The Importance of Breast Cancer Screening

Breast cancer is the most common cancer amongst Singaporean women. In fact, in the last 50 years, the breast cancer incidence rate has increased threefold. The age-specific incidence rates for breast cancer from the cancer registry report in 2015 were 43.2 per 100,000 for the 30 – 39-year-old age group, 139.1 per 100,000 for the 40 – 49-year-old age group; and 195.7 per 100,000 for the 50 – 59-year old age group. With these higher occurrences of the disease in patients over 40, it is vitally important for women to undergo regular screening.

What is breast cancer?

Breast cancer is the development of abnormal cancer cells originating in the breast. These malignant cells grow rapidly and, like other cancers, can spread to other sites around your body. Without screening, breast cancer is usually only noticeable once a lump that is big enough to be seen or felt has developed, or if it has spread to armpit or neck lymph nodes, causing limitation in movement at the armpit or neck, or if it has spread to the spine, backache.

Symptoms of breast cancer

The common symptoms of breast cancer are:

• A lump in the breast or underarm area, which may be very small at first
• A change in the size or shape of the breast
• Red or irritated skin on the breast or on the nipple
• Dimples or puckering
• Nipple discharge, which might be clear or blood tinged
• Any other significant changes to the breast

What is a mammogram?

A mammogram, one of the most common diagnostic tools used to check for breast cancer, is simply a special form of x-ray that reveals changes and abnormalities in the breast tissue.

How is a mammogram done?

During a mammogram, your x-ray technician will compress your breast tissue between 2 plates and take images from various angles to form a complete picture of your breast for your doctor to examine.

Mammograms can be digital or non-digital. Digital mammograms are generally preferred where possible, because background noise is minimised resulting in clearer images.

Why is a mammogram done?

A mammogram is recommended to detect changes in breast tissue, most commonly as part of breast cancer screening. It may also be used to confirm a diagnosis.

• Screening mammograms

  Screening mammograms help to detect breast cancer in its early stages, before symptoms appear. It can detect abnormalities, such as microcalcifications, before they can be felt.

• Diagnostic mammograms

  Diagnostic mammograms help to confirm if breast changes or other symptoms are indeed caused by breast cancer. It may be recommended to further evaluate any abnormalities found in a screening mammogram, or to detect if the cancer has returned in women who were previously treated for breast cancer. It usually involves taking more mammogram images, including compression or magnification views, compared to a screening mammogram.

When should you get a mammogram?

There is no ideal age and recommendations vary. The general consensus is for women with average risk to take their first mammogram at the age of 40 while women who are deemed at high risk may consider starting at a younger age to better detect breast cancer as early as possible.

Women with average risk

Women aged 40 – 49 are advised to go for a mammogram annually, and thereafter once every 2 years. Note that this only applies for people without lesions that need follow-up. For those with abnormalities, the interval may vary.

Women with high risk

Women who have a higher risk for breast cancer may benefit from getting their first mammogram before 40 years of age. It is best to speak with your doctor for advice based on your personal and family history of breast cancer.

Are mammograms effective?

There has been some controversy around the use of mammograms to check for breast cancer due to instances where false positives have led to unnecessary further testing and the possibility of invasive surgical procedures.

However, medical professionals and the Breast Cancer Foundation of Singapore still recommend mammograms as an essential part of early breast cancer detection. The effectiveness of the mammography, and whether there is a false positive result, is dependent on many factors. These include the patient's breast density, the competence of the radiographer, the quality of the mammography itself and the standard of the reporting radiologist.

Make an appointment for a mammogram at Gleneagles Hospital.

What other breast screening tests might you need?

Any further tests you might undergo would depend on the surgeon interpreting the results and the standard of your imaging results. They might include:

Ultrasound tests

Ultrasound tests, which use sonography, are sometimes used in conjunction with mammograms to increase the pick-up rate for cancers and other suspicious lesions. This is because the Asian population tends to have fairly dense breast tissue, and not all cancers are seen on a mammogram or ultrasound tests alone.

Breast biopsy

If your doctor thinks there is a high likelihood of the presence of abnormal cells, they might order a biopsy, where some of your breast tissue is removed and tested. This is more invasive than a mammogram or ultrasound, although removing suspicious breast lesions using vacuum-assisted and imaging-guided biopsy techniques are minimally invasive. Whether you undergo any surgical procedures or not is dependent on your clinical history, family history, initial imaging results and your doctor.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) may be recommended if you are 25 – 30 years old and in a high risk group, such as if you carry the BRCA 1 or 2 genes (that makes you more susceptible to certain cancers) or if you have a family history of breast cancer. If you have had injections of silicone or other chemicals to augment your breasts, mammograms and ultrasounds may be ineffective, and an MRI might also be required. However, an MRI is not recommended for routine breast screening of normal-risk women.

Breast tomosynthesis (X-ray)

If you have dense breasts, you may also be offered supplementary breast tomosynthesis. This is where multiple low-dose x-rays of the breast are obtained at different angles and reconstructed into a 3D image. This technology reduces the problem of overlapping dense breast tissue covering an underlying mass.

Do you need to go for breast cancer screening?

According to Singapore national screening guidelines, normal-risk women aged 40 and above require yearly mammograms, and those aged 50 and above require a mammogram every 2 years. Your doctor will discuss with you the risks and benefits of your screening options when you reach the recommended age bracket. If you have not had a mammogram and you are over 40, you should make an appointment.

Additionally, if you have any concerns about your breast tissue, or notice any changes, you should also make an appointment with your doctor, no matter what your age. Conducting monthly self-examinations will help you to make sure you are aware of anything that looks or feels unusual. Early detection can make a big difference in your treatment options and recovery rates.

In addition to screening for breast cancer, women should also learn more about regular screening for other cancers such as cervical cancer and other conditions which become more common with age, such as metabolic diseases.

As always, prevention and early detection is preferable to treatment. Learn more about the healthcare needs of women and how to live your best life.