Breast cancer is the most common cancer among Singaporean women, affecting over 1000 women annually. Its rising incidence makes the disease a major public health problem. Although largely a female disease, its incidence in men is 1% of that in women. A complex interplay of factors such as hormonal, reproductive, genetic, environmental, dietary and other factors cause breast cancer. Heredity is one of the factors that causes cancer in 5-10% of patients.(See article Genetics of breast cancer in Singapore by Dr Ann Lee).

However, for many patients, several factors contribute to cancer. Incidence rates are relatively low in Asia, as compared to the West. In Singapore, breast cancer rates are a third of that the US, and half that of Europe, but it is still higher than many Asian countries. Calorie-rich diets, decreasing physical activity, changes in body fat, younger age of menarche, delayed first births, and less breast feeding have all contributed to the upward trend. Incidence in the 40-50 age group has nearly caught up with the incidence of the same age group in the US, where breast cancer mortality has been declining and the incidence levelling since the 1990s. In contrast, Singapore's rising incidence continues to spiral and the current incidence is 2.3 times that in 1968-72.

The declining mortality rates in the West are probably a result of mammography screening and early diagnosis, and advances in adjuvant treatment using chemotherapy and Tamoxifen. These advances need to be mirrored in Singapore.

To control the rising incidence, public education is necessary to raise awareness among women in their 40s that early screening is important. A woman with a lump in her breast needs appropriate evaluation right away. She does not need screening but definitive evaluation for diagnosis. Women without symptoms will also benefit from screening.

To receive optimal care, the patient should go to a multidisciplinary centre where she is seen by a team of specialists - a breast surgeon, a plastic or reconstructive surgeon, a medical oncologist, a radiation oncologist, a dedicated pathologist and other supporting healthcare providers. At National Cancer Centre (NCC), this comprehensive range of services under one roof. However, the role of General Practitioners in early detection, proper referral and shared care is just as important. In this issue, we hope to reach out to you in an effort to reduce breast cancer incidence and mortality by providing a concise overview and important 'pearls' in breast cancer management.

Happy reading!


Dr Sandeep Rajan, Editor
Dr Bhupinder Mann, Guest Editor