itchy rash around the nipple
- Changes in the size or shape of the breast
- Thickening or swelling of all or part of the breast
Breast Cancer Causes and Risk Factors
While the exact causes of breast cancer may not be fully known, some risk factors have been observed to affect the development of breast cancer. These risk factors fall into two categories — non-modifiable and modifiable. Non-modifiable risk factors refer to conditions that are out of our control and cannot be altered; while modifiable risk factors can be changed through actions and decisions we make.
Non-modifiable risk factors: factors we cannot change
The main risk factor of breast cancer is our gender. While males do get breast cancer, the condition is much more common in women than men. This also explains why there is often the misconception that breast cancer only happens to women.
Cancers may likely occur in the older age groups as they take many years to develop from initial stages until they are diagnosed. Hence, as our birthdays pass us by and we mature, our chance of developing breast cancer increases. In fact, more than half of Singaporean women diagnosed with breast cancer fall between 45 and 64 years old. However, we should not forget that breast cancer can occur regardless of age.
Breast tissue density
Breast density, which can be measured through a mammogram, compares the amount of the tissue types in our breasts. A denser breast holds a higher risk of breast cancer. This means having more fibrous and glandular tissues than fatty tissues in a breast. The former two types of tissue are responsible for holding the breast in place and milk production, respectively, while the fatty tissue fills up space in between. The reason between a higher density and its risk for cancer is still under study. However, it is strongly encouraged to undergo a mammogram to learn more about your breast density.
Family history of breast cancer
The risk of breast cancer can be passed down the family line due to the inheritance of certain genes. Having an immediate family member with breast cancer thus increases the risk for others within the family.
For those who have one female relative with breast cancer, the risk is doubled; and for those with two, the risk is five times higher than average. Having a male relative with breast cancer similarly increases one’s risk of getting the condition.
Personal history of breast cancer
For breast cancer survivors, the chance of developing cancer in another part of or the other breast is three to four times higher than another who never had the condition previously.
Modifiable risk factors: factors we can change
Compared to non-drinkers, women who have one drink a day have a 7-10% higher risk of being diagnosed with breast cancer; those who drink two to three drinks a day would have as high as a 20% increase in risk. Similarly, men should also avoid heavy drinking as it could lead to liver disease and a higher risk of developing breast cancer.
Estrogen levels are linked to breast cancer – especially for post-menopausal women. In women, estrogen is primarily produced by the ovaries before menopause. Upon menopause, the source of production is replaced by fat tissues. Being overweight would naturally raise estrogen levels, thereby increasing the chances of developing breast cancer. For men, fat cells convert the male hormones (androgen) into estrogen. Hence, obesity in men also translates to an increased risk of breast cancer.
A growing number of research has linked physical inactivity to a higher risk of breast cancer in both men and women. Regular activity may also reduce invasive breast cancer and studies have also shown that physical activity could lower estrogen levels in the blood, reducing your risk for breast cancer.
Smoking, including second-hand smoke exposure, can increase our risk of breast cancer, particularly in premenopausal women.
For new moms, you may want to consider breastfeeding if it is an option. Besides lowering breast cancer risk, breast milk has many health benefits for the child too. However, it is a personal choice and depends on our individual situation and preferences.
Hormone Replacement Therapy
Hormone replacement therapy is usually used for women undergoing menopausal transition. This involves a supplementation of hormones that are lost during this phase which includes estrogen and progesterone.
Women taking combined HRT and for an extended period of time are more likely to be at risk of breast cancer too.
Hormone replacement therapy (HRT), often used to ease menopausal symptoms, can increase our breast cancer risk by about 75%, even when used for only a short time.
Breast Cancer Prevention
Here are some lifestyle habits we can adopt to reduce our risk of developing breast cancer too.
Limit Your Alcohol Intake
Next time you are contemplating a drink, choose water or a non-alcoholic drink instead. Better yet, avoid consuming alcohol altogether. If you decide to drink, make sure to do so in moderation and limit yourself to no more than one drink a day.
If you have not been active, you do not have to jump to intense exercises and workouts right away. We can start by ditching the escalator or lift for stairs when commuting or jogging for 30 minutes each day in your neighbourhood park. Remember to exercise within your own limits to avoid injuring yourself.
Avoid or Quit Smoking
If you are not a smoker, do not start. If you are a smoker, take steps to quit today. Quitting smoking is not an easy process, but support is available. Learn more about the resources available here.
Maintain a Healthy Weight
As obesity is a risk factor for breast cancer, we should have a balanced food intake while keeping up with an active lifestyle to maintain a healthy weight range and minimise our breast cancer risk.
Adopt a Healthy Diet
No one food or diet can prevent breast cancer entirely, but a healthy, well-balanced diet rich in fibre, vitamins and antioxidants can reduce our risk of breast cancer and boost our overall well being.
Limit Hormone Replacement Therapy
If HRT cannot be avoided, make sure to discuss with your doctor about all your options and try to work out an effective way to limit the dose and duration of hormone therapy, to possibly reduce your risk of breast cancer.
Breast Cancer Screening
The benefits of early detection and treatment should not be undermined. In fact, individuals diagnosed with breast cancer at stage 1 can have a survival rate as high as 91%. Here are the common screening methods that can help to detect breast cancer as early as possible.
Women are strongly encouraged to perform a breast self-examination every month to detect any unusual changes and symptoms early. Learn more about how you can perform a simple breast self-examination in the comfort and privacy of your home here.
Mammography can detect small lumps in the breasts before we can feel it physically. The Singapore Health Promotion Board (HPB) recommends women above the age of 50 to go for mammogram screenings yearly even if they feel well.
Breast Cancer Treatment
Treatment types for breast cancer can be classified into two groups: local and systemic therapy.
Local therapy includes surgery and radiotherapy, and treats cancer at the site without affecting the rest of the body. Meanwhile, systemic therapy, which includes chemotherapy, hormone therapy and targeted therapy, involves the administration of drugs into the bloodstream to kill cancer cells throughout the body.
There are two main types of surgery for breast cancer. In a lumpectomy, (also known as Breast-Conserving Surgery (BCS)), the tumour is removed while most of the breast remains. However, in a mastectomy, the whole breast is removed along with the tumour.
Depending on a variety of factors including the size and location of the tumour, breast size and personal preference, a lumpectomy or a mastectomy may be performed.
Radiation therapy uses high-energy rays to kill or limit the growth of cancer cells and is often performed before and/or after surgery, to reduce the size of the tumour and to prevent recurrence respectively.
Side effects may include redness and dryness of the skin, swelling, and an increase or decrease in sensitivity. However, these effects tend to be manageable and are temporary.
Hormonal therapy is a treatment method that alters or stops estrogen secretion and is often used in conjunction with other measures. It can also be used as a preventive measure for women at high risk of breast cancer.
By introducing drugs into the bloodstream, chemotherapy helps to eliminate cancer cells throughout the body. However, the disadvantage is that many healthy cells die alongside the cancer cells.
Similar to chemotherapy, targeted therapy involves the use of drugs to kill cancer cells. However, these drugs target specific genes, proteins, or tissue environments that contribute to cancer growth and survival, leaving healthy cells largely unaffected.
Breast Cancer Support Groups
Being diagnosed with breast cancer does not only affect us physically but can have an impact on our mental wellbeing too. That’s why it’s important to have a strong support system in place. Besides family and friends, breast cancer patients and survivors in Singapore can join support groups and connect with peers going through similar experiences as themselves.
With a support group, you can give and receive psychological and emotional support, and take part in educational, social and recreational activities together. Here are some of the breast cancer support groups in Singapore that you can join for free.
Formed in May 2014, Bishana is a support group for all female cancer patients and survivors as a platform for women to give and receive psychological and emotional support, and participate in education, social and recreational activities together. Membership is free.
Reach to Recovery
Reach to Recovery is a breast cancer support group that meets every fourth Saturday of the month, 10am to 12noon, at the Singapore Cancer Society Multi-Service Centre. Established in 1973 with the aim of helping women cope with everyday challenges after a breast cancer diagnosis, members participate in activities ranging from educational talks or workshops, social and recreational events, outings, and enrichment programmes.
Look Good Feel Better Programme
The Look Good Feel Better programme was specially developed to help women build self-esteem and manage the appearance-related changes brought about by cancer treatment such as chemotherapy or radiotherapy. Hands-on workshops that help women learn about cosmetic techniques and hair alternatives are held at various hospitals island-wide on a rotational basis.
Living with Breast Cancer
Navigating the breast cancer journey is not easy – from the initial diagnosis and treatment to learning to live with the changes breast cancer and its treatment have on our lives. No matter how hard the going gets, always remember that you are not alone. Have faith and do not hesitate to reach out for help if you need it.
- B Hook, D. (2017). When to Worry About Breast Lumps. Everyday Health. Retrieved 29 June 2020, from https://www.everydayhealth.com/womens-health/when-to-worry-about-breast-lumps.aspx.
- Breast Cancer Risk Factors: Family History. Breastcancer.org. Retrieved 26 June 2020, from https://www.breastcancer.org/risk/factors/family_history.
- Breast, prostate cancers rising sharply in Singapore. The Straits Times. (2017). Retrieved 26 June 2020, from https://www.straitstimes.com/singapore/health/breast-prostate-cancers-rising-sharply-in-spore.
- Breast-conserving Surgery (Lumpectomy). American Cancer Society. (2019). Retrieved 26 June 2020, from https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/breast-conserving-surgery-lumpectomy.html.
- Breastfeeding History. Breastcancer.org. Retrieved 26 June 2020, from https://www.breastcancer.org/risk/factors/breastfeed_hist.
- Common Types of Cancer. Singapore Cancer Society. Retrieved 26 June 2020, from https://www.singaporecancersociety.org.sg/learn-about-cancer/cancer-basics/common-types-of-cancer-in-singapore.html.
- Hack, C. C., Voiß, P., Lange, S., Paul, A. E., Conrad, S., Dobos, G. J., Beckmann, M. W., & Kümmel, S. (2015). Local and Systemic Therapies for Breast Cancer Patients: Reducing Short-term Symptoms with the Methods of Integrative Medicine. Geburtshilfe und Frauenheilkunde, 75(7), 675–682. https://doi.org/10.1055/s-0035-1557748
- How Hormones Affect Breast Cancer Risk. (2019). [Ebook]. Retrieved 26 June 2020, from https://ww5.komen.org/uploadedFiles/_Komen/Content/About_Breast_Cancer/Tools_and_Resources/Fact_Sheets_and_Breast_Self_Awareness_Cards/How%20Hormones%20Affect%20Breast%20Cancer.pdf.
- Kraft, S. (2019). Male breast cancer: Symptoms, statistics, tests, and treatment. Medical News Today. Retrieved 26 June 2020, from https://www.medicalnewstoday.com/articles/179457.
- Lifestyle-related Breast Cancer Risk Factors. American Cancer Society. (2019). Retrieved 26 June 2020, from https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/lifestyle-related-breast-cancer-risk-factors.html.
- Male Breast Cancer. National Breast Cancer Foundation. Retrieved 26 June 2020, from https://www.nationalbreastcancer.org/male-breast-cancer.
- Personal History of Breast Cancer. Breastcancer.org. Retrieved 26 June 2020, from https://www.breastcancer.org/risk/factors/personal_history.
- Physical Activity and Cancer. National Cancer Institute. (2020). Retrieved 26 June 2020, from https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet.
- Risk Factors for Breast Cancer in Men. American Cancer Society. (2018). Retrieved 26 June 2020, from https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html.
- Smoking. Breastcancer.org. Retrieved 26 June 2020, from https://www.breastcancer.org/risk/factors/smoking.
- Using HRT (Hormone Replacement Therapy). Breastcancer.org. Retrieved 26 June 2020, from https://www.breastcancer.org/risk/factors/hrt.