Up to 20% of all cancers diagnosed in women are breast cancers. Between 1988 and 1992, about 2,600 women were diagnosed to have breast cancer in Singapore.

Nine out of 10 women who go to their doctors with breast lumps have a benign disorder, not cancer. Normal changes associated with the menstrual cycle can make breasts feel lumpy.

Most women with breast cancer have no high risk factors.

One high risk factor is a prolonged fertile period, i.e. the first menstrual period at a young age and the late onset of menopause. A woman who has menopause at 55 years has twice the risk of a woman who has menopause at 45 years.

Women who have never been pregnant also have a high risk of breast cancer. Getting pregnant for the first time after the age of 30 also increases the risk. On the other hand, breast-feeding protects against breast cancer.

Hormone replacement therapy after menopause may increase the risk but is effective against many other diseases. These issues should be discussed with a gynaecologist before embarking on hormone replacement therapy.

Between 5 to 10% of all breast cancers are associated with genetic factors. The genes BRCA1 and BRCA2 have been identified and may be associated with breast cancer. But not everyone with the abnormal gene will develop breast cancer. Testing for these genes is not widely available as yet.

Lymph glands of the armpit may also be enlarged and appear as lumps.

In advanced stages, breast cancer can spread to the liver, lung, bone and brain. Abnormalities in these organs may also be present.

Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of breast cancer may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with breast cancer is good.

A suspicious lump is subject to a mammogram and a needle biopsy.

A mammogram is an x-ray examination which helps to define the extent of the lump. The examination can be slightly uncomfortable as the breast is compressed against a metal surface to obtain a good x-ray image. A mammogram is sometimes combined with a scan of the breast to determine if the lump is mainly solid or cystic, i.e. filled with liquid only.

A biopsy removes some tissue from the breast lump using a needle and syringe. This may be done in the clinic under local anaesthesia. The tissue is sent to the pathologist, a doctor who examines the tissue under a microscope to see if the tissue is cancerous or not.

The doctor looks for the following features:

• The size of the breast lump. The larger the lump, the more likely the cancer will recur. Size also determines if the breast lump can be operated on.
• The number of the lymph glands in the armpit involved. Women with more than 10 lymph glands affected have a fairly high chance of the cancer recurring. High dose chemotherapy and bone marrow transplantation or peripheral stem cell rescue may be offered as an experimental option after surgery to try to prolong survival. (For more info on high dose chemotherapy, also see Lymphoma treatment)
• High-risk features such as involvement of the blood vessels or lymph channels in the mastectomy specimen.

Once cancer is diagnosed, other tests such as chest x-rays, scans of the liver and bones may be required to determine if the cancer has spread to other parts of the body.

Cancer cells left in the remaining breast tissue may cause the cancer to recur in the breast at a later date, i.e. local recurrence, therefore, radiotherapy may be necessary after surgery. Radiotherapy to the chest where the breast was, for 5 to 6 weeks may cause temporary side effects such as skin redness.

Radiotherapy is almost always mandatory if only a wide excision of the cancer is performed.

Chemotherapy aims to prevent cancer recurrence in the lung, liver and other tissues. It is usually recommended for younger women where the breast lump was larger than 2cm at time of diagnosis or if the cancer also involved the lymph glands in the armpits. The exact choice of drugs will depend on the person's general health and other medical illnesses, and the stage of the cancer. Chemotherapy is given over 4 to 6 months. There is usually mild nausea or vomiting, hair loss, lethargy or tiredness, and loss of appetite. Most women will be able to carry on working during this period.

If the breast cancer was especially large, more than 5 cm at time of diagnosis, chemotherapy is given to shrink the tumour before surgery is performed.

Since breast cancer is hormone dependant, hormone treatment may have an effect on certain types of breast cancer. So in older women and women who have reached menopause, tamoxifen may be prescribed.

Radiotherapy may be given in addition to hormone therapy or chemotherapy.

In certain medical centres, high dose chemotherapy and bone marrow transplantation or peripheral stem cell rescue is offered as an experimental option after surgery to try to prolong survival in women considered to have an extremely high risk of cancer recurrence. (For more info on high dose chemotherapy, also see Lymphoma treatment)

Breast reconstruction is an operation to create a new breast in place of the breast which has been removed. This procedure does not affect breast cancer survival or treatment and can be performed at the same time as the mastectomy or at a later date. Most women who have had a mastectomy can opt for reconstruction. Age is not a limiting factor. The breast can be reconstructed using an implant, such as silicone, or tissue from the patient's own body.

Breast reconstruction is now available using silicone or other tissue expanders. Surgeons will be able to advise on the options available and if breast reconstruction is necessary.

The Singapore Cancer Society has a Reach to Recovery Program which provides physical, cosmetic, post-operative and psychological support. Volunteers are usually women who have undergone mastectomies and are living proof of how normal life can be after surgery.

If I have a mammogram regularly, will I be exposed to too much radiation?
Radiation exposure from modern mammogram equipment is minimal. It is far more dangerous not to detect breast cancer in its earliest stages.

I have a lump in my breast. I am frightened to see the doctor in case it is cancer.
No matter how you feel you should see your family doctor as soon as possible. The great majority of breast lumps are not cancerous.

My mother/ aunt died of breast cancer. Am I likely to get breast cancer too?
A small proportion of breast cancer is linked to factors that can be. Women whose parent, sibling or child had breast cancer may themselves have a 50% risk of contracting the disease. You may not necessarily get breast cancer but you have a greater chance than a woman who does not have a family history of breast cancer. Most family doctors or hospitals will provide information on breast self-examination and mammograms.

I have been diagnosed with breast cancer. Will I get better?
Many women who have had breast cancer live a normal lifespan. Present treatments offer a good prognosis but you may need several types of treatment to prevent recurrence of the cancer.

Will I have to have a mastectomy?
This depends on the size, position and type of your breast cancer as well as the size of your breast. You should discuss this option with your surgeon.