The Types of Breast Cancer Surgery: Lumpectomy, Mastectomy and More

Breast cancer is a significant health concern in Singapore, as it is the most commonly diagnosed cancer among women. According to the Singapore Cancer Registry Annual Report 2020, breast cancer accounted for about 30% of all newly diagnosed cancer cases in women between 2016 to 2020. The rise in breast cancer cases emphasises the importance of early detection and effective management strategies to fight the disease. Breast surgery plays a crucial role in breast cancer management as it aims to remove the tumour and prevent its spread to other parts of the body. While combining two or more types of treatments – such as surgery, radiotherapy and chemotherapy – may be more effective than a single therapy alone, breast surgery remains the first treatment step in most early-stage breast cancer. There are different types of surgery for breast cancer. Your doctor will discuss the most suitable option for your treatment based on the size of the tumour and its location, your breast size, and your personal wishes and feelings. What is a Lumpectomy? Lumpectomy is a breast-conserving surgery that is typically recommended for small, localised and early-stage cancer (stage 0, 1 and 2)[1]. This approach allows for breast preservation while effectively treating the cancer. During a lumpectomy, the breast surgeon will remove the breast tumour and a margin of healthy breast tissue surrounding it. In addition, a sentinel lymph node biopsy is often performed, involving the removal of a few lymph nodes from the underarm area. If cancer cells are detected in the sentinel nodes, further lymph nodes may be removed through a procedure called axillary node dissection1. After a lumpectomy, your doctor may recommend radiation therapy to remove any cancer cells that might remain and reduce cancer recurrence in the preserved breast.   What is a simple (or total) mastectomy? During a simple (or total) mastectomy, your surgeon removes the entire breast, including the nipple and areola. In the case of a modified radical mastectomy, lymph nodes in the underarm region are also removed1. Mastectomy is typically recommended when1: the cancer is present in more than one area of the breast, the tumour is relatively large in relation to the size of the breast, the patient is not suitable for radiotherapy due to other medical conditions, or she does not want to undergo radiation therapy after surgery Mastectomy serves as an effective treatment option in cases where breast conservation is not feasible. This surgery technique ensures the comprehensive removal of the cancerous tissue. Breast reconstruction surgery after mastectomy Some women may worry about how their breasts will look after a mastectomy. In most cases, breast reconstruction surgery can be done to resolve this. The surgery rebuilds the breast so it is similar in size and shape to your other breast2. Many women have breast reconstruction done at the same time as a mastectomy. Some wait and have it done as a second surgery later. You can talk to a breast cancer specialist about reconstructive surgery options. Other options after a mastectomy include wearing a breast form (breast prosthesis) or a special mastectomy bra. What is oncoplastic breast surgery? Oncoplastic breast surgery is an emerging discipline that combines plastic surgical techniques with breast-conserving surgery. In oncoplastic surgery, the cancer and a rim of surrounding normal breast tissue are removed, and the remaining breast is then reshaped3. The patient then receives radiation therapy to the remaining part of the breast. Oncoplastic breast surgery has several advantages over mastectomy, as it enables women to preserve their natural breasts. Women can then retain a breast that is warm, soft and sensate. The breast will also fit comfortably into her bra, allowing her to move naturally in her daily life. Oncoplastic surgery also helps to reduce surgical trauma and minimise associated complications. This approach prioritises the preservation of the breast and the patient’s overall well-being and quality of life. However, oncoplastic breast surgery may not be suitable for certain types of breast cancer, such as inflammatory breast cancer or cancers that have extensively spread5. The procedure may not be possible in cases where there are multiple tumours throughout the breast unless the breast is quite huge5. Importance of discussing surgery options with healthcare providers Essentially, the specific surgical procedure recommended for patients depends on factors such as the size and location of the breast cancer and what is most suitable for the patient. Our experienced doctors at Solis will guide women through available options and recommend the most appropriate approach tailored to the patient’s needs. Our team of dedicated breast surgeons collaborates closely with Luma Women’s Imaging Centre and Luma Medical Centre. This collaborative approach involves a multi-disciplinary approach, where our team of breast radiologists and in-house pathologists work together to provide comprehensive breast care. As Singapore’s first private integrated breast care centre, we are committed to combining expertise and advanced technology to provide holistic breast care for our patients. 1 HealthXchange, “Breast Cancer Treatment: An Overview” 2 John Hopkins Medicine, “Mastectomy” 3 HealthXchange, “Breast Surgery: Fresh Hope in Oncoplastic Surgery” 5 BreastCancer.org, “What is Oncoplastic Lumpectomy Surgery?”
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Dear Mum, It’s Ok To Get A Mammogram

Stigma Around Breast Screening and Breast Cancer Treatment for older women Breast cancer is one of the most prevalent cancers among women in Singapore, and early detection through screening and treatment are essential to improve outcomes. However, despite the importance of breast cancer screening and treatment, there remains a significant stigma surrounding these topics particularly among older women. This stigma can result in older women avoiding screenings and seeking treatment early, which can negatively impact their health outcomes.  In this article, we will explore the stigma surrounding breast cancer screening for older women and suggest ways to overcome it.  Factors Contributing to Stigma While breast cancer is the number one cancer among women in Singapore, only two in five women have kept up with their regular screening mammogram, according to the National Population Health Survey 2020. Some factors for the low screening rate and stigma on breast cancer screening among older women include:  Perceived costs versus the benefits of breast cancer screening Perceived high breast cancer screening costs versus the benefits of breast cancer screening among women in Singapore was identified as the most common obstacle to breast cancer screening in Singapore. Fear of breast cancer screening Another common factor is the fear of the screening procedure itself, such as the potential of pain during a mammogram, or exposure to radiation from mammograms, as well as the fear of potential outcomes arising from the breast cancer screening[1]. These outcomes include the fear of being diagnosed with breast cancer and the resulting financial burden of the treatment, the fear of a diminished quality of life, the fear of treatment side effects and of having to take medication for life.  Personal priorities Women may not place priority on breast cancer screening as there are many other commitments that are deemed as more important. Common reasons include having “no time” due to personal or professional responsibilities and the “inconvenience”[1] in having to personally attend the screening that may or may not be nearby. Modesty, embarrassment and distrust of breast cancer screening Modesty and embarrassment related to cultural beliefs[1] were frequently cited as reasons for women not undergoing breast cancer screening, as seen in several studies. The presence of male staff during the procedure, as well as previous negative screening experiences (either personal or witnessed in others) were identified as significant barriers to breast cancer screening.  Perceived susceptibility to breast cancer “I’m healthy” was commonly cited as a reason for avoiding breast cancer screening among women who have not undergone a mammogram before. Malay women were found to indicate this more often as a reason to avoid screening[1] compared with their Chinese and Indian counterparts. Another common reason cited for avoiding breast cancer screening was the perception of not being at risk. Women often cited a lack of family history, feeling healthy, and having undergone a prior mammogram with normal results as reasons for exemption from regular screening. Some women also believed that actively seeking cancer screening would increase their risk of getting breast cancer1 and that getting regular screening meant that something was wrong with them. Perceived severity of breast cancer False beliefs, where women believe their health outcomes were beyond their control, were also identified as a significant barrier to breast screening uptake. Women aged 60 years and above were more likely to cite these false beliefs compared to younger women. [1] Benefits of regular breast cancer screening Mammography lowers a woman’s risk of dying from breast cancer. It’s recommended for women aged 50 to 69 years old to have mammograms on a regular basis[2]. A meta-analysis that combined the results from six randomised controlled trials[2] found that: Women aged 50-59 who got mammograms on a regular basis had a 14 percent lower risk of dying from breast cancer than women who didn’t get mammograms. Women aged 60-69 who got mammograms on a regular basis had a 33 percent lower risk of dying from breast cancer than women who didn’t get mammograms. For women aged 50 and above, they are encouraged to go for a mammogram screening once every two yearsunless the doctor advises otherwise.  For women aged 40 to 49, a yearly mammogram is recommended.  Do consult a doctor on the benefits and limitations of doing a mammogram at this age. How to address breast cancer screening stigma Understand the importance of going for a mammogram It’s important to know that going for regular breast cancer screening is the right thing to do. In Singapore, Breast cancer is the most common cancer among women, accounting for all female cancers between 2015 and 2019. However, the good news is that early detection significantly increases the chances of surviving breast cancer. Mammograms are one of the most reliable screening tools for breast cancer, as they can detect suspicious areas before they can be felt by hand. Mammograms are also particularly effective for women aged between 50 and 70 years old.  Manage the anxiety about going for a mammogram Be prepared for the breast cancer screening by managing anxiety and obtaining all the necessary information, including what to expect and what to wear etc. The imaging centre will be able to provide a preparation list for you.   Talking to someone who has undergone breast screening previously, or consulting with a doctor[5], or breast cancer specialist, can also help to alleviate any fears or uncertainties that an older woman may have on breast cancer screening. It’s natural to feel some discomfort during the screening procedure as breast compression is required to obtain a clear image. However, the level of pain can vary among individuals. Women can share their pain concerns with the radiographer conducting the screening, who will then make adjustments for better comfort  Go with a friend for the mammogram Having someone to accompany a woman for her mammogram can help lighten the mood and keep her relaxed. Women can encourage their girlfriends, especially those who have never undergone breast cancer screening before, to get screened together with them.  Women can use this opportunity to meet up and help promote good health for everyone.  Stay calm after going for a mammogram Waiting for the screening results can be agonising for some women but instead of dwelling on the outcome, try to keep calm and keep themselves busy with activities they enjoy.  It’s also helpful to keep in mind the following facts: No screening test is entirely accurate, and women may be asked to undergo further tests, such as a repeat mammogram or ultrasound scan. In most cases, these additional tests will show that everything is clear. Only one in 10 breast lumps are cancerous5 so there’s no need to worry too much.  There are various effective breast cancer treatment options available today, and survival rates have significantly improved.  By taking the time to get regular screening, women can catch any potential issues early, which can increase their chances of successful treatment and recovery. Breast cancer screening is a quick and mostly painless process and it could save lives. Women should not let fear keep them from taking care of their health.  This Mother’s Day, women can give the gift of health to their mother by encouraging her to get a mammogram. Show love and appreciation by scheduling a mammogram for mum and joining her for the appointment. Together, let’s make women’s health and well-being a priority.  References Academy of Medicine Singapore, “Barriers to breast cancer screening in Singapore: A literature review”, https://annals.edu.sg/barriers-to-breast-cancer-screening-in-singapore-a-literature-review/ Susan G.Komen, “Breast Cancer Screening for Women at Average Risk, https://www.komen.org/breast-cancer/screening/when-to-screen/average-risk-women/ Singapore Cancer Society, “Mammogram”, https://www.singaporecancersociety.org.sg/get-screened/breast-cancer/mammogram.html Health Promotion Board, “Singapore Cancer Registry Annual Report 2019”, https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-2019_annual-report_final.pdf Healthub, “5 Ways to Psych Yourself for a Mammogram”, https://www.healthhub.sg/live-healthy/1839/5-ways-to-psych-yourself-for-a-mammogram
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An Early Diagnosis of Cancer Leads to a Higher Chance of Treatment Success

In our new series, Best Advice from Women, for Women, Ms Jayde Simpson, an expatriate from the United Kingdom shares with us on finding out about her breast cancer diagnosis, coupled with the discovery of a high-risk gene. What kind of breast health issue did you face? I was diagnosed with Stage 2 Breast Cancer, which was ER+ PR- and HER2. How did you discover it? I felt a lump whilst on vacation that didn’t go away. Upon my return I scheduled an appointment with a breast specialist who performed an ultrasound. Within the week I had a mammogram, MRI and a PET scan which confirmed the suspicion. However, it wasn’t until a biopsy was conducted that it was confirmed as breast cancer. What was your biggest revelation after you were diagnosed? I did a gene test and discovered that I have a gene that makes my risk of breast cancer higher than the general population, although only a small number of cancers are hereditary.  Lifestyle and other factors influence an individual’s risk profile. What is one thing you wish you knew before you started treatment? Understanding the type of breast cancer (ER/PR/HER2 positive or negative) can lead to different recommendations on the type of treatment you should get.  I was upset when I had to get chemotherapy, believing what I had seen in the movies about the side effects from it.  However, I sailed through this.  A friend had recommended doing something nice around chemo and for me what stood out during my treatment was celebrating the end of each chemo with a lunch with a friend. My chemo duration had plenty of nice lunches and different friends supporting me throughout. What has the journey of dealing with or managing this issue been like for you? The absolute worst part was receiving the diagnosis as I did not truly believe this would happen to me and that all the tests would show this was a false alarm.  The biopsy I received confirmed this was not the case.  After that I did everything that I could to take a holistic integrative approach. I had a great breast surgeon and oncologist who partnered to give me the best medical treatment and tailored my treatment specific to me, e.g. my oncologist added a chemo that is shown to have more effect for people with the gene that I had, while my breast surgeon helped to add regular ultrasounds so we could measure the impact the chemo was having on reducing the tumour. This helped alleviate any anxiety on whether the treatment was working or not.  I focused on ensuring that I did everything at home that I could to help – diet, exercise and I worked with a naturopath to identify supplements that would help me through the treatment. After the chemo I had a double mastectomy with immediate reconstruction and whilst this was a challenging decision, I did everything I could to minimise any future risk.  I believe all of these things helped me to achieve a ‘pathological complete response’. The cancer diagnosis gave me the discipline I needed to prioritise me and ensure that I focused on a diet and exercise regime to best support my treatment. Despite the numerous rounds of chemo, I never once felt ill and felt stronger and fitter throughout.  I had the odd tired day and some other limited symptoms. However, the treatment was nowhere near as bad as I expected. Before this cropped up, what was your attitude toward breast health? Sadly, I had a close friend who passed away from Breast Cancer and so I was very much aware of the need to do regular self-exams.  The earlier you identify an issue, the more likely you have the chance of successfully dealing with it.  I was aware of how my breasts would change during my regular cycle and so managed to self-identify the lump early enough to have a very successful outcome. Did this journey change that attitude? It only strengthened it.  I am more in tune and aware of my body and if anything doesn’t feel right.  I take care to watch stress levels and not overreact and am focused on ensuring that I have balance in my life with adequate sleep, exercise, supplements and focusing on what I eat (80% of the time). What do you think women in general feel about breast health? Whilst I was aware of the importance, I think I still thought of myself as being invincible and that something would not happen to me.  I think women in general put other family members first and neglect to prioritise themselves.  These two things together can mean that they neglect breast health.  I also think sometimes people can feel embarrassed about seeking help or not wanting to expose themselves, or think “it’s probably nothing, I don’t want to bother anyone”. What are your thoughts when it comes to general awareness/education in this area? I hear of friends who tell me they don’t really know how to do a self-exam, or they skipped the last mammogram because they had to do something else and forgot to reschedule.  I think they are missing the 2 most important factors here:  1. prevention is always better than cure (focusing on healthy lifestyle can reduce your risk) 2. the earlier you catch these things, the better your outcome.  Whilst it’s rare, the tumour I had was not present on a mammogram but could be seen on the ultrasound, MRI and PET scan.  My advice would be to listen to your body and if something doesn’t feel right, advocate for yourself and seek a referral to a breast specialist who can help allay any fears or help ensure you get treatment early. What advice would you give women about breast health? The risk is too high so early identification will give you more chance of success.  Previously I did not prioritise myself, making excuses that I needed to attend to work, husband, children and that I had limited time.  I now consider that prioritising my health means I will be around longer to enjoy time with my family.  Ensuring I take steps to monitor my health and raising any concerns to my doctor means I’m around longer to enjoy my family.  The earlier you detect something the more chance of success you have.  Everyone I met throughout my journey was empathetic, caring, listened to me and addressed any concerns; the only downside is not acting early.
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