- How Common Is Breast Cancer?
It is commonest cancer in Singapore women with over 1000 new cases detected each year. A Singaporean woman has a 5% chance of developing breast cancer in her lifetime.
- How Can We Fight Breast Cancer?
There are 3 means of controlling breast cancer:
1) Prevention is possible only by elimination of known risk factors and this is a difficult and long-term goal - eg. change of diet and lifestyle habits.
2) Early Detection is currently the most promising mean to fight breast cancer. The main advantages are:
a) Improved survival
b) Less mutiliating surgery
c) Less toxic drugs
3) Better treatment is an expensive means to fight breast cancer as new surgical techniques and drugs usually take time and resources to develop.
How Can We Classify Breast Cancer?
For practical purposes, breast cancer can be classified either according to their stage (extent of spread) or grade (aggressiveness of tumour). The stage and grade of a breast cancer are vital pieces of information in predicting survival and in determining the treatment.
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| Stage |
Description |
Average Survival (%) |
0 |
Non invasive cancer |
90% |
1 |
Small invasive cancer |
80% |
2 |
Invasive tumour >2cm with lymph nodes |
70% |
3 |
Locally advanced cancer |
50% |
4 |
Widespread cancer |
30% |
- How Do We Treat Breast Cancer?
Broadly speaking, treatment consists of 2 parts:
1) Locoregional Treatment which is the use of surgery or optional radiotherapy to eliminate the cancer from the breast and armpit / axilla.
2) Systemic treatment which is the use of chemotherapy or hormonal drugs (e.g. Tamoxifen) to eliminate the cancer cells in the body. This is because we know that cancer cells can spread to other parts of the body via the blood stream.
-
What Is The Role of Surgery In Breast Cancer Treatment?
1) Diagnosis of Breast Cancer. New biopsy techniques are now minimally invasive, such as mammotome biopsy under ultrasound or mammographic guidance.
2) Local control of the cancer. The 2 surgical techniques are Mastectomy or Wide Excision (Lumpectomy). The newer technique is Wide Excision which is removal of the tumour with a margin of normal breast tissue. The rest of the breast is untouched to maintain good cosmesis.
3) Axillary or armpit surgery.
- Is Wide Excision a Safe Option Compared To Mastectomy?
After Wide Excision, radiotherapy is given to the breast for 6 weeks. Research has shown that Wide Excision plus Radiotherapy is a safe option as it also has a low recurrence rate that is comparable with Mastectomy.
- Which patients are suitable for Wide Excision plus Radiotherapy?
1) Tumours less than 2 to 3 cm diameter
2) Breast of a suitable size
3) Tumour situated away from the nipple
- Which patients are not suitable for Wide Excision plus Radiotherapy?
1) Young women (<30 years old), who have a high recurrence rate after this procedure
2) Women with connective tissue disease, such as lupus, who are not suitable for radiotherapy
3) Pregnant women
4) Patients with 2 or more tumours within the same breast
- Why Is Axillary Surgery is required?
Axillary surgery is required to remove lymph glands (called nodes) for diagnostic and therapeutic purposes. Knowing whether the lymph glands are infiltrated by cancer is important in determining the stage of the cancer. Removal of the lymph nodes also prevents recurrence of the cancer in the axilla.
In this operation called Axillary Clearance or Dissection, the surgeon removes all or most of the lymph nodes in the axilla. Some patients may suffer from temporary shoulder stiffness and arm swelling (lymphoedema) after axillary dissection.
There is a technique called Sentinel Lymph Node Biopsy (SLN Biopsy) that is also closely linked with axillary surgery and presents an alternative to Axillary Dissection.
Sentinel lymph nodes are lymph nodes that act as gateways to the axilla. Recent research has shown that if there is cancerous involvement of the axillary lymph nodes they will be affected first. 1 or 2 of these lymph nodes are present in every patient, and are termed sentinel lymph nodes.By identifying these sentinel nodes and biopsying them one can determine whether the rest of the axillary lymph nodes are involved by the cancer. Hence if the sentinel lymph node biopsy is negative, there is no involvement of the axillary nodes and vice versa.
If one where to compare, sentinel lymph node biopsy causes fewer side effects than Axillary Dissection because of the limited extent of the surgery during SLN biopsy.
- What is Sentinel Lymph Node Biopsy (SLN Biopsy) ?
Recent research has shown that 1 or 2 lymph nodes act as gateway to the axilla and if there is cancerous involvement of the axillary lymph nodes they will be affected first (sentinel lymph nodes).
By identifying these sentinel nodes and biopsying them one can determine whether the axillary lymph nodes are involved by the cancer.
Hence if the sentinel lymph node biopsy is negative, there is no involvement of the axillary nodes and vice versa.
Because of the limited extent of the surgery, sentinel lymph node biopsy has less side effects when compared to Axillary Dissection.
- Is Sentinel Lymph Node Biopsy suitable for all patients?
The sentinel lymph node biopsy is a treatment option for patients with:
1) Small tumours
2) Non palpable nodes in the axilla
It is not suitable for patients in which the chances of nodal involvement is high e.g. patients with large tumours, multiple tumours within the same breast or palpable nodes. In such patients an Axillary Dissection should be performed.
It is also not necessary for patients in which the chances of nodal involvement is low e.g. non invasive tumours. In such patients no Axillary surgery at all is required.
Is Sentinel Lymph Node Biopsy a safe option compared to Axillary Dissection?
The technique has been evaluated and found to be accurate (>90%). The American Cancer Society recommends it as an option for the accurate assessment of the lymph node status of the axilla.
- Is There Any Hope of ''Saving The Breast" after Mastectomy?
Yes. The breast can be reconstructed and there is an improved technique of breast reconstruction called "Skin Sparing Mastectomy (SSM) and Reconstruction".
