Content provided by Parkway Cancer Centre

Mastectomy for breast cancer treatment

Dr See Hui Ti from Parkway Cancer Centre addresses a common fear that women have.

Ms Ling wiped away her tears as she spoke, but she could not keep the bitterness out of her voice.

"I don't drink, I don't smoke, I don't eat a lot of meat, and no one in my family has had breast cancer before. So why do I have breast cancer?"

But what the 42-year-old seemed to be most concerned about was the treatment she might have to undergo. "I'm not married yet and do not wish to remove my breast," she told me. "Are there alternatives?"

One can understand her feelings.

First, there was the shock of being diagnosed with breast cancer, which hits one out of 15 women in Singapore before the age of 75 years old. The incidence rate is highest among women at ages 45 to 64 years old.

The general perception is that only people carrying genetic mutations or those who have a poor diet over the years are in danger of having breast cancer. Since Ms Ling belonged to neither of the two groups, it was hard for her to imagine that she would be a victim.

Statistics, however, indicate that only up to 15 per cent of cases in Singapore are hereditary. And while smoking and drinking are high-risk activities, breast cancer can occur in healthy women.

Second, there was the common perception that getting breast cancer automatically meant having to undergo a total mastectomy.

In fact, there are several options of treatment, and it depends on what type of breast cancer a patient gets, and other factors. Apart from a complete removal of the breast, surgeons may also perform a partial removal.

In deciding which surgical procedure to undertake, surgeons will take into account the patient's age, medical conditions, breast size, location of breast tumour, and whether the breast tumour is multicentric.

If the tumour is too close to the nipple or the breast size does not allow for sufficient breast tissue to maintain the appearance of a healthy breast after surgery, the surgeon may recommend total mastectomy.

If the patient does not want a total mastectomy, surgeons may recommend neoadjuvant chemotherapy, a new chemotherapy treatment that shrinks breast tumours down, before performing a partial mastectomy.

Choosing a partial removal of the breast, however, has some implications.

Because it is sometimes difficult to predict how tumour margins of multicentric breast cancers (more than one tumour in different sections of the breast) might develop, partial mastectomy inevitably means that there will be residual cancer cells.

So if a patient has multicentric breast cancer, surgeons usually recommend a total mastectomy. The patient can then choose to have her breast reconstructed to restore the appearance of the missing breast.

There are a number of different ways to do this, and it depends on the stage of the cancer, and whether radiation therapy is required.

For a partial mastectomy - wide excision breast surgery to remove the tumour plus some surrounding tissue - to be done, the breast must be bigger than the tumour, so that sufficient breast tissue can be used to maintain the appearance of a healthy breast after surgery.

Going for partial instead of total mastectomy usually also means undergoing radiation therapy after surgery, to reduce the chances of a recurrence of the cancer. Patients who do not wish to undergo radiation therapy should therefore opt for a total mastectomy.

The recurrence rates for total and partial mastectomy combined with radiotherapy are the same - less than five per cent.

Some women even go as far as to remove both breasts to avoid any future risk of developing breast cancer in the unaffected breast.

Ever since Hollywood actress Angelina Jolie had both breasts removed three years ago after finding she was carrying a genetic mutation, risk reduction mastectomy has gained worldwide recognition.

Nevertheless, women who are tested positive for genetic mutation need to consider the option carefully before doing the same.

Fortunately, this kind of genetic mutation is rare in Singapore. Women would do well to protect themselves against breast cancer by educating themselves, which will go a long way in empowering them to make the best informed choice for their health.

For Ms Ling, too, she had discovered her breast cancer early enough.

"Don't worry," I told her, to her great relief. "You have options."

And indeed she does.

Breast cancer: The facts

  • Breast cancer is the most frequent cancer for women in Singapore.
  • 1 in 15 women will develop breast cancer before the age of 75.
  • Chinese women have a higher risk compared to Malay and Indian women.
  • A majority of cancer cases were diagnosed at Stages 1 and 2 and at ages 45-64.

Source: Singapore Cancer Registry, Trends in Cancer Incidence in Singapore 2010-2014

Screening: When to go

39 years and below:

  • Monthly breast self-examination

40 to 49 years:

  • Monthly breast self-examination
  • Annual screening mammography

50 years and above:

  • Monthly breast self-examination
  • Two-yearly screening mammography

Source: Parkway Cancer Centre

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