Breast Cancer
In 2007, TIME magazine reported that 1 million women in the world will be diagnosed with breast cancer that year. The incidence is typically higher in developed nations and cities. Over the years, this number continues to increase at an alarming rate.
It has been postulated that changes in our lifestyles over the decades are partly responsible for this increase. Women are delaying childbearing and having fewer or no children. Girls begin menstruating earlier and women enter menopause at a later age. Use of hormone replacement therapy after menopause, a Westernized diet high in red meat and fat content, prevalence of obesity and lack of regular exercise have also been blamed.
The American Cancer Society encourages women to have a healthy diet of fresh fruits and vegetables, reduction in consumption of red meat and fats, prevention of obesity/weight gain, and regular exercise at least 5 times a week to reduce cancer risk. However, many other factors such as hormonal and genetic effects cannot be changed. The best strategy to protect ourselves hence is for early detection and treatment of breast cancer.
Early detection of breast cancer
Mammogram screening is the gold standard for detecting early cancer change in the breasts. However it is generally recommended only for women who are at least 40 years in age. Mammogram may detect microcalcifications, tissue distortion or abnormal lumps. Depending on the findings, a biopsy may be necessary to determine if the abnormality is due to cancer change. Mammogram may be able to detect Stage 0 cancer, the earliest form of breast cancer where the cancer is pre-invasive and hence not able to spread beyond the breast. Treatment of Stage 0 breast cancer can result extremely high cure rates.
Women with dense breasts or who have a family history of breast cancer should also consider adding ultrasound (but not replacing mammography) for screening. However, ultrasound alone is not sufficient for breast cancer screening in women 40 years old and above. Ultrasound should be used as an adjunct to mammogram screening. It is used alone only in women who are younger than 40 years old.
MRI screening of the breasts is only for a select group of women. These include women with breast implants or with previous breast procedures which may make interpretation of the mammogram/ultrasound challenging. Women with a strong family history of breast and/or ovarian cancer, who themselves are high risk for breast cancer, may also benefit from MRI screening. MRI has a higher sensitivity than mammogram and ultrasound, but sometimes it may not be as specific in its results. The MRI appearance of the breasts may also be affected by the monthly hormone cycle so it is best to undergo the MRI when the monthly period is over.
All women should perform monthly breast self examination to detect any abnormal changes in their breasts such as lumps, rashes or nipple discharge. This is best done when the period is over, as this is the time when the breasts are least lumpy. For women after menopause, choose a fixed date each month so it is easier to remember.
Recommendations for breast cancer screening

Age > 25 years: Monthly breast self examination
Age 40-49 years and above: Monthly breast self examination
Yearly Mammogram +/- ultrasound of the breasts
Age 50 and above: Monthly breast self examination
1-2 yearly Mammogram +/- ultrasound of the breasts
Breast biopsy
Detection of an abnormality is usually followed by a biopsy to confirm the diagnosis. Most of the time, a simple needle biopsy (such as a core needle or vacuum-assisted needle) under local anaesthesia in an outpatient setting can be done, without having to undergo surgery for diagnosis. These biopsies are highly accurate and leave only very small scars.  These procedures typically take between 15-30 minutes in the office.
Advances in breast cancer surgery
When breast cancer is diagnosed, treatment is multi-disciplinary in nature. Surgery is always required whereas chemotherapy and radiotherapy may also be needed depending on type of surgery and stage of disease. Oral medication may also be prescribed for hormone receptor positive cancer.
Surgery for breast cancer is no longer as debilitating as once thought. A diagnosis of breast cancer does not equate to loss of the breast. In a large majority of early breast cancer cases, the breast can be conserved by removing just the tumour with a rim of normal tissue. Oncoplastic surgery techniques are then employed to obliterate the tissue defect so that the final cosmetic appearance of the breast approaches as near normal as possible.  Alternatively, sometimes chemotherapy can be given first to shrink the cancer in order to allow a smaller volume of breast tissue to be removed. For women who require removal of the whole breast, they may choose to have immediate breast reconstruction using either their own fatty/muscle tissue, a silicone implant or a combination of both. The cosmetic results are very good and it is a tremendous boost to a woman's body image after breast cancer treatment.
Part of breast cancer surgery involves removal of the lymph nodes under the armpit for accurate staging. As recent as ten years ago, the standard practice was to routinely remove all the lymph nodes. This may result in shoulder stiffness, weakness and arm swelling or lymphoedema for some women. Nowadays, a new technique termed sentinel lymph node biopsy reduces the need for such radical surgery. By making use of a radioactive tracer, a blue dye or both techniques, the first draining lymph node(s) in the armpit can be identified accurately and removed. These sentinel lymph nodes are then tested for cancer. If the cancer is early and the sentinel lymph nodes are negative for cancer, then the remaining lymph nodes do not need to be removed. This greatly reduces the risk of the woman developing complications associated with radical lymph node surgery. All the lymph nodes are removed only if the sentinel lymph node contains cancer, or if the sentinel lymph node cannot be identified.
Breast cancer is highly curable
Breast cancer should not be feared. Almost every woman will know a friend, colleague or relative who has been treated for breast cancer. The good news is that the cure rates for breast cancer are very high if it is diagnosed and treated appropriately in the early stages. Treatment has also become more sophisticated with many options and fewer long term undesirable sequelae if the cancer is detected early. Lead a healthy lifestyle with a good diet and exercise, attend regular health screening and seek medical advice when there is an abnormality. Early detection is the best strategy to combat breast cancer!
Breast Cancer Related Information:
Breast Cancer
Warning Signs of Breast Cancer
Breast Cancer Screening
Reducing the risk of Breast Cancer