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How Mammogram & Ultrasound Provide Peace of Mind

Providing peace of mind: Breast screening for early cancer detectionOne in 13 women in Singapore will develop breast cancer in their lifetime [1]. It is very likely that you know someone who is living with or caring for a breast cancer patient. Regular breast screening with mammograms and/or ultrasounds is key to identifying subtle abnormalities on imaging before they manifest into advanced symptoms. Treatment of breast cancer in the early stages are associated with better outcomes with reduced morbidity and mortality rates.Mammograms for Early Detection of Breast CancerMammographic screening is the most reliable and cost-effective modality for detecting early breast cancer. It involves taking low dose x-rays of the breast tissues. Screening mammograms are done for women with no symptoms to look for early signs of breast cancer. On the other hand, diagnostic mammograms are performed to assess women with symptoms such as breast lumps, nipple discharge and/or skin changes.Regular mammographic screening has been proven to be instrumental in reducing the risk of mortality associated with breast cancer. Mammographic screening should be performed every year for women aged between 40 and 49, and every two years for women aged 50 and above [1].What is a 3D Mammogram?3D mammograms (also known as digital breast tomosynthesis) involves using low-dose x-rays shot through a continuous arc to obtain multiple slices of images through the breast. These are then reconstructed into a scrollable image stack for evaluation.3D Mammograms are More ComfortableThere are multiple advantages of 3D mammograms over standard 2D mammograms, which is why we advocate for its use in screening at Luma Women’s Imaging Centre.Compared to 2D mammograms, 3D mammograms offer greater diagnostic accuracy resulting in increased cancer detection. This is especially significant for women with dense breasts, which are very common in the Asian population. Due to our ability to scroll through a stack of layered images to differentiate between normal breast tissue and true abnormalities, 3D mammogram reduces the need to recall patients for additional imaging. With our Luma 3D mammogram machines, there is overall reduced radiation exposure in contrast to 2D mammogram. Reduced compression force is required to produce 3D mammogram images; therefore, patients experience improved comfort during the imaging process.Ultrasound: Process and its BenefitsBreast ultrasound is an imaging technique that uses sound waves to examine the breast’s internal structures. It demonstrates high sensitivity in identifying breast abnormalities such as cysts, solid masses, abscesses and lymph nodes. Breast ultrasound is often used to supplement a mammogram in evaluation of mammographic abnormalities and/or for assessment of breast symptoms [2].Breast Ultrasound vs MammogramBreast ultrasounds and mammograms are two different imaging modalities with different functions, and one does not replace the other.Mammogram remains the gold standard in detecting early breast cancers, which commonly present as calcifications. Breast ultrasound has high sensitivity for identifying small lumps and aids in evaluation of mammographic abnormalities, but is unable to as reliably pick up calcifications.Supplemental breast ultrasound may be considered in the following settings:Women with dense breasts, which are common in the Asian population. Dense breast tissues are difficult to penetrate even with x-rays and are difficult to evaluate with mammograms alone. Pregnant women. Ultrasound does not use ionising radiation like in mammograms, thus making it safer for the developing foetus. Women who are younger than age 40 with strong risk factors for breast cancer [3]. requiring an enhanced breast screening regime.Regular Breast Screening Provides for Peace of MindMammograms and breast ultrasounds play a vital role in the early detection of breast cancer and provide peace of mind for women who undergo regular screening. By combining these screening methods, women are empowered to take a proactive approach towards their breast health, ensuring that any subtle abnormalities are being appropriately investigated.By raising awareness, promoting breast care education, and prioritising early detection and prevention efforts, we can work towards a future where breast cancers are diagnosed at an early and most treatable stage. This in turn saves lives and improves the overall well-being of women and our community.1. Singapore Cancer Society, “Breast Cancer” 2  John Hopkins Medicine, “Breast Ultrasound”3 Breast Cancer Detection : 3D Mammogram Better Than 2D Scan, Study Finds 
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How a Sub-specialised Breast Pathologist Helps Patients in their Fight Against Breast Cancer

The role that pathologists play in diagnosing breast cancer is a crucial and emotional one. They are the ones who use their expertise to analyse tissue samples that have been excised from patients and determine if they have breast cancer.Professor Tan Puay Hoon shares with us on what her sub-specialisation in breast pathology brings to the table of breast cancer diagnoses and the advantages of being a female pathologist.Ever since she was a student, Professor Tan Puay Hoon has always enjoyed the investigative aspect of making a diagnosis based on the histological appearances of tissue sections evaluated down the microscope. After excelling in pathology during the fourth year of her medical school examination and receiving a medal for the subject, she went on to become a pathologist after her graduate studies.The role that pathologists play in diagnosing breast cancer is a crucial and emotional one. They are the ones who use their expertise to analyse tissue samples that have been excised from patients and determine if they have breast cancer. As a pathologist, Prof Tan ensures that the surgical specimen excised or resected from the patient by the breast surgeon is carefully inspected at the laboratory. Sampling of the relevant specimen parts are also processed into microscopy slides, which are then evaluated using the microscope.“We also render comprehensive reports of cancers that will allow the clinicians to be able to decide on treatment. The pathologist confirms that a breast tumour is malignant (cancer), the types and grades of the cancer, determine its prognosis and whether it will respond to certain treatments,” explains Prof Tan. “Without a pathological diagnosis, patients will not be able to receive appropriate treatment, and surgeons will not know which type of operation to offer the patient for the best outcome. Oncologists also depend on pathology input to decide what type of adjuvant therapy is suitable,” she adds.Pathologists like Prof Tan also advise clinicians on the likely behaviour of cancers (prognostication) and predict if the cancers will respond to specific treatments. “As a woman, I feel privileged to be able to work in a field that impacts women significantly. I empathise deeply with women who are diagnosed with breast cancer, as this disease and its treatment affects their image and so much of the psychosocial aspects of their lives, as mothers, wives, daughters. I want to be able to provide diagnoses that add value to their treatment journey,” says Prof Tan.Early breast cancer diagnosis leads to a higher chance of cure and hence, Prof Tan also advocates breast cancer awareness among all women, young and old.  “Women in the appropriate age group should attend regular breast screening, and all females should seek early medical attention for breast symptoms,” says Prof Tan.As a pathologist, Prof Tan also provides second opinions on cases that are sent for her review. She recounts a recent case in which a relatively young woman was diagnosed with breast cancer on needle aspiration (a small amount of breast tissue or fluid is removed from a suspicious area with a thin, hollow needle to check for cancer cells) and the patient was scheduled for cancer surgery. “The original needle aspiration slides were sent to me to review, and I thought the appearances were benign and possibly a fibroadenoma (a benign tumour),” Prof Tan explains. A core biopsy was conducted to clarify the discordance between the original diagnosis and Prof Tan’s review, which later confirmed that it was a fibroadenoma. “I was so happy for the patient,” says Prof Tan.Given that she holds the hope and well-being of countless women in her hands with each slide she examines, how does she perceive her role as a pathologist? “I would like to think of a pathologist as a ‘cell whisperer’ of sorts – the cells in the tissue are giving clues to their nature, and it is up to us as pathologists to put all this information together. Sometimes the cells are really ugly which often reflects an aggressive cancer. Other times, there are beautiful patterns that remind me of things I see in life,” she says.Since pathology is a very academic discipline, Professor Tan said pathologists need to be at the forefront of all diagnostic development. “Being involved in clinical research is integral to being a pathologist who is current with the developments in the field and also as someone who can offer depth to disease diagnosis,” she adds. Prof Tan also emphasised the important role that pathologists play as educators for the next generation  as well as in conveying pathology information to clinical colleagues.So, what makes Prof Tan feel fulfilled in her job as a pathologist? “I feel fulfilled when I’m able to make an accurate comprehensive diagnosis which allows the clinicians to treat the patients,” she says. Prof Tan also enjoys working with her clinical colleagues who are experts in their fields and collaborating with her pathologist friends and colleagues in the international arena.  She feels gratified to be part of the WHO Editorial Board that classifies breast tumours and is also actively involved in international research that can refine and improve the classification of breast tumours for better treatment.
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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 surgeryMastectomy 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 mastectomySome 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 providersEssentially, 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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