Breast Cancer

The Breast Surgical Oncology Team from NCCS consists of Drs Veronique Tan, Yong Wei Sean, Benita Tan, Preetha Madhukumar, Sim Yirong, Lim Sue Zann, Julie Liana Bte Hamzah,Tan Si Ying and Christina Yang Shi-hui. As a team, we are active in both clinical and translational breast cancer research. The overarching aims are to investigate breast cancer biology and improve diagnosis, treatment and clinical outcomes. In addition, research is also actively being done in the areas of phyllodes tumours and breast sarcomas.

Ongoing clinical research includes efforts to characterise aspects of breast cancer in the Asian population. We explore the spectrum of breast cancers, from in-situ cancers (DCIS) to locally advanced cancers, and analyse special populations - such as pregnancy associated breast cancers, genetic carriers, young patients and the very elderly, to identify peculiarities and unmet needs. As NCCS treats the majority of Singapore’s breast cancers, we also actively identify factors that influence patients in treatment related decision-making, patient reported outcomes and survivorship care issues unique to the Singapore population. An example is the study on the role of decision aids and self efficacy, in EmPowerIng Breast Cancer Survivors (EPiCS), led by Clin Asst Prof Sim Yirong, who was awarded the Population-based, Unified, Learning System for Enhanced and Sustainable Health (PULSES) grant, 2023. 

Significant efforts also go to advancing loco-regional treatment of breast cancer. Examples include a Phase II trial on the use of INTRABEAM intra-operative radiotherapy for ductal carcinoma in-situ and have also embarked on a pilot study on the role and utility of the novel tracer SentiMag® for sentinel lymph node identification. A/Prof Veronique Tan was awarded the SingHealth Duke-NUS Oncology ACP Breast Cancer: Tackling Cancer Progression Grant to investigate the feasibility and accuracy of the novel SaviScout® device and the role of targeted axillary dissection for advanced-stage breast cancer patients with clinical complete nodal response post neoadjuvant systemic therapy.

On the translational research front, our clinician scientist, Clin Asst Prof Sim Yirong won the SingHealth Strategic Scientific Start up Grant to characterise the molecular profiling of breast fibroepithelial lesions. She studies the novel genomic assay as a potential adjunctive diagnostic tool, in collaboration the Department of Pathology, headed by Prof Tan Puay Hoon, and the Integrated Genomics Platform, NCCS, headed by Prof Teh Bin Tean. She is also the recipient of the NCCS Cancer Fund (Research) to study the role of inflammation and breast cancer. A/Prof Veronique Tan and A/Prof Benita Tan, together with Prof Kanaga Sabapathy received the NCCS Project Grant to investigate how the microenvironment of a breast cancer influences cancer growth. Work is also being done with Prof Ann Lee to explore the efficacy of circulatory micro-RNA signatures as non-invasive markers for breast cancer diagnosis.

In addition to the extensive successful collaborations with scientists and clinicians from various disciplines at NCCS, SGH and Duke-NUS, we also partner with other institutions both locally and overseas. These include multiple collaborations with researchers at the Saw Swee Hock School of Public Health (NUS) to study our national breast cancer cohort epidemiology and economic dimensions; the National Technological University of Singapore (NTU) to study gene regulators in breast cancer cells; and A*STAR and Institute of Molecular and Cell Biology (IMCB). Regional collaborations include the regional breast cancer survival and outcomes in partnership with the University of Malaya Medical Centre; as well as international collaborations on genomic assays with the University of Hong Kong, Koo Foundation Sun Yat-Sen Cancer Center (KFSYSCC), Taiwan, Seoul National University Hospital (SNUH), South Korea, Sanger Institute, UK and Karolinska Institute, Sweden.

The Breast Surgical Oncology Team:

Selected References (highlighted names are members of SD Breast Team):

1. Tan SY, Tang MSS, Ong CJ, Tan VKM, Shannon NB. Impact of COVID-19 on Public Interest in Breast Cancer Screening and Related Symptoms: A Google Trends Analysis. JMIR Cancer. 2023 Jun 6;9:e39105. doi: 10.2196/39105. PMID: 37163461.
2. Tan HJ, Tan PH, Leong LCH, Tan VKM, Tan BKT, Lim SZ, Preetha M, Wong CY, Yong WS, Sim Y. Encapsulated papillary carcinoma of the breast: An institutional case series and literature review. Cancer Med. 2023 May;12(10):11408-11416. doi: 10.1002/cam4.5855. Epub 2023 Mar 31. PMID: 36999966.
3. Choo ALE, Sim LS, Sittampalam K, Tan WC, Tay AZE, Nadarajah R, Tan VKM, Sim Y. Breast metastasis from endometrial clear cell carcinoma: A case report and review of the literature. Front Oncol. 2023 Jan 25;12:1070744. doi: 10.3389/fonc.2022.1070744. PMID: 36761429; PMCID: PMC9905423.
4. Busmanis I, Leong L, Lee K, Lim SZ. A curious breast pseudomalignancy. Pathology. 2023 Feb; 55 (S52). doi: 10.1016/j.pathol.2022.12.165.
5. Lim JSH, Sim Y, Ngeow J, Yuen J, Tan VKM, Tan BKT, Yong WS, Wong CY, Lim SZ, Hamzah JLB, Tan SY, Wong FY, Madhukumar P. Male breast cancer: a Singapore perspective. ANZ J Surg. 2022 Jun;92(6):1440-1446. doi: 10.1111/ans.17737. Epub 2022 Apr 25. PMID: 35470542.
6. Sim Y, Lim C, Phyu N, Tan KTB, Chew LST, Wong CY, Madhukumar P, Yong WS, Lim SZ, Hamzah JLB, Tan SY, Chay WY, Wong FY, Tan PH, Tan VK. The Impact of Statin Use and Breast Cancer Recurrence - A Retrospective Study in Singapore. Front Oncol. 2022 Mar 31;12:835320. doi: 10.3389/fonc.2022.835320. PMID: 35433431; PMCID: PMC9008885.
7. Bong TSH, Tan JKT, Ho JTS, Tan PH, Lau WS, Tan TM, Wong JSL, Tan VKM, Tan BKT, Madhukumar P, Yong WS, Lim SZ, Wong CY, Ong KW, Sim Y. Atypical Ductal Hyperplasia of the Breast on Core Needle Biopsy: Risk of Malignant Upgrade on Surgical Excision. J Breast Cancer. 2022 Feb;25(1):37-48. doi:10.4048/jbc.2022.25.e7. PMID: 35199500; PMCID: PMC8876544.
8. Lim SZ, Kusumawidjaja G, Mohd Ishak HM, Tan BKT, Tan SY, Hamzah JL, Madhukumar P, Yong WS, Wong CY, Sim Y, Lim GH, Lim SH, Tan SM, Wong FY, Tan VKM. Outcomes of Stage I and II Breast Cancer with Nodal Micrometastases Treated with Mastectomy without Axillary Therapy. Breast Cancer Res Treat. 2021 Oct;189(3):837-843. doi: 10.1007/s10549-021-06341-1. Epub 2021 Aug 3. PMID: 34342766.
9. Chan JJ, Sim Y, Ow SGW, Lim JSJ, Kusumawidjaja G, Zhuang Q, Wong RX, Wong FY, Tan VKM, Tan TJY. The impact of COVID-19 on and recommendations for breast cancer care: the Singapore experience. Endocr Relat Cancer. 2020 Sep;27(9):R307-R327. doi: 10.1530/ERC-20-0157. PMID: 32544879.
10. Hamzah JL, Tan BKT, Tan V, Madhukumar P, Lim SZ, Sim YR, Yong WS, Lee ZJ, Ong KW. A pilot study comparing Sentimag/Sienna versus standard modality for sentinel lymph node identification in patients with breast cancer. Breast J. 2020 May;26(5):1074-1077. doi: 10.1111/tbj.13660. Epub 2019 Oct 14. PMID: 31612623.
11. Tay THC, Ng WY, Ong KW, Wong CY, Tan BKT, Yong WS, Madhukumar P, Tan VKM, Lim SZ, Sim Y. Impact of hormonal status on ductal carcinoma in situ of the breast: Outcome and prognostic factors. Breast J. 2020 May;26(5):937-945. doi: 10.1111/tbj.13738. Epub 2019 Dec 26. PMID: 31876337.
12. Sim Y, Ng GXP, Ng CCY, Rajasegaran V, Wong SF, Liu W, Guan P, Nagarajan S, Ng WY, Thike AA, Lim JCT, Nasir NDBM, Tan VKM, Madhukumar P, Yong WS, Wong CY, Tan BKT, Ong KW, Teh BT, Tan PH. A Novel Genomic Panel as an Adjunctive Diagnostic Tool for the Characterization and Profiling of Breast Fibroepithelial Lesions. BMC Med Genomics. 2019 Oct 23;12(1):142. doi: 10.1186/s12920-019-0588-2. PMID: 31647027; PMCID: PMC6813086.
13. Lim SZ, Ng CCY, Rajasegaran V, Guan P, Selvarajan S, Thike AA, Nasir NDBM, Koh VCY, Tan BKT, Ong KW, Teh BT, Tan PH. Genomic profile of breast sarcomas: a comparison with malignant phyllodes tumours. Breast Cancer Res Treat. 2019 Apr;174(2):365-373. doi: 10.1007/s10549-018-5067-5. Epub 2018 Dec 3. PMID: 30511242.
14. Sim Y, Tan VKM, Sidek NAB, Chia DKA, Tan BKT, Madhukumar P, Yong WS, Wong CY, Ong KW. Bilateral breast cancers in an Asian population, and a comparison between synchronous and metachronous tumours. ANZ J Surg. 2018 Oct;88(10):982-987. doi: 10.1111/ans.14773. Epub 2018 Aug 23. PMID: 30141242.
15. Lee CM, Zheng H, Tan VK, Tan TJ, Kanesvaran R, Wong FY, Sim YR, Yong WS, Madhukumar P, Ong KW, Tan BK. Surgery for early breast cancer in the extremely elderly leads to improved outcomes-An Asian population study. Breast. 2017 Dec;36:44-48. doi: 10.1016/j.breast.2017.09.002. Epub 2017 Sep 22. PMID: 28942237.
16. Lim JT, Koh JJE, Ho PJ, Liu J, Lim SH, Tan EY, Tan BKT, Tan VKM, Tan SM, Yong WS, Hartman M, Chen C. Impact of Subsidy on the Use of Personalized Medicine in Breast Cancer. Value Health Reg Issues. 2022 May;29:108-115. doi:10.1016/j.vhri.2021.10.002. Epub 2022 Jan 29. PMID: 35104748.
17. Ho PJ, Khng AJ, Loh HW, Ho WK, Yip CH, Mohd-Taib NA, Tan VKM, Tan BK, Tan SM, Tan EY, Lim SH, Jamaris S, Sim Y, Wong FY, Ngeow J, Lim EH, Tai MC, Wijaya EA, Lee SC, Chan CW, Buhari SA, Chan PMY, Chen JJC, Seah JCM, Lee WP, Mok CW, Lim GH, Woo E, Kim SW, Lee JW, Lee MH, Park SK, Dunning AM, Easton DF, Schmidt MK, Teo SH, Li J, Hartman M. Germline breast cancer susceptibility genes, tumor characteristics, and survival. Genome Med. 2021 Dec 2;13(1):185. doi: 10.1186/s13073-021-00978-9. PMID: 34857041; PMCID: PMC8638193.
18. Loo SY, Toh LP, Xie WH, Pathak E, Tan W, Ma S, Lee MY, Shatishwaran S, Yeo JZZ, Yuan J, Ho YY, Peh EKL, Muniandy M, Torta F, Chan J, Tan TJ, Sim Y, Tan V, Tan B, Madhukumar P, Yong WS, Ong KW, Wong CY, Tan PH, Yap YS, Deng LW, Dent R, Foo R, Wenk MR, Lee SC, Ho YS, Lim EH, Tam WL. Fatty acid oxidation is a druggable gateway regulating cellular plasticity for driving metastasis in breast cancer. Sci Adv. 2021 Oct 8;7(41):eabh2443. doi: 10.1126/sciadv.abh2443. Epub 2021 Oct 6.
19. Ho PJ, Dorajoo R, Ivanković I, Ong SS, Khng AJ, Tan BK, Tan VKM, Lim SH, Tan EY, Tan SM, Tan QT, Yan Z, Ngeow J, Sim Y, Chan P, Chuan JCJ, Chan CW, Tang SW, Hartman M, Li J. DNA methylation and breast cancer-associated variants. Breast Cancer Res Treat. 2021 Aug;188(3):713-727. doi: 10.1007/s10549-021-06185-9. Epub 2021 Mar 26. PMID: 33768416.
20. Ng CCY, Md Nasir ND, Loke BN, Tay TKY, Thike AA, Rajasegaran V, Liu W, Lee JY, Guan P, Lim AH, Chang KTE, Gudi MA, Madhukumar P, Tan BKT, Tan VKM, Wong CY, Yong WS, Ho GH, Ong KW; International Fibroepithelial Consortium, Yip GWC, Bay BH, Tan P, Teh BT, Tan PH. Genetic differences between benign phyllodes tumors and fibroadenomas revealed through targeted next generation sequencing. Mod Pathol. 2021 Jul;34(7):1320-1332. doi: 10.1038/s41379-021-00787-w. Epub 2021 Mar 16. PMID: 33727697.
21. Zou R, Loke SY, Tan VK, Quek ST, Jagmohan P, Tang YC, Madhukumar P, Tan BK, Yong WS, Sim Y, Lim SZ, Png E, Lee SYS, Chan MYP, Ho TSJ, Khoo BKJ, Wong SLJ, Thng CH, Chong BK, Teo YY, Too HP, Hartman M, Tan NC, Tan EY, Lee SC, Zhou L, Lee ASG. Development of a microRNA Panel for Classification of Abnormal Mammograms for Breast Cancer. Cancers (Basel). 2021 Apr 28;13(9):2130. doi: 10.3390/cancers13092130. PMID: 33925125; PMCID: PMC8124944.
22. Ho PJ, Yeoh YS, Miao H, Lim SH, Tan EY, Tan BKT, Tan VKM, Tan SM, Yong WS, Wong FY, Madhukumar P, Chan CW, Iau PTC, Lee SC, Putti T, Buhari SA, Lee JY, Lim GH, Woo E, Yan Z, Chan PMY, Chen JJC, Lu SQ, Dent R, Lee WP, Mok CW, Seah JCM, Sim X, van Dam RM, Chia KS, Li J, Hartman M. Cohort profile: The Singapore Breast Cancer Cohort (SGBCC), a multi-center breast cancer cohort for evaluation of phenotypic risk factors and genetic markers. PLoS One. 2021 Apr 26;16(4):e0250102. doi: 10.1371/journal.pone.0250102. PMID: 33901219; PMCID: PMC8075208.
23. Ho WK, Tan MM, Mavaddat N, Tai MC, Mariapun S, Li J, Ho PJ, Dennis J, Tyrer JP, Bolla MK, Michailidou K, Wang Q, Kang D, Choi JY, Jamaris S, Shu XO, Yoon SY, Park SK, Kim SW, Shen CY, Yu JC, Tan EY, Chan PMY, Muir K, Lophatananon A, Wu AH, Stram DO, Matsuo K, Ito H, Chan CW, Ngeow J, Yong WS, Lim SH, Lim GH, Kwong A, Chan TL, Tan SM, Seah J, John EM, Kurian AW, Koh WP, Khor CC, Iwasaki M, Yamaji T, Tan KMV, Tan KTB, Spinelli JJ, Aronson KJ, Hasan SN, Rahmat K, Vijayananthan A, Sim X, Pharoah PDP, Zheng W, Dunning AM, Simard J, van Dam RM, Yip CH, Taib NAM, Hartman M, Easton DF, Teo SH, Antoniou AC. European polygenic risk score for prediction of breast cancer shows similar performance in Asian women. Nat Commun. 2020 Jul 31;11(1):3833. doi: 10.1038/s41467-020-17680-w. PMID: 32737321; PMCID: PMC7395776.
24. Ho PJ, Ow SGW, Sim Y, Liu J, Lim SH, Tan EY, Tan SM, Lee SC, Tan VK, Yap YS, Chay WY, Tan BKT, Wong FY, Li J, Hartman M. Impact of deviation from guideline recommended treatment on breast cancer survival in Asia. Sci Rep. 2020 Jan 28;10(1):1330. doi: 10.1038/s41598-020-58007-5. PMID: 31992769; PMCID: PMC6987174.
25. Loke SY, Munusamy P, Koh GL, Chan CHT, Madhukumar P, Thung JL, Tan KTB, Ong KW, Yong WS, Sim Y, Oey CL, Lim SZ, Chan MYP, Ho TSJ, Khoo BKJ, Wong SLJ, Thng CH, Chong BK, Tan EY, Tan VK, Lee ASG. A circulating miRNA signature for stratification of breast lesions among women with abnormal screening mammograms. Cancers (Basel). 2019 Nov 26;11(12):1872. doi: 10.3390/cancers11121872. PMID: 31769433; PMCID: PMC6966622.