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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 and Tan Si Ying. 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.

Significant efforts also go to advancing loco-regional treatment of breast cancer. We currently have 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 is currently looking into a 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. 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; 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:

Clin A/Prof Veronique Tan Kiak Mien​MBBS (S’pore), MMed (Surgery), MSc, FRCS (Edinburgh)
Clin A/Prof Yong Wei Sean​ MBBS, FRCSEd, FRCSG, FAMS​
Clin A/Prof Benita Tan​ ​MBBS (S'pore), MMed (Surgery), FRCS (Edinburgh, General Surgery), FAMS, PhD (SSHSPH, NUS)
Asst Prof Preetha Madhukumar​ MBBS, FRCSG, FAMS​
​Clin Asst Prof Sim Yirong MB BChir (Cantab) MA (Cantab) PhD (Cantab) MMed (Gen Surg), FRCS (Edin, General Surgery)​
​Dr Lim Sue Zann ​MBBS (Hons), MMed (Surgery) FRCS (Edinburgh, General Surgery)
Dr Julie Liana Hamzah​ MBBS (S'pore), MMed (Surg), FRCS​
Dr Tan Si Ying​ MBBS (S'pore), MRCS (Edin), MMed (Gen Surg) FRCS (Edinburgh, General Surgery)​

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

  1. 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.
  2. 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 VKM, Tan BKT, Spinelli JJ, Aronson KJ, Hasan SH, Rahmat K, Vijayananthan A, Sim X, Pharoah PDP, Zheng W, Dunning AM, Simard J, van Dam RM, Y CH, Mohd Taib NA, 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.
  3. 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.
  4. 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.
  5. Nasir NDM , Ng CCY, Rajasegaran V, Wong SF, Liu W, Ng GXP, Lee JY, Guan P, Lim JQ, Thike AA, Koh VCY, Loke BN, Chang KTE, Gudi MA, Lian DWQ, Madhukumar P, Tan BKT, Tan VK, Wong CY, Yong WS, Ho GH, Ong KW. International Fibroepithelial Consortium, Patrick Tan P, Teh BT, Tan PH. Genomic characterisation of breast fibroepithelial lesions in an international cohort. J Pathol. 2019 Dec; 249(4): 447-460. doi: 10.1002/path.5333. Epub 2019 Oct 8.
  6. Loke SY, P Munusamy, Koh GL, Chan CHT, P Madhukumar, Thung JL, Tan BKT, Ong KW, Yong WS, Sim Y, Oey CL, Lim SZ, Chan PMY, Ho JTS, Khoo JBK, Wong JSL, Thng CH, Chong BK, Tan EY, Tan VKM, 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.
  7. Sim Y, Ng GXP, Ng CCY, Rajasegaran V, Wong SF, Liu W, Guan P, Nagarajan S, Ng WY, Thike AA, Lim JCT, Nasir NDB, Tan VK, 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 Medical Genomics. 2019 Oct 23; 12(1): 142. doi: 10.1186/s12920-019-0588-2.
  8. Lim SZ, Ng CCY, Rajasegaran V, Guan P, Selvarajan S, Thike AA, Md Nasir D, Koh VCY, Tan BKT, Ong KW, Teh BT, Tan PH. Genomic profile of breast sarcomas: a comparison with malignant phyllodes tumours. Breast Cancer Research and Treatment (2019) 174:365–373. Doi: 10.1007/s10549-018-5067-5.
  9. 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.
  10. 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.
  11. SH Chun Cheng, TT Huang, YH Cheng, BKT Tan, CF Horng, YA Wang, NS Brian, LS Shih, BL Yu. Validation of the 18-gene classifier as a prognostic biomarker of distant metastasis in breast cancer. PLOS ONE. 2017 Sep 8;12(9):e0184372. doi: 10.1371/journal.pone.0184372. eCollection 2017.
  12. Lim SZ, Selvarajan S, Thike AA, Nasir D, Tan BKT, Ong KW, Tan PH. Breast sarcomas and malignant phyllodes tumours: comparison of clinicopathological features, treatment strategies, prognostic factors and outcomes. Breast Cancer Res Treat. 2016 Sep;159(2):229-44. DOI 10.1007/s10549-016-3946-1. Epub 2016 Aug 19.
  13. Tan J, Ong CK, Lim WK, Ng CC, Thike AA, Ng LM, Rajasegaran V, Myint SS, Nagarajan S, Thangaraju S, Dey S, Nasir ND, Wijaya GC, Lim JQ, Huang D, Li Z, Wong BH, Chan JY, McPherson JR, Cutcutache I, Poore G, Tay ST, Tan WJ, Putti TC, Ahmad BS, Iau P, Chan CW, Tang AP, Yong WS, Madhukumar P, Ho GH, Tan VK, Wong CY, Hartman M, Ong KW, Tan BK, Rozen SG, Tan P, Tan PH, Teh BT. Genomic landscapes of breast fibroepithelial tumors. Nat Genet. 2015 Nov;47(11):1341-5. doi: 10.1038/ng.3409.