What is a mammogram?
A mammogram is a type of x-ray that allows doctors to observe any abnormalities or changes in breast tissue. Regular mammograms are currently one of the best ways to detect early signs of breast cancer — plus, they can be easy, cheap and safe.
Why is breast cancer screening important?
Breast cancer is the leading form of cancer amongst Singaporean women — affecting 1 in 11 individuals here. Several factors contribute to your breast cancer risk, some that cannot be changed and some that can.
While leading an active and healthy lifestyle helps to minimise our risk of breast cancer, identifying breast cancer early greatly improves the chances of surviving it.
Here’s where breast cancer screening comes in. Early detection through mammograms and breast self-examinations, along with subsequent intervention, could mean that you’ll less likely need to resort to invasive treatments like surgery or mastectomies (breast removal).
According to the National Breast Cancer Foundation, Stage 0 to Stage 1 breast cancer — where cancer is limited to the area where abnormal cells first start to form — is highly treatable and survivable, and may not even require chemotherapy to treat.
Who should go for a mammogram?
The Singapore Health Promotion Board (HPB) recommends that women aged 50 or more get mammograms regularly (once every two years), even if you do not feel like there might be anything wrong.
If you are between the age of 40 to 49, you should seek your doctor’s advice on whether or not you should get a mammogram done.
Besides age, other factors that could put women at a higher risk of breast cancer include:
- A family history of breast cancer
- A history of ovarian cancer
- Early-onset of menstruation
- Late menopause
- Having a first child after the age of 30
- Being on hormone replacement therapy
- Gaining weight after menopause
Learn more about your breast cancer risk by referring to our guide on the causes and risk factors of breast cancer.
Mammogram screening for women under the age of 40 is typically not done as pre-menopausal women typically have denser breast tissue, reducing the effectiveness of mammograms in detecting early breast cancer.
If you happen to notice any changes in your breasts — regardless of age — consult a doctor immediately.
What’s the mammogram process like?
First of all, you should try to schedule your appointment a week after your menstruation ends. If you no longer have periods, you can schedule it at any time that is convenient for you.
On the day of your mammogram, avoid applying any deodorant, talcum powder, lotion or ointment to your underarms. As you will have to undress from the waist up, do wear a two-piece outfit if you can as well.
During your mammogram, a trained female technician will lead you to a special low-dose x-ray machine. She will position your breast between two flat plates and compress them slightly for less than 2 minutes. This will be performed on one breast at a time. The compression is to allow the machine to capture better images of the flattened breast tissue.
The whole mammogram procedure usually lasts about 30 minutes. These images will later be examined by a radiologist for any abnormalities or signs of cancer.
You should receive your results within 4 weeks by post or at a consultation with the doctor.
If your results are normal, do continue to perform monthly breast self-examinations and go for regular mammogram screening at the recommended frequency for your age. It is best to stick to the same screening centre.
If you are notified that your results require further investigation, do not panic. 90% of the time, individuals receive normal results after further testing.
Are mammograms painful?
As your breasts have to be compressed for the x-ray machine to capture a clear image, mammograms are usually uncomfortable or slightly painful — especially if you have dense breasts.
To reduce the tenderness, you can consider scheduling your mammogram a week or so after your period, to avoid the timeframe where your breasts might be more sensitive than usual.
How much does a mammogram cost?
A mammogram costs $100 before GST at participating centres. However, HPB’s Screen For Life programme provides subsidies for mammograms.
Mammogram Subsides in Singapore
Under Screen for Life (SFL), women that meet the eligibility criteria can benefit from subsidised mammogram screenings at participating centres (see Where Can I Get My Mammogram in Singapore for details).
After the subsidy, mammogram screenings will cost:
- $50 for Singapore citizens
- $75 for Permanent Residents (PRs)
- $2 for the Merdeka Generation (born between 1950 and 1959)
- Free for the Pioneer Generation (Born on or before 31 Dec 1949)
Here are the criteria for subsidised mammograms under HPB’s Screen for Life:
- Singapore citizen or PR
- 50 years old and above, or between the age of 40-49 and have been directed to go for a mammogram after consulting your doctor
- Have not gone for a mammogram screening in the last 24 months (if above 50 years of age), or within the past 12 months (if between 40-49 years of age), and have been directed to go for a mammogram after consulting your doctor
- Do not have breast cancer symptoms such as lumps, blood-stained nipple discharge, persistent rash around nipple, swollen skin, skin that is dented or folded outwards, retracted nipples
- Have not been breastfeeding for the past six months
If you are 50 and above, you may use your MediSave to pay for the mammogram at MediSave-approved centres.
Free Mammograms in Singapore
The Singapore Cancer Society (SCS) offers free mammography services for women aged 50 and above at the SCS Clinic @ Bishan, if they:
- Have not gone for a mammogram screening in the last two years
- Have a valid Community Health Assist Scheme Card (CHAS) Blue or Orange
Here is the full list of MediSave-approved centres for mammogram screening:
- Ang Mo Kio Polyclinic
- Bukit Batok Polyclinic
- Bukit Merah Polyclinic
- Choa Chu Kang Polyclinic
- Geylang Polyclinic
- Clementi Polyclinic
- Hougang Polyclinic
- Jurong Polyclinic
- Pasir Ris Polyclinic
- Queenstown Polyclinic
- Sengkang Polyclinic
- Tampines Polyclinic
- Toa Payoh Polyclinic
- Woodlands Polyclinic
- Yishun Polyclinic
Hospitals and Specialist Centres
- Khoo Teck Puat Hospital
- KK Women’s And Children’s Hospital
- Mt Alvernia Hospital
- National Cancer Centre
- National University Hospital
- Orchard Imaging Centre
- Singapore General Hospital
- Starmed Specialist Centre Pte Ltd
- Tan Tock Seng Hospital
- Thomson Medical Centre
- Radiologic Clinic (At Health Promotion Board)
- Radiologic Clinic – Breast Imaging Centre
- Raffles Hospital
- Alexandra Hospital
How often should I go for a mammogram?
Even though you might be cleared after your first mammogram, breast tissue can still change over time.
As such, women aged 50 and above should get their mammogram done once every two years. If you are aged 40 to 49 and have been advised by your doctor to get a mammogram, you should do so once every year.
Pregnant women are not advised to go through a mammogram screening, as the x-rays could pose a risk to the foetus. If you have recently given birth, you should only get your mammogram done at least six months after you stop breastfeeding, for the most accurate results.
Balancing the Risks of Breast Screening
Breast cancer screening can save lives — however, there are still women who feel uncertain about undergoing breast cancer screenings like mammograms due to the perceived risks.
Here are some risks commonly associated with mammograms, along with the reasons why it’s still worth it:
During a mammogram, your breasts are exposed to very small amounts of medical radiation. This radiation is equivalent to about six months of background radiation you would be exposed to in daily life and is at a lower dose compared to regular x-rays. Regardless, the benefits of screening and early detection outweigh this small risk of undergoing mammograms.
* Pregnant women are still not advised to undergo a mammogram, as it may pose a risk to the foetus.
2. Callback Distress and False Positives
Mammograms aren’t always accurate — factors such as age and breast density can reduce the accuracy of mammograms. Roughly 10% of mammograms may require additional testing.
Having an abnormal mammogram result does not necessarily mean you have cancer — it just means that an abnormality has been detected in your breast tissue that needs to be investigated further with tests that are only available in the hospital.
Take the follow-up checks with a calm mind and approach them as you would with any ordinary medical follow-up.
3. False Negatives
In the same vein, sometimes cancer may not be detected on mammograms. Factors that contribute to this include the cancer being too small, being in an area difficult to view via mammogram, or having dense breast tissue that might obscure signs of cancer.
However, this should not deter you from undergoing your regular mammogram screening. Continue conducting your own monthly breast examinations (some cancers might be detected by physical examination but not by mammogram), and consult a doctor if you have any concerns.
Be Aware of Your Breasts
The best way to detect anything unusual in your breasts is to be familiar with them from the get-go. Monthly breast-self examinations are a great tool to help you understand what is normal for your breasts and when there might be changes to flag out.
The Singapore Cancer Society has an easy 3-step DIY Breast Self-Check that you can do every month:
Standing in front of a mirror, place your hands on your hips and look out for changes in breast shape and skin surface, as well as any nipple abnormalities. Raise your arms above your head and look for changes (especially dimples) on the underside of your breast.
2. Touch (Breasts)
Using your middle three fingers, gently massage each breast in a circular motion, starting from the outer area near your armpit and ending towards the nipple. Lightly squeeze your nipple to check for any discharge.
3. Touch (Overall)
Did you know that your armpit area is also part of your breast tissue? Do a final check by feeling your entire chest area from underarm to cleavage, looking out for any lumps.
Early Detection Saves Lives
Even though breast cancer research is always advancing and there are several options for effective treatment out there, early detection is still your best bet. More than 90% of women diagnosed with breast cancer at the earliest stage remain disease-free for five years or more, while their chances of living without serious long-term complications become much higher as well.
As the Screen for Life programme puts it: the best time to get a screening is when you still feel fine. Be aware of your body, consult your doctor if ever in doubt and stay on track with your regular health check-ups! If you prefer to consult your doctor in the privacy of your home, consider engaging a house call doctor.