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Should You Get a Second Opinion for Breast Cancer? Making Treatment Decisions with Confidence

Should You Get a Second Opinion for Breast Cancer? Making Treatment Decisions with Confidence A breast cancer diagnosis can bring with it a whirlwind of emotions, appointments and information. In what can feel like the blink of an eye, you may find yourself discussing surgery, medications or treatment plans that could have ripple effects on your health,daily life and future plans Many women expect that once a diagnosis is confirmed, there will be one clear path forward. Instead, they are sometimes presented with choices, and with those choices comes an unexpected question: "How do I know I'm making the right decision?" If you've ever felt overwhelmed or worried about choosing the "wrong" treatment, know that you are not alone. Women facing breast cancer treatment decisions commonly experience uncertainty, anxiety and ongoing worry as they try to balance medical information with what feels right for them and their families [1][2][3]. Many women arrive at this stage after a period of uncertainty, additional investigations or follow-up appointments. If that’s where you are now, our article on what to do when rest results aren't clear explains what often happens before treatment decisions are discussed. Should You Get a Second Opinion for Breast Cancer? One of the most common questions women ask after a breast cancer diagnosis is whether they should seek a second opinion. There is no universal rule that every patient needs one. However, many women choose to seek a second opinion when they want additional reassurance, when several treatment options are available, or when they are unsure they fully understand their diagnosis or treatment recommendations. Importantly, seeking a second opinion does not mean you distrust your doctor. Rather, it is a recognised part of breast cancer care that can help patients better understand their situation and feel more confident about the decisions ahead [4][5]. In many cases, the second opinion confirms the original diagnosis or treatment plan. While this may not change the treatment itself, it often changes how patients feel about moving forward. Knowing that two specialists have independently arrived at similar conclusions can provide valuable reassurance during a time of uncertainty [4][6]. Occasionally, a second opinion may also identify additional treatment options or alternative approaches that are equally supported by current evidence [5][6][7]. Ultimately, the goal is not necessarily to find a different answer. It is to ensure you fully understand your diagnosis and feel confident about your next step.When Breast Cancer Treatment Decisions Feel Overwhelming Treatment decisions are rarely just about treating the cancer. They are also about understanding how different options may affect the life you hope to return to afterwards. You may find yourself thinking about your recovery, your independence, your family responsibilities, your work, or how treatment could affect your body and quality of life [2]. Surgery, chemotherapy, radiotherapy and other treatments each come with their own benefits, considerations and potential side effects, and these may matter differently from one person to another [3]. At the same time, you are often trying to process unfamiliar medical terms and a large amount of information within a short consultation. It's therefore perfectly normal to leave an appointment only to think of new questions once you're home. This isn't a sign that you weren't listening. Rather, it reflects how emotional stress can affect the way we absorb and process information. Evidence indicates that patients who are not given adequate time to process information and participate in treatment decisions are more likely to experience uncertainty and feel less involved in their care [1][8][9]. Why Breast Cancer Treatment Plans May Not Be the Same for Everyone Many people assume there is only one "correct" treatment for breast cancer. In reality, there may be more than one appropriate option depending on factors such as the type and stage of breast cancer, tumour biology, your overall health, and your personal priorities [10]. For example, some women may be suitable candidates for either breast-conserving surgery or a mastectomy. Both may be medically appropriate, but each comes with different considerations that extend beyond cancer treatment alone, including recovery, body image, future treatment needs and personal preferences [3]. This is where shared decision-making becomes important. Rather than choosing a treatment based solely on clinical evidence, doctors also work with patients to understand what matters most to them. For some women, preserving the breast may feel important. For others, reducing the likelihood of another surgery may bring greater peace of mind. The goal is not simply to identify a medically appropriate treatment, but one that also aligns with your individual circumstances, priorities and values.Can You Get a Second Opinion for Breast Cancer in Singapore? Patients in Singapore are free to seek a second opinion if they would like further clarification about their diagnosis or treatment options. This typically involves another breast specialist reviewing existing medical records, imaging studies, pathology reports and treatment recommendations before providing an independent assessment. Many patients seek a second opinion not because they wish to change doctors, but because they want greater clarity about their options before making important treatment decisions. Whether the second opinion confirms the original recommendation or presents additional considerations, the process can help patients feel more informed and reassured about the path they ultimately choose.Questions Many Women Wish They Had Asked Sooner As the initial shock settles and you've had time to reflect, new concerns often come to mind. This highlights the importance of having enough time to process information before moving forward [9][11]. If you're preparing for another appointment or considering a second opinion, you may find it helpful to ask questions such as: [6] Can you explain my diagnosis in simpler terms? Why is this treatment being recommended for me? Are there other treatment options that may also be suitable? What are the benefits, risks and possible side effects of each option? How might treatment affect my daily life, work or family responsibilities? Is there enough time for me to consider my options or seek a second opinion? Are there any additional tests that would help guide this decision? No question is too small. Understanding the reasons behind a recommendation can often bring greater clarity and reassurance than simply hearing the recommendation itself. What Does Decision Confidence Mean Decision confidence does not mean feeling completely certain or never experiencing fear. Few people feel that way after a breast cancer diagnosis. Instead, confidence comes from knowing that you have been given the opportunity to understand your options, ask the questions that matter to you and make a decision that reflects both sound medical advice and your own priorities. Research has found that patients who are involved in decisions to the extent they wish to be are often more satisfied with their care and less likely to experience regret about their treatment choices later on [3][8].Why Seeking More Information Is Not the Same as Delaying Care Many patients worry that taking more time to ask questions or seek a second opinion will slow down their treatment. While every situation is unique, there is often an appropriate window to better understand your diagnosis before moving forward with treatment. Taking the time to understand your options should never be mistaken for avoiding treatment. Rather, it is about ensuring that when you move forward, you do so with confidence instead of uncertainty. Breast cancer treatment decisions rarely feel easy. However, confidence does not come from having all the answers immediately. It comes from having the opportunity to understand your options, ask questions, seek clarification when needed and make decisions that align with both medical evidence and your personal priorities. Whether you are considering a second opinion or simply looking for more clarity about your treatment options, our breast specialists at Solis Breast Care & Surgery Centre in Singapore are here to support you with the information, time and guidance needed to help you move forward with confidence.References [1] Rivers, A. S., & Sanford, K. (2021). A special kind of stress: Assessing feelings of decisional distress for breast cancer treatment decisions. Patient Education and Counseling. https://doi.org/10.1016/j.pec.2021.04.020[2] Reyna, V. F., Nelson, W. L., Han, P. K., & Pignone, M. P. (2015). Decision Making and Cancer. The American Psychologist, 70(2), 105–118. https://doi.org/10.1037/a0036834[3] Cheng, Q., Jiang, Q., Chen, X., Hu, X., Xia, M., & Jiao, Y. (2025). Early decision regret and its relationship with decision participation among breast cancer patients undergoing surgery. The Breast, 84, 104585. https://doi.org/10.1016/j.breast.2025.104585[4] Beer, M., Allison, H., Fisher, C., & Fan, B. (2022). Second Opinions in Breast Cancer Surgery: What Have We Learned? Cureus. https://doi.org/10.7759/cureus.30180[5] National Cancer Institute - NCI Dictionary of Cancer Terms. (2025). Second Opinion. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/second-opinion[6] Cleveland Clinic. (2025, April 2). What To Know About Getting a Breast Cancer Second Opinion. https://health.clevelandclinic.org/breast-cancer-second-opinion[7] Varman, P. M., Conner, A., Bennett, W. C., Taft, D., Chichura, A. M., Wu, V., Escobar, P., Woo, K. P., Cech, A., Rosenberg, C., & Zahraa Al-Hilli. (2025). Impact of Second Opinions on Time to Treatment of Breast Cancer. Annals of Surgical Oncology, 32(11), 8286–8294. https://doi.org/10.1245/s10434-025-17934-1[8] Stacey, D., Paquet, L., & Samant, R. (2010). Exploring Cancer Treatment Decision-Making by Patients: A Descriptive Study. Current Oncology, 17(4). https://doi.org/10.3747/co.v17i4.527[9] Herrmann, A., Sanson-Fisher, R., & Hall, A. (2019). Not having adequate time to make a treatment decision can impact on cancer patients’ care experience: Results of a cross-sectional study. Patient Education and Counseling, 102(11), 1957–1960. https://doi.org/10.1016/j.pec.2019.06.011[10] Mayo Clinic. (2025, January 10). Breast Cancer - Diagnosis and Treatment. https://www.mayoclinic.org/diseases-conditions/breast-cancer/diagnosis-treatment/drc-20352475[11] Huijgens, F. L., Hillen, M. A., Huisinga, M. J., Vis, A. N., Tillier, C. N., Oldenburg, H. S. A., Diepenhorst, G. M. P., & Henselmans, I. (2025). Cancer Patients’ Experiences of Burden when Involved in Treatment Decision Making. Medical Decision Making, 45(5), 533-544. https://doi.org/10.1177/0272989x251334979‌ ‌‌‌‌‌ ‌ ‌
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Triple-Negative Breast Cancer (TNBC): Symptoms, BRCA Risk, Diagnosis and Latest Treatment Advances

Triple-Negative Breast Cancer (TNBC): Symptoms, BRCA Risk, Diagnosis and Latest Treatment Advances Understanding Triple-Negative Breast Cancer (TNBC) Triple-negative breast cancer (TNBC) is biologically and clinically different from other forms of breast cancer because it lacks three key biomarkers on the surface of the cancer cells: oestrogen receptors, progesterone receptors, and the HER2 protein, explains Dr Tan, breast surgeon. These biomarkers are important because they allow doctors to classify breast cancer into three broad categories: hormone receptor-positive cancers, HER2-positive cancers, and triple-negative cancers.Each category behaves differently and requires different treatment approaches. Hormone receptor- positive cancers, for example, may respond to hormone-blocking therapies, while HER2-positivecancers can be treated with HER2-targeted drugs. TNBC, however, doesn’t carry these treatment targets, making its management clinically different from many other breast cancer subtypes. Because of this, testing for these biomarkers forms a critical part of breast cancer diagnosis, helping doctors determine the most appropriate treatment strategy for each patient. Why TNBC Can Be More Agressive TNBC is often described as more aggressive because, among the three major categories of breast cancer, it tends to grow more quickly and spread earlier when left untreated. At the same time, TNBC is also considered relatively chemosensitive, meaning many tumours respond fairly well to chemotherapy. This creates a complex clinical picture where some patients may experience a strong initial response to treatment, while others later develop more challenging disease patterns. Although many TNBC tumours can be treated successfully, some unfortunately have a tendency to recur aggressively in other parts of the body, creating greater treatment challenges than other breast cancer subtypes. This can occur even when the tumour initially responds well to treatment. While chemotherapy may eliminate most cancer cells, it may not eradicate every single one. Some surviving cancer cells can gradually develop new mutations that make them more resistant to treatment over time. Eventually, these resistant cells may begin multiplying again and manifest as recurrent disease. This phenomenon isn’t unique to TNBC and can occur across many cancer types. However, TNBC relapses tend to occur earlier, often within the first few years after treatment, compared with hormone receptor-positive breast cancers, where recurrence can sometimes happen many years or even decades later.Signs and Symptoms to Watch For One of the most common early signs of TNBC is a self-detected lump in the breast or underarm, says Dr Tan. The underarm lump may represent an enlarged lymph node. Unlike what many people assume, cancerous breast lumps are often painless, and in TNBC, the lump may increase in size relatively quickly. The absence of pain can sometimes create a false sense of reassurance, causing some women to delay seeking medical attention.TNBC can also be more difficult to detect on routine screening mammograms because it often doesn’t produce the abnormal calcifications commonly seen in other breast cancer subtypes. This means TNBC may occasionally be missed during its earlier stages, particularly in women with dense breast tissue. As a result, a recent normal mammogram shouldn’t discourage women from seeking medical evaluation if they notice a new breast lump or unusual change. When symptoms persist despite a normal mammogram or initial reassurance, further evaluation may still be necessary. A physical examination, along with additional tests such as an ultrasound or breast MRI may be recommended, particularly for younger women with dense breast tissue. If the clinical or imaging findings raise concern for possible malignancy, a breast biopsy may then be required to confirm the diagnosis. Another less common but important presentation is inflammatory breast cancer, which can cause sudden breast swelling, redness, warmth, or mild tenderness that may initially be mistaken for an infection or inflammation. While empirical antibiotics may sometimes be prescribed first, persistent symptoms that don’t improve should be evaluated further by a breast specialist. Dr Tan adds that TNBC also tends to occur more frequently in younger women, including those below the age of 40, which is younger than the typical age at which routine breast cancer screening begins. This makes breast awareness especially important, even among younger women who may not consider themselves at risk. The Role of BRCA and Genetic Testing TNBC is sometimes associated with inherited genetic mutations, particularly BRCA1 and BRCA2, which are among the most common genetic mutations linked to hereditary breast and ovarian cancers. TNBC is especially associated with BRCA1 mutations, particularly when breast cancer develops at a younger age, such as before the age of 50. The presence of a BRCA mutation can influence both surgical decisions and systemic treatment strategies. It may also have important implications for the long-term cancer risk of other family members, making genetic counselling and testing an important consideration in selected patients. Genetic testing is often recommended for women diagnosed with breast cancer under the age of 50, including those with TNBC. It may also be considered in women who develop cancer in both breasts, have a personal history of more than one cancer, or have a strong family history of breast, ovarian, or certain other cancers. A positive BRCA result means that even after successful treatment of the initial breast cancer, there remains an increased risk of developing a new primary cancer in the future due to the underlying inherited genetic predisposition. It can also influence several aspects of long-term management, including: • The use of certain targeted cancer drugs designed for BRCA-associated breast cancers• Surgical planning, where some patients may consider bilateral mastectomy rather than breast- conserving surgery• Long-term surveillance of other high-risk organs, particularly the ovaries • Discussions around preventive surgery, including removal of the ovaries and fallopian tubes in selected patients The implications can also extend to family members, as relatives may potentially carry the same BRCA mutation. When a patient is found to have a BRCA mutation, family members may also be advised to undergo genetic testing. Those who are subsequently found to carry the mutation may include:• Earlier and more intensive cancer surveillance, including breast screening from a younger age using mammograms, ultrasound, and/or breast MRI • Ovarian cancer screening using blood tests and ultrasound • Consideration of preventive surgeries such as risk-reducing double mastectomy or removal of the ovaries and fallopian tubes in appropriate clinical settings Advances in TNBC Treatment One of the major advances in TNBC treatment has been a shift towards using neoadjuvant chemotherapy, where chemotherapy is given before surgery rather than after, notes Dr Tan. This approach allows doctors to assess how well the tumour responds to treatment, which can then help guide and tailor subsequent treatment decisions after surgery.Using chemotherapy upfront may also help shrink the tumour, improving the chances of breast- conserving surgery rather than requiring more extensive surgery. In patients whose TNBC hasspread to the underarm lymph nodes, neoadjuvant chemotherapy can sometimes downstage the cancer sufficiently so that fewer lymph nodes need to be removed during surgery. This represents an important change from previous practice, where routine removal of all underarm lymph nodes was more common and carried a higher long-term risk of complications such as lymphoedema, a chronic swelling condition that can affect the arm. Another important advancement is immunotherapy, which works by targeting immune-related proteins that cancer cells use to evade the body’s immune system. Dr Tan adds that immunotherapy, when combined with neoadjuvant chemotherapy, has been shown to significantly improve survival outcomes in selected patients with TNBC. Patients with higher-risk TNBC are more likely to be considered for immunotherapy. Factors such as tumour size, lymph node involvement, and other markers suggesting a higher risk of recurrence are often taken into account when determining suitability for these newer treatments. With the addition of immunotherapy, studies have shown improved response rates and better overall survival outcomes in selected patients with TNBC. Several newer drug classes have also shown promising results in clinical trials and are expected to become part of mainstream TNBC treatment over time. Despite the aggressive nature of TNBC, there has been a significant leap in medical treatment over the past decade, leading to improving clinical outcomes for many patients.Expert ContributorDr Tan Yah Yuen Senior Consultant & Breast Surgeon Solis Breast Care & Surgery Centre, Singapore http://www.solis.sg/ http://www.instagram.com/solisbreastcare Article reviewed by Dr Tan Yah YuenOriginally published on Expert-led Health, Fitness & Nutrition Insights. Republished with permission.
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Heart Health and Breast Cancer: Why It Matters

Breast cancer is the most commonly diagnosed cancer in women, while cardiovascular disease remains the leading cause of death among women in Singapore. Together, they account for a large proportion of morbidity and mortality. The important thing to note is that they are connected in many ways, especially for breast cancer patients and survivors.The strong link between heart health and cancer has led to the growth of cardio-oncology - a multidisciplinary approach dedicated to protecting the heart throughout the cancer journey and improving long-term survival for cancer survivors at higher risk of heart disease.¹Why Breast Cancer Survivors Are at Higher Heart Risk Treatment-related cardiac effects of cancer therapy play a major role. Some common breast cancer treatments can affect heart health: Anthracycline chemotherapy (e.g. doxorubicin) is linked to heart damage.² Risk increases with higher cumulative doses and in patients with pre-existing cardiovascular risk factors. Trastuzumab (Herceptin) can affect cardiac function, especially when combined with other agents that affect the heart.² Unlike anthracyclines, trastuzumab-related heart dysfunction is often reversible when detected early. Radiotherapy, especially to the left side of the chest, can unintentionally affect the heart.² Modern techniques have reduced but not eliminated this risk. These effects may not appear immediately; slow, cumulative damage can develop years after treatment.²Heart-Healthy StrategiesA. Stay Active Physical activity is one of the most powerful ways to reduce cardiovascular risk after breast cancer³: Survivors who are physically active have a significantly lower risk of cardiovascular death and all-cause mortality.³ Even adding ~2,500 extra steps per day or moderate exercise can reduce risk.³ Guideline recommendation: According to the Health Promotion Board (HPB) and World Health Organisation, aim for at least 150-300 minutes of moderate-intensity aerobic physical activity per week, or 75 minutes of vigorous activity, plus strength training on 2 days/week.³B. Eat a Heart-Healthy Diet Nutrition plays a key role in cardiovascular health: Diets similar to DASH (Dietary Approaches to Stop Hypertension) or Mediterranean patterns are associated with lower risk of heart disease in breast cancer survivors.⁴ Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats, while minimising processed foods, added sugars, and excessive salt.⁴ This supports healthy blood pressure and overall heart function.C. Monitor Key Risk Factors Regular monitoring of cardiovascular risk factors is essential: Blood pressure Blood cholesterol Blood sugar Weight Physical inactivity Smoking status These factors contribute to cancer-related heart risk and can often be improved through lifestyle changes or medication.²D. Work with Your Healthcare Team Collaborating with oncology and cardiology teams improves outcomes¹,²: Tailored cardiovascular risk assessments before, during, and after treatment - including heart imaging (such as echocardiograms) and functional evaluations when appropriate - help detect issues early.² Shared-care models that involve oncologists, cardiologists, primary care, and rehabilitation professionals achieve the best long-term results.¹E. Consider Structured Rehabilitation Some programmes, called Cardio-Oncology Rehabilitation (CORE), integrate cardiovascular and cancer survivorship care¹,³: Exercise training Nutritional counselling Psychological support Education on risk factors Smoking cessation support These programmes are similar to traditional cardiac rehabilitation programmes but adapted for cancer survivors, and can reduce long-term heart risk and support overall health.Summary Breast cancer survivors face elevated long-term risk for cardiovascular disease due to treatment effects and shared risk factors.1,2 The good news is that this risk can be managed and reduced through: Regular physical activity³ Heart-healthy eating⁴ Routine monitoring of cardiovascular risk factors² Close collaboration with healthcare providers¹ Many cancer centres and breast surgeons in Singapore now work closely with cardiologists to monitor heart health during and after treatment. With proactive care, breast cancer survivors can improve long-term heart health and overall quality of life.Article reviewed by Dr Benji Lim, Interventional Cardiologist at Novena Heart Centre.References Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, et al. Cardiovascular disease and breast cancer: where these entities intersect: a scientific statement from the American Heart Association. Circulation. 2018;137(8):e30-e66. doi:10.1161/CIR.0000000000000556. Epub 2018 Feb 1. PMID: 29437116. https://pubmed.ncbi.nlm.nih.gov/29437116/ Bostany G, Chen Y, Francisco L, et al. Cardiac dysfunction among breast cancer survivors: role of cardiotoxic therapy and cardiovascular risk factors. J Clin Oncol. 2025;43(1):32-45. PMID: 38833638. https://pubmed.ncbi.nlm.nih.gov/38833638/ Wilson OWA, Wojcik KM, Cohen CM, Kamil D, Butera G, Matthews CE , Dieli-Conwright CM , Jayasekera J, et al. Exercise and cardiovascular health among breast cancer survivors: a scoping review. Cardio-Oncology. 2025;11:24. PMID: 40012001. https://pubmed.ncbi.nlm.nih.gov/40012001/ Vo JB, Ramin C, Veiga LHS, Brandt C, Curtis RE, Bodelon C, Barac A, Roger VL, Feigelson HS, Buist DSM, Bowles EJA, Gierach GL, González ABE, et al. Dietary patterns and cardiovascular risk in breast cancer survivors. J Natl Cancer Inst. 2024;[Epub ahead of print]. PMID: 38718210. https://pubmed.ncbi.nlm.nih.gov/38718210/
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