Breast cancer today

This year’s SingHealth Breast Cancer Awareness Month (BCAM) theme is “Be Empowered!” It hopes to encourage women to take charge of their breast health and actively participate in decision-making that impacts breast cancer screening and treatment, and their overall quality of life. Empowerment comes from knowledge, and this BCAM, we share the latest in breast cancer statistics, diagnostics, and treatments in Singapore to help patients and their loved ones stay informed about how advancements are improving outcomes.

 

This 2024 SingHealth Breast Cancer Awareness Month (BCAM) theme is “Be Empowered!”

(Credit: iStock.com/Atstock Productions)

Current statistics and trends

Breast cancer is increasingly common, with diagnoses rising from around 8,500 women between 2008 and 2012 to over 13,100 women between 2018 and 2022 in Singapore. While these figures might seem concerning, earlier detection is making a significant difference. The percentage of breast cancers diagnosed at Stage I in Singapore has increased dramatically from 33% between 2008 and 2012 to over 57% between 2018 and 2022 (National Registry of Diseases Office, 2024).

This shift reflects greater awareness and improved screening practices. Despite the rising incidence, breast cancer consistently has some of the best survival rates of common cancers among females in Singapore. The age-standardised relative survival rate, which tracks survival five years after diagnosis, has risen from 49.9% between 1973 and 1977 to over 83% between 2018 and 2022 (National Registry of Diseases Office, 2024).

Get the lowdown on breast cancer diagnosis •       Over 57% of breast cancers in Singapore are now diagnosed at Stage I, a significant improvement from 2017 when only a third were diagnosed at this stage (National Registry of Diseases Office, 2024). • Regular mammograms are essential for early detection and increased survival rates.  •      The Health Promotion Board (HPB) recommends women aged 50 and above undergo mammogram screening every two years. • Women between 40-49 years old should discuss the benefits of an annual screening mammogram with their doctors. • To register for a mammogram screening by BreastScreen Singapore, please click here. For more information on breast cancer screening programmes and subsidy eligibility, click here.

Breast cancer treatments are more personalised

 

The NCCS Department of Breast & Gynaecological Medical strikes a pose for Breast Cancer Awareness Month 2024.

“Breast cancer treatments have evolved significantly, moving beyond past practices. Our patients are often apprehensive during their first visit, but I tell them that the situation is different now!”

Dr Ma Jun, Associate Consultant in the Department of Breast and Gynaecological Medical Oncology at the National Cancer Centre Singapore (NCCS) shared new discoveries are presented every few months at major breast cancer conferences and meetings worldwide, driving advances in therapies and targets that now offer more personalised options. 

A major change in the past 10 years is the use of personalised treatment for breast cancer - whether it be neoadjuvant treatment or targeted treatment tailored to each patient’s unique breast cancer type. When neoadjuvant therapy was first introduced in the 1980s, it was intended to reduce tumour burden in patients with locally advanced, inoperable disease to facilitate surgery.  

Over time, neoadjuvant chemotherapy has become the standard treatment for certain types of early breast cancer, namely early triple-negative breast cancer or HER2 positive cancer. Neoadjuvant therapy helps reduce tumour size, allows for better breast conservation, and facilitates the refinement of subsequent treatment regimens based on the patient’s response to initial treatment.

Dr Ma Jun explained, “A patient’s response to neoadjuvant therapy is assessed at surgery. If she achieves a complete response – her risk of recurrence is much lower. If there is incomplete response, she may require escalated therapy, emphasising the personalised nature of modern breast cancer treatment.”

For patients with metastatic or late-stage breast cancer, there are now molecular tests that can identify specific mutations to determine suitability for targeted therapies.

“One patient with advanced breast cancer tested positive for the PIK3CA gene mutation, allowing us to use an oral targeted therapy. This spared her from undergoing injection chemotherapy and the resulting side effects, which improved her quality of life and managed the cancer for a few more months,” said Dr Ma Jun. 

Advances in breast surgery for better quality of life

 

The NCCS and SGH Department of Breast Surgery are privileged to journey with their patients.  

“It is a privilege to journey with our patients and witness the many milestones in their lives. We inevitably form a bond, making it natural to want the very best for them and their families,” shared Associate Professor Veronique Tan, Head of the Department of Breast Surgery at Singapore General Hospital and NCCS.

Until recently, breast cancer patients who have cancer in their armpit or axillary lymph nodes underwent an axillary clearance surgery. This surgery removes all lymph nodes within defined boundaries of the armpit or axilla. This type of surgery predisposes patients to developing lymphoedema or swelling of the arm which is uncomfortable and leaves them prone to infection. 

Now, patients who respond well to neoadjuvant therapy and show no remaining cancer in the lymph nodes may be eligible for a more targeted axillary dissection. This new procedure combines a sentinel node biopsy with surgery to remove lymph nodes that had been shown to be cancerous and were marked with clips prior to chemotherapy. This targeted approach to assessing the axilla allows patients with no residual cancer in the axillary lymph nodes to avoid a complete axillary dissection, reducing the likelihood of lymphoedema and improving long-term outcomes.

“With this more targeted procedure, we are still treating our patients effectively while de-escalating treatment safely. We are ensuring better long-term outcomes for these patients so that they can go back to living normally,” said Assoc Prof Tan.

Looking ahead

As breast cancer treatment continues to advance, improving survival and quality of life, it is crucial for women and their loved ones to remain vigilant, participate in regular screenings, and make informed decisions about their care. Empowerment through knowledge and proactive health management is key to navigating the breast cancer journey effectively.

References:

National Registry of Diseases Office (2024). Singapore Cancer Registry Annual Report 2022. 

Retrieved from: https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-ar-2022_web-report.pdf?sfvrsn=a9eb8c10_1