Six things youth should know about breast cancer

This series on common health concerns among youth was created in collaboration with Tan Tock Seng Hospital.

October is Breast Cancer Awareness Month, part of an annual international campaign held to increase awareness regarding breast cancer. 

Given its prevalence, it is inevitable that you or someone close to you has a family member who has suffered from breast cancer. 

During this time, it is important to encourage your family and friends to get their screening mammograms and perform their breast self-examinations, as early detection can save lives.

Here are six things you should know about breast cancer.

In Singapore, breast cancer is the most common cancer among women and is the leading cause of cancer-related deaths. One in 13 Singaporean women are estimated to develop breast cancer in their lifetime. 

Nonetheless, Singapore has a lower percentage of women who are likely to develop breast cancer compared to the Western population, where an estimated one in 6 women are at risk of developing the disease.

While an ultrasound is commonly offered as part of health screening packages, it is not  part of the screening guidelines. 

Younger women typically have denser breasts, reducing the sensitivity of routine mammography screening to detect abnormalities. Hence, screening mammography is not typically recommended for women under the age of 40. 

However, it is possible for screening ultrasounds to detect benign breast lumps even when the risk of breast cancer is low.

A monthly breast self-examination (BSE) is recommended for women aged 20 to 39.  It can easily be performed at home by yourself. If you detect a breast lump during the examination, you should consult your general practitioner and arrange for an ultrasound if necessary. 

If an abnormality is detected in the breast, a procedure may also be necessary. However, not all breast lumps require removal. 

Screening guidelines currently recommend women aged 40 to 49 years old to get an annual screening breast mammogram. This is when the incidence of breast cancer increases substantially for women between these ages, and early detection can help to provide the most benefit.

Meanwhile, women aged 50 and above are advised to get a screening mammography once every two years. This procedure can easily be arranged at any neighbourhood polyclinic. 

However, if you have a strong family history of breast cancer, such as a sibling or a parent with the disease, you may be advised to start screening at an earlier age. 

Breast self-examination is a quick and easy way to evaluate your breast health at home. It can be done in the comfort of your own home after your shower.

As you stand in front of a mirror, place your hands on your hips and examine both sides of your breasts. Look for any changes in the shape, symmetry, skin colour or dimpling of the skin. Inspect the nipple area and check if there is any redness or inversion of the nipple. Raise your hands and repeat this process.

Once you have completed the above inspection, lie down in a comfortable position and begin to feel your breasts. Using three fingers, palpate your breast in a circular motion from the nipple outward, covering all areas of the breast. Squeeze the nipple lightly to check for any discharge. Repeat this on both sides, using varying pressure to feel all depths of the breast.

Breast cancer is the most commonly occurring cancer amongst women. However, less than 10 per cent of them are directly linked to inherited genetic mutations. Just because a relative has been diagnosed with breast cancer does not mean that you will develop breast cancer in the future.

To assess if you have a significant family history of breast cancer, ask your parents if there is a history of cancer on both sides of the family, especially ovarian and breast cancer, as well as colorectal and thyroid cancer. 

In addition, take note of the age at which these cancers were diagnosed. A family with multiple members suffering from breast or ovarian cancer is a possible indication of hereditary breast cancer.

Genetic breast cancer is an inherited condition that predisposes a person to the  disease. The most common and well-studied genetic breast cancers are mutations in the BRCA1 and BRCA2 genes. Mutation of these genes leads to abnormal cell growth, causing an increased risk of both breast and ovarian cancer. 

If you have a strong family history of breast or ovarian cancer, it is recommended to start breast screening ten years before the age of diagnosis of the youngest patient in the family. Screening techniques may include ultrasound or magnetic resonance imaging (MRI) of the breast.

As technology progresses, more imaging modalities have become available. The most common modality is the mammogram. Essentially, this is a specialised X-ray of both breasts taken from various angles. Mammograms allow the detection of abnormalities such as microcalcifications that may indicate early signs of breast cancer. However, for women under 40, the breast tissue is dense and does not detect abnormalities as easily.

Another commonly used imaging modality is an ultrasound of the breasts, which is preferred for younger patients. This form of imaging utilises special sound waves and a probe to assess the breast tissue, with no harmful radiation or side effects. Ultrasounds can be used to assess the architecture of the breast tissue and detect nodules or cysts. 

Newer imaging tools also include the MRI. With this method, the specialised scanner uses magnetic and radio waves to detect the concentration of water in tissues and forms a detailed image of the breast.

With these imaging techniques available, it is important to discuss with your specialist which modality is ideal for your condition and age group.

You can arrange for a screening mammogram or find out more about Breast Cancer Awareness Month here.

To further contribute to breast cancer research and the development of better future treatment, visit: https://www.giving.sg/ttsh-community-fund/bcam21.

Dr Ang Wei-Wen is an Associate Consultant at Tan Tock Seng Hospital. Adjunct Assistant Professor Juliana Chen is the Head of Service (Breast & Endocrine Surgery) and Senior Consultant at the Tan Tock Seng Hospital Breast Unit.