Understanding Breast Cancer

Statistics from the latest Singapore Cancer Registry Annual Report 2023 show that breast cancer was the most common cancer in females, with approximately 1 in 12 women likely to develop the disease in their lifetime and close to 14,000 new cases diagnosed in Singapore between 2019 and 2023. Although it is more common in women, men can also be diagnosed with the disease.

The body normally repairs and replaces tissue through controlled cell growth. When this process becomes disrupted, cells may begin to grow and multiply abnormally. If these abnormal cells form a lump or mass, it is known as a tumour.

Benign vs Malignant Tumours

Not all tumours are cancerous: 

• Benign tumours grow slowly and do not spread to other parts of the body. 
• Malignant tumours contain cancer cells that can invade surrounding tissues and potentially spread to other organs.

How Breast Cancer Develops

Breast cancer occurs when cells in the breast mutate and grow in an uncontrolled way to form tumours. Most breast cancers begin in the ducts (the tubes that carry milk), while a smaller number start in the lobules (the glands that produce milk). Some tumours progress slowly, while others may grow more quickly.

Over time, breast cancer may spread to nearby lymph nodes or other areas such as the bones, liver, lungs or, less commonly, the brain. This is why identifying any symptom of breast cancer early and seeking medical evaluation promptly is important.

Breast Cancer Screening

Early detection plays an important role in identifying breast changes or abnormalities early before symptoms develop, so that they can be assessed and treated promptly.

Breast screening includes breast self-examinations, clinical examinations and imaging tests. The type of screening recommended depends on an individual’s age, risk factors and medical history.

1. Breast Self-Examination (BSE)

Being familiar with how your breasts normally look and feel can help you notice changes earlier. Breast Self-Examination (BSE) is a simple self-check that you can do at home once a month.

When to perform BSE

• Around one week after the start of your menstrual period 
• If you no longer have periods, choose the same date each month

Seek medical advice if you notice changes such as redness, swelling, a lump, skin dimpling or nipple discharge.

A. Look for changes

Stand in front of a mirror and observe your breasts with your :

• Arms relaxed at your sides
• Arms raised 
• Hands pressed firmly on hips

Check for:

• Changes in size or shape 
• Skin puckering or dimpling 
• Altered nipple appearance

B. Feel for changes while lying down

1. Place a small pillow under your shoulder and rest the hand on the same side behind your head. 
2. Using the pads of your fingers, examine the entire breast in small circular motions. 
3. Start from the outer edge and move towards the nipple. 
4. Check the armpit area for lumps or thickening. 
5. Gently squeeze the nipple to check for discharge. 
6. Repeat the check on the other breast.

2. Clinical Breast Examination (CBE)

Women aged 40 and above are advised to have their breasts examined by a doctor or trained nurse once a year.

A CBE includes:

• A visual assessment 
• Manual examination of the breast tissue and underarm area

If any abnormalities are found, imaging tests may be recommended for further assessment.

3. Mammogram Screening

A mammogram is a low-dose X-ray that allows specialists to view the internal structure of the breast. It is one of the most reliable methods for detecting early breast cancer, even when there is no visible lump.

What to expect

• The breast is gently compressed between two plates to obtain clear images. 
• Standard screening usually requires two views of each breast. 
• Additional angles or magnified images may be taken if an area needs closer evaluation.

Who should consider mammograms?

• Women aged 40 and above 
• Women with higher risk (e.g. strong family history of breast cancer) — screening intervals may differ

Your doctor can advise the most suitable schedule based on your risk factors and medical history .

Additional Breast Imaging Tests

While not routinely used for general screening, these tests may be recommended for further evaluation or for women at higher risk:

• Breast ultrasound: Helps to assess lumps or dense breast tissue. 
• Tomosynthesis (3D mammography): Provides clearer cross-sectional images. 
• Breast MRI: Useful for high-risk individuals or when mammogram results are unclear.

These tests complement mammography but do not replace it for routine population cancer screening.

Symptoms of Breast Cancer

Breast cancer does not always cause symptoms in its early stages. Some conditions, such as ductal carcinoma in situ (DCIS), may only be detected during a routine screening mammogram. In some cases, DCIS may cause a small lump or blood-stained nipple discharge, but many women experience no noticeable signs.

For most people, early breast cancer is painless, and changes may be subtle. As the tumour grows, more recognisable symptoms can appear. Being familiar with the normal look and feel of your breasts can help you detect changes sooner.

Common Signs to Look Out For

Any symptom of breast cancer should be checked by a doctor promptly. Possible signs may include:

• A persistent lump or area of thickening in the breast or underarm (axilla) 
• Changes in breast size or shape, especially if one breast looks noticeably different 
• Alterations in the skin, such as redness, dimpling, puckering or a texture resembling orange peel 
• Nipple discharge, particularly if it is bloody or occurs without squeezing 
• Changes in the nipple or areola, including inversion (pulling inward), a persistent rash or scaling

These symptoms do not always mean cancer, as many breast changes are due to benign conditions. However, any new or unusual symptom or change should be assessed by a doctor to ensure appropriate follow-up and peace of mind.

Reducing the Risk of Breast Cancer

While there is no definitive way to prevent breast cancer, you can lower your risk by maintaining an active lifestyle, having a balanced diet and not smoking.

Lifestyle Measures That May Reduce Risk

• Stay physically active: Regular exercise supports overall wellbeing and helps to maintain a healthy weight, which is particularly important after menopause. 
• Maintain a balanced diet: Eating nutritious foods and avoiding excessive weight gain can reduce increase cancer risk .
• Limit alcohol consumption: Cutting back on alcohol has been shown to lower the likelihood of developing several cancers, including breast cancer. 
• Avoid smoking: Smoking is linked to increased risk of various cancers. 
• Discuss hormonal medication with your doctor: Long-term use of oral contraceptive pills (OCP) or hormone replacement therapy (HRT) may increase risk in some women. Medical advice can help you weigh the benefits and risks. 
• Minimise unnecessary radiation exposure: Medical scans such as CT imaging should be used only when medically needed, as repeated exposure can increase long-term risks.

Risk-Reducing Strategies for High-Risk Individuals

Women with a strong family history of breast cancer or those who carry certain genetic mutations (such as BRCA1 or BRCA2) may benefit from additional preventive measures, which can include:

• Medication to reduce risk: Certain drugs may be recommended to lower the likelihood of developing breast cancer. 
• Risk-reducing surgery: In selected cases, procedures such as preventive mastectomy or removal of the ovaries may be advised after specialist consultation.

Enhanced Surveillance

For women at higher risk who choose not to pursue medication or breast surgery, closer monitoring is another option. Although this does not prevent breast cancer, it improves the chances of detecting changes early, when treatment is most effective.

Genetic Risk Assessment for Hereditary Breast Cancer and Its Implications

A small percentage of breast cancersare caused by inherited genetic changes. The most recognised cause is a mutation in the BRCA1 or BRCA2 genes, which normally help to repair damaged DNA. When there is mutation of these genes, the risk of developing certain cancers, including breast and ovarian cancer, becomes significantly higher.

Individuals with these mutations may develop cancer at a younger age, face a higher likelihood of cancer affecting both breasts, and may have increased risk of developing more than one type of cancer across their lifetime. Other less common genetic mutations can also raise the risk of developing cancer .

Individuals Who May Carry a Higher Genetic Risk

HBOC syndrome can be passed from one generation to the next. Certain family patterns may suggest an inherited predisposition, including:

• Breast cancer diagnosed at a younger age than usual 
• Personal or family history of bilateral breast cancer or multiple cancers in one individual 
• Relatives with ovarian, fallopian tube, peritoneal, pancreatic cancers or melanoma 
• A history of male breast cancer in the family

These features do not confirm a hereditary syndrome but indicate that further assessment may be helpful.

Diagnosis of Hereditary Breast and Ovarian Cancer

Diagnosis involves genetic testing, usually through a blood test that examines specific genes, including BRCA1 and BRCA2. Because test results have medical, emotional and familial implications, genetic testing is always accompanied by genetic counselling, both before and after testing, to ensure individuals fully understand the process and potential outcomes.

Testing is typically recommended only when established criteria suggest a meaningful likelihood of hereditary risk.

Role of Genetic Counselling

Genetic counselling is a structured, supportive process carried out by a trained genetic counsellor or cancer geneticist. The discussion helps individuals:

• Understand their personal risk and how genetics may influence cancer development 
• Explore the potential outcomes and consequences of genetic testing 
• Consider the emotional, psychological and family implications of test results 
• Decide whether genetic testing is appropriate for their situation

This approach ensures informed decision-making and provides ongoing support.

Responding to Concerns About Family History

Anyone who notices a pattern of breast or ovarian cancers within their family is encouraged to speak with their doctor. A clinical review can help determine whether genetic risk assessment or testing is recommended.

Implications of Genetic Testing for Families

A confirmed hereditary mutation can offer valuable insights, helping to:

• Inform relatives about their own cancer risks 
• Guide screening schedules and preventive strategies 
• Avoid unnecessary testing in family members who do not carry the mutation 
• Clarify cancer patterns seen across generations

This information supports families in making proactive, informed health decisions.

Cancer Genetics Service at NCCS

At NCCS, the Cancer Genetics Service (CGS) provides genetic counselling to individuals with a personal and/or family history of cancer. If you have a personal or family history suspicious for a hereditary cause, you may want to discuss this with your general practitioner (GP). Your doctor may refer you to Cancer Genetics Service to speak with a genetic counsellor.

Causes and Risk Factors for Breast Cancer

The exact cause of breast cancer is not fully understood, but research has shown that several factors can increase a person’s likelihood of developing the disease. Having risk factors does not mean someone will get breast cancer, many people diagnosed have no obvious risk factors. However, understanding these influences can help guide screening, lifestyle choices and discussions with your healthcare team.

Non-Modifiable Risk Factors

These are factors that individuals cannot alter: 

• Age and gender: Breast cancer is far more common in women due to the influence of female hormones such as oestrogen and progesterone. Breast cancer risk also increases with age. 
• Hormonal milestones: Longer lifetime exposure to hormones can raise risk. Factors include: 
  • Early onset of menstruation (before age 12) 
  • Late menopause (after age 55) 
• Family history and inherited genetic changes: Having a close relative (such as a mother, sister or daughter) diagnosed with breast cancer increases risk. Some people inherit mutations in genes such as BRCA1 or BRCA2, which significantly elevates lifetime risk of developing breast cancer. 
• Personal medical history: A previous diagnosis of breast cancer or certain non-cancerous breast conditions—such as atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS)—may increase the likelihood of developing breast cancer later. 
• Radiation exposure for medical reasons: Receiving radiation therapy to the chest, particularly at a young age, may increase risk.

Modifiable Risk Factors

These factors relate to lifestyle choices or external influences that individuals may be able to change:

• Physical inactivity: A sedentary lifestyle is associated with higher breast cancer risk. 
• Excessive alcohol intake: Drinking alcohol over long periods can raise hormone levels which contributes to risk. 
• Smoking: Smoking has been linked to the increased risk of several cancers.
• Long-term use of hormonal medications: Extended use of oral contraceptive pills (OCPs) or combined hormonal replacement therapy (HRT) may increase risk, depending on the duration and dosage of hormonal medication.

Important to Remember

• Many people who develop breast cancer have no identifiable risk factors. 
• Having one or more risk factors does not mean someone will develop breast cancer. 
• Ongoing research continues to explore how genetics, lifestyle and environmental factors interact to influence risk.

Diagnosis

Diagnosing breast cancer involves understanding both the type of cancer present and the extent of its spread.

Types of Breast Cancer

Breast cancer is broadly classified in two ways:

1. Stage of Cancer at Diagnosis

Staging describes how advanced the cancer is at the time of diagnosis. Earlier stages generally have better treatment outcomes, while more advanced cancers may require multiple forms of therapy.

Staging considers:

• Whether the cancer is non-invasive or invasive 
• The size of the tumour 
• Whether cancer has reached the lymph nodes 
• Whether cancer has spread to other organs in the body

Understanding Key Stages

• Stage 0 (DCIS – Ductal Carcinoma in Situ): A non-invasive form of breast cancer where abnormal cells are confined within the milk ducts. DCIS is not life-threatening but may increase the risk of developing invasive breast cancer later.
• Invasive Breast Cancer: Cancer cells have spread beyond the ducts or lobules into the surrounding breast tissue. Common subtypes include invasive ductal carcinoma and invasive lobular carcinoma.
• Metastatic Breast Cancer (Stage IV): Cancer has spread beyond the breast to distant organs such as the bones, liver or lungs.

2. Tumour Biology

Tumour biology examines the characteristics of the cancer cells, which can influence how the cancer behaves and treatment options. Key features include:

• Hormone receptor status: Whether the cancer has oestrogen (ER) or progesterone (PR) receptors 
• HER2 status: Whether the cancer produces high levels of the HER2 protein 
• Histopathological subtype: How the tumour cells look under the microscope. Examples include: 
  • Invasive carcinoma of no special type (NST) 
  • Lobular, tubular, cribriform, mucinous, papillary, apocrine, metaplastic and other subtypes 
• Tumour grade: How abnormal the cancer cells appear, indicating how quickly they may grow or spread

Tumour biology helps to determine the most appropriate breast cancer treatment, including suitability for hormonal therapy, targeted therapy or other systemic treatments.

How Breast Cancer Is Diagnosed

If you notice a lump or any concerning changes in your breast, medical evaluation is essential. Diagnosis usually involves imaging tests followed by a biopsy to confirm the presence of cancer.

1. Imaging Tests

• Mammogram: A mammogram is a low-dose X-ray that produces detailed images of the breast. It can identify tumours or calcifications that may not be felt during examination. Special views or magnified images may be taken if abnormalities are detected. Previous mammograms are helpful for comparison. 
• Ultrasound: Breast ultrasound uses sound waves to create images of breast tissue. It is often used alongside mammography, particularly for women with dense breasts. Ultrasound helps distinguish fluid-filled cysts from solid lumps. 
• Magnetic Resonance Imaging (MRI): MRI uses magnetic fields and radio waves to produce detailed cross-sectional images. It is useful for assessing dense breast tissue, clarifying uncertain findings from mammograms or ultrasound, and screening women considered at higher genetic risk. 
• Tomosynthesis (3D Mammography): This imaging method takes multiple X-ray images from different angles to generate a 3D view of the breast, improving detection of small or hidden abnormalities.

2. Biopsy Procedures

A biopsy is required to confirm a cancer diagnosis. It involves removing cells or tissue samples for laboratory examination.

• Core Needle Biopsy: A wide needle is used to remove small tissue samples from the area of concern. Local anaesthetic is applied before the procedure. Ultrasound guidance is often used when abnormalities cannot be felt during examination. 
• Vacuum-Assisted Breast Biopsy (VAB): This technique uses a probe with a vacuum system to collect larger tissue samples. It is particularly useful for small or subtle abnormalities, including microcalcifications seen on mammography. A tiny marker clip may be placed to identify the biopsy site for future reference. 
• Fine Needle Aspiration (FNA): A thin needle is used to withdraw cells or fluid from a lump. It is a quick procedure that helps determine whether a lump is solid or cystic. Samples are examined to identify abnormal or cancerous cells. 
• Excision Biopsy: This minor surgical procedure removes the entire lump or a suspicious area for detailed analysis. It may be performed when needle biopsy results are unclear or when imaging shows that complete removal is required. In cases where the lump cannot be felt, a wire or marker is inserted under imaging guidance to identify the exact location.

Breast Cancer Treatment

Breast cancer treatment often involves a combination of therapies. The recommended approach depends on several factors, including:

• The type and stage of breast cancer 
• The size and location of the tumour 
• Whether breast preservation is an option 
• The patient’s overall health 
• The patient’s preferences, where suitable options exist

Navigating treatment choices can feel overwhelming. Many patients find it helpful to attend consultations with a family member or friend to support discussions and decision-making.

Breast cancer treatment is broadly divided into local therapy and systemic therapy.

Local therapy targets cancer in the breast and nearby lymph nodes. It includes:

• Surgery 
• Radiation Therapy

These treatments focus on the specific area affected by cancer.

Systemic therapy uses medications that travel throughout the body to treat cancer cells wherever they may be. These include:

• Chemotherapy 
• Hormonal therapy 
• Targeted therapy 
• Immunotherapy

Treatment sequencing

• In early-stage breast cancer, surgery is often the first step of treatment. 
• Systemic therapies may be used before surgery (neoadjuvant) to shrink the tumour or after surgery (adjuvant) to reduce the chance of recurrence. 
• Radiation therapy is commonly recommended after surgery. 
• In stage IV or metastatic breast cancer, systemic therapy may be recommended while surgery or radiation therapy may be used to relieve symptoms or manage specific complications.

Local Therapy

1. Surgery

Surgery for breast cancer has two main components:

(1) surgery to the breast and (2) surgery to assess or remove lymph nodes.

I. Surgery to the Breast

Breast-Conserving Surgery (BCS)

• Breast-conserving surgery removes the tumour along with a margin of healthy tissue, preserving most of the breast. A scar and changes in shape or size may occur. 
• Radiation Therapy is usually recommended after BCS to lower the risk of recurrence. 
• A second operation may be required if cancer cells are found at or near the margins of the removed tissue.

Oncoplastic Breast-Conserving Surgery

For some patients, additional techniques may be used to maintain breast shape and minimise deformity. These include:

• Breast reshaping (mammoplasty): Uplift or reduction procedures to improve symmetry. 
• Volume replacement using local tissue flaps: Fatty tissue from nearby areas is used to fill the space left after tumour removal.

Image-Guided Localisation

If the tumour cannot be felt, imaging guidance (mammogram, ultrasound or MRI) is used to place a wire or marker to show the surgeon exactly where to operate.

II. Mastectomy

• A mastectomy removes the entire breast, including the nipple-areola complex unless a nipple-sparing approach is possible. 
• A surgical drain usually remains for one to two weeks after the procedure.

Breast Reconstruction

Reconstruction can restore breast shape using flap reconstruction where tissue from the abdomen, back, thigh or buttock is used to form a new breast. Examples include:

• TRAM flap 
• DIEP flap 
• Latissimus dorsi flap

This is major surgery, often requiring multiple drains and a longer hospital stay.

Implant-based reconstruction

Silicone implants may be placed either:

• Immediately during the mastectomy 
• In stages using a temporary tissue expander followed by a permanent implant

Nipple-Sparing and Skin-Sparing Approaches

In selected patients, the skin or nipple may be preserved if tissue sampling confirms no cancer involvement. If later results reveal cancer cells, a minor follow-up procedure may be required.

III. Axillary (Lymph Node) Surgery

Sentinel Lymph Node Biopsy (SLNB)

SLNB identifies the first lymph nodes that cancer is likely to spread to. A dye or radioactive tracer is used to guide the surgeon. If no cancer is found in these nodes, further lymph node surgery is usually unnecessary.

Axillary Clearance

If cancer is present in the nodes, a full removal of underarm lymph nodes may be recommended. Side effects may include:

• Shoulder stiffness 
• Numbness in the upper inner arm 
• Lymphoedema (arm swelling)

Complications of Surgery

All surgery carries risks, including:

• Bleeding 
• Infection 
• Seroma formation (fluid collection) 
• Skin or tissue healing difficulties 
• Long-term numbness 
• Lymphoedema 
• Rare complications related to anaesthesia

A breast care nurse typically provides guidance on post-surgery wound care, drains, exercises and recovery planning.

2. Radiation Therapy

Radiation therapy uses high-energy X-rays to destroy cancer cells in a specific area of the body. It reduces the risk of cancer returning in the treated area and is often used alongside surgery.

Radiation Therapy may be advised:

• After breast-conserving surgery (almost always)
• After mastectomy in patients with larger tumours or multiple lymph nodes involved 
• For symptom relief in advanced cancer

How Radiation Therapy Works

Treatment is usually delivered daily, five days per week, over 1 to 6 weeks.

• Planning (CT Simulation): A CT scan is used to map the treatment area. Specialists plan radiation delivery to maximise precision while protecting the heart and lungs. 
• Treatment Delivery: Each session lasts 30–60 minutes, is painless and performed as an outpatient procedure.

Side Effects

Early effects (during or shortly after treatment)

• Fatigue 
• Skin redness, dryness or irritation 
• Mild breast swelling

These usually improve within weeks.

Late effects (months or years later)

• Firming or hardening of breast tissue 
• Rare lung or heart complications depending on treatment area

Your doctor will discuss individual risks.

Intraoperative Radiation Therapy (IORT)

IORT delivers a single, concentrated dose of radiation during surgery, immediately after tumour removal. It is suitable only for selected patients undergoing breast-conserving surgery.

Benefits

• One-time radiation dose for selected early-stage cases 
• Reduces exposure to surrounding tissues

Possible side effects

• Temporary hardening of the breast tissue 
• Fluid or blood buildup that requires drainage 
• Localised skin changes

Systemic Therapy

1. Chemotherapy

Chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body.

It may be given:

• Before surgery (neoadjuvant) 
• After surgery (adjuvant) 
• For advanced or metastatic cancer

Treatment is delivered in cycles over three to six months.

Common side effects

• Hair loss 
• Nausea 
• Mouth ulcers 
• Low blood counts 
• Infection risk

Side effects are usually temporary and can be managed with supportive care.

In some cases of triple negative breast cancer, chemotherapy may be combined with immunotherapy, which activates the immune system to target cancer cells.

2. Targeted Therapy

Targeted therapies act on specific proteins or pathways in cancer cells. The most well-known example is HER2-targeted therapy (such as trastuzumab).

These drugs are used for HER2-positive cancers and have significantly improved outcomes.

Side effects

• Infusion-related reactions (fever, chills) 
• Rare risk of heart muscle weakness

Other targeted drugs (e.g., lapatinib, bevacizumab) may be used depending on the cancer’s characteristics.

3. Hormonal Therapy

Hormonal therapy is used for hormone receptor-positive breast cancer, where cancer growth is influenced by oestrogen or progesterone.

Tamoxifen: Often recommended for premenopausal women.

Possible effects include:

• Hot flushes 
• Mood changes 
• Vaginal discharge 
• Rare risk of blood clots or thickening of the uterus lining

Aromatase Inhibitors (AIs): Used mainly in postmenopausal women (e.g., anastrozole, letrozole, exemestane).

Possible effects include:

• Joint stiffness or pain 
• Fatigue 
• Bone thinning (osteoporosis)

Newer hormonal and targeted agents (e.g., SERDs, CDK4/6 inhibitors) are increasingly used for specific patient groups.

Follow-Up Care

Regular follow-up is essential after treatment. Appointments usually include:

• Physical examination of the breast, chest wall and lymph nodes 
• Mammograms at recommended intervals 
• Review of new symptoms or concerns

Patients should report:

• Changes in the surgical area 
• New lumps 
• Arm swelling 
• Persistent cough or breathlessness 
• Bone pain 
• Yellowing of the skin (jaundice)

Post-Surgery Care

Recovering after breast cancer surgery involves caring for the wound, managing care of drainage tubes that remove fluids and pain management. Understanding what to expect can help patients feel more confident and supported during this stage.

Wound and Drain Care

Most surgical wounds are closed with absorbable stitches, so stitch removal is usually not required.

Patients are taught how to care for their wounds, including:

• How to keep the area clean and dry 
• When to change dressings 
• How to bathe safely

Drains

A soft, flexible drain may be placed under the skin to remove any fluid that collects after surgery. Patients who do not undergo breast reconstruction typically go home with the drain still in place.

Patients are shown:

• How to measure and record the fluid drained 
• How to keep the drain site clean

The drain is removed in clinic once the fluid reduces, usually within one to two weeks.

Seek medical help if you notice:

• Fever above 38°C 
• Redness, warmth or swelling around the wound 
• Pus or unusual discharge from the wound or drain site 
• Worsening pain 
• Separation of the wound edges

Medication and Diet

Your doctor will advise on any medications to be taken. There are usually no special dietary restrictions post-surgery, although eating nutritious food supports recovery.

Activity and Rehabilitation

Patients are encouraged to return to light daily activities as soon as possible . Most individuals who undergo, breast-conserving surgery and simple mastectomy can resume their normal routine shortly after surgery .

Those who have breast reconstruction will receive specific instructions, as recovery may take longer and heavy lifting or certain movements may need to be avoided.

Arm Exercise Programme

To prevent shoulder stiffness and improve arm mobility, patients will be taught arm exercises to do post-surgery.

Benefits include:

• Restoring normal arm movement 
• Improving posture 
• Promoting lymphatic flow to reduce swelling

Exercises are done daily, with several repetitions of each movement. Strenuous activities should be avoided for the first few weeks after surgery.

Arm and Hand Care

After lymph node surgery, the risk of lymphoedema (arm swelling) increases. Extra care is needed to protect the arm from injury and infection.

Patients may be recommended the following for lymphoedema management:

• Skin care 
• Gentle exercise 
• Compression garments 
• Manual lymphatic drainage (specialised massage)

Preventive Measures

Skin Protection

• Keep the skin moisturised 
• Avoid injections, blood tests and or taking your blood pressure on the operated side where possible 
• Wear gloves when handling chemicals or immersing hands in water 
• Use sunblock (SPF 30 or higher)

Avoid Excess Heat

• Do not apply heat rubs, hot oil or heating pads 
• Avoid saunas, steam rooms or hot springs 
• Protect the arm from prolonged, direct sunlight 

Avoid Compression

• Do not wear tight sleeves, bracelets or watches 
• Avoid carrying heavy bags on the forearm 
• Take your blood pressure on the other arm

Maintain Movement

• Use the arm for daily tasks such as combing hair, dressing or bathing 
• Avoid carrying heavy items 
• Maintain a healthy weight to reduce risk of lymphoedema 
• Continue prescribed exercises until full mobility returns 

Physical Appearance and Prosthesis Options

Some patients choose breast reconstruction, while others prefer not to undergo further surgery. For those who decide against reconstruction, breast prostheses offer a way to restore shape and balance.

Breast Prostheses

Breast forms come in different shapes, sizes and skin tones. Some fit inside specially designed bras while others adhere directly to the skin.

A prosthesis:

• Helps to maintain posture 
• Restores breast symmetry 
• Provides comfort and confidence

A prosthesis fitting can be arranged around six weeks after surgery. Soft padding may be used in the early healing phase.

When choosing a breast form, selecting a size and weight similar to the natural breast helps prevent back or neck strain.

Commonly Asked Questions

1. How common is breast cancer?

Breast cancer is the most frequently diagnosed cancer among women. In Singapore, more than a quarter of cancers affecting women are breast cancers, with over 2,500 new cases detected each year.

Most breast lumps, however, are not cancerous. Many are benign changes linked to natural hormonal cycles.

2. Can an injury to the breast cause cancer?

No. A bruise or injury does not cause cancer. Injury may lead to temporary scar tissue, which can look abnormal on imaging, but symptoms should ease within a few weeks. If symptoms persist, speak to your doctor.

3. Are most breast lumps cancerous?

The majority of breast lumps are benign. It is estimated that only one in ten breast lumps turn out to be cancer. Lumps become more concerning with age, so any changes should be assessed by a doctor.

4. Can a benign lump become cancerous later?

Most benign lumps remain harmless. The key is to ensure that the breast lump is examined by a doctor and accurately diagnosed as benign.

5. Can benign breast problems return?

Most benign issues do not recur, but some women may develop new benign breast lumps over time.

6. If my lump does not appear on a mammogram, does that mean it is not cancer?

No single test is perfect, if you feel a lump that is not visible on mammography, your doctor may recommend further investigational tests such as ultrasound, MRI or a biopsy.

7. What happens if a lump is confirmed to be cancer?

Early breast cancer is often highly treatable. Your doctor will discuss the diagnosis and explain the most appropriate treatment options.

8. What if I am still worried after my doctor says everything is normal?

If your symptoms are thought to be hormonal, you may wait until after your next period to reassess. If you are still concerned, you can return to your doctor for further checks or request a second medical opinion.

9. What if there is breast cancer in my family?

A strong family history may increase your risk, especially if close relatives were diagnosed at a young age. Speak with your doctor, who may refer you to a breast specialist or discuss genetic assessment.

10. Will I still have my periods after breast cancer treatment?

Some treatments, including chemotherapy and hormonal therapy, may cause temporary or permanent changes to your menstrual cycle. Women nearing menopause may stop having periods altogether.

11. Can I become pregnant after breast cancer?

Pregnancy after treatment may be possible, but timing is important. Some doctors recommend waiting one to two years before conceiving. Always seek advice from your treating doctor before planning a pregnancy.

12. When is a mastectomy recommended?

The decision depends on tumour size, breast size, cancer type and patient preference. Some women opt for mastectomy for cosmetic or medical reasons, particularly when reconstruction is planned.

13. Does having regular mammograms expose me to harmful radiation?

Modern mammography uses very low radiation doses and is considered safe for regular screening.

14. I found a lump but I am afraid to see a doctor. What should I do?

Most breast lumps are benign. Seeing a doctor promptly will give you peace of mind and ensures treatment is started early, if needed.

15. If my mother or aunt had breast cancer, am I at higher risk?

A small proportion of breast cancers are inherited. Your risk depends on the number of affected relatives and their ages at diagnosis. Screening and guidance are available.

16. Will I get better after being diagnosed with breast cancer?

Many women treated for breast cancer go on to live long, healthy lives. Your doctor can advise on what to expect based on your diagnosis.

17. Will I need a mastectomy?

Not always. The type of surgery recommended depends on breast size, tumour size and tumour location. Breast-conserving surgery may be possible for many women.

18. Does radiation therapy or chemotherapy cause long-term damage?

Most side effects from chemotherapy and radiation therapy are temporary and can be managed by your clinical care team.

19. Why is hormone therapy recommended?

Some breast cancers grow in response to female hormones such as oestrogen. Hormonal therapy blocks or reduces these effects, helping to prevent recurrence.

20. What hormonal therapy medication will I be given?

Tamoxifen is a commonly used tablet that blocks the action of oestrogen. Other medicines may be prescribed depending on the tumour biology and menopausal status of the patient.

21. What side effects might I experience from hormonal therapy?

Possible effects include:

• Hot flushes 
• Vaginal dryness or irritation 
• Mood changes 
• Irregular periods

More serious complications such as blood clots or changes to the uterus lining are rare but require monitoring.

22. Why do some women need hormonal treatment while others do not?

Only cancers with hormone receptors (oestrogen or progesterone receptors) respond to hormonal therapy.

23. What choices do I have for a breast prosthesis?

Breast forms come in different shapes, sizes and skin tones. They are designed to match your natural breast and support posture and comfort.

24. How do I care for a prosthesis?

Most prostheses can be gently washed and stored in their protective case when not in use.

25. What is breast reconstruction?

Reconstruction recreates the shape of the removed breast using implants or your own tissue. It can be done during the mastectomy or later. Your surgeon will advise on suitable options.

26. Can I exercise after reconstruction?

Gentle activity, such as walking, is encouraged. Your care team will advise when to resume your exercise regime.

27. Do I still need breast screening after reconstruction?

Yes. Regular mammograms of the remaining breast are important. You should also continue monthly self-checks.

28. Can I breastfeed after breast cancer?

You may breastfeed from the unaffected breast. Breastfeeding from the treated breast may be affected after mastectomy or radiation therapy.

29. Can I breastfeed after lumpectomy or biopsy?

A lumpectomy generally will not affect breastfeeding, although radiation therapy may reduce milk production. A biopsy does not affect your ability to breastfeed.

30. Why do I need arm exercises after surgery?

Arm exercises help to prevent shoulder stiffness, promote lymphatic flow to manage swelling and support the recovery of normal arm movement.

31. When can I begin exercising?

Your doctor will advise when you can start light exercise after surgery to restore strength and flexibility.