Breast Screening in Singapore: Mammogram & Ultrasound

Breast cancer is the most common cancer among women in Singapore. Data from the Singapore Cancer Registry under the Ministry of Health (MOH) shows that over 2,000 women in Singapore are diagnosed with breast cancer each year.

When detected early, breast cancer is highly curable, and patients can remain well for 5, 10, or even 20 years after. The earlier the detection through breast cancer screening, the higher the chance one can recover from breast cancer.

The recommended method to detect early signs of breast cancer is to go for a mammogram. A supplementary breast ultrasound may also be ordered by your doctor as well. In this article, we will explain what you need to know about breast cancer screening.

There are 2 common types of clinical breast examination that you can choose from, on top of monthly breast self-examinations:

1. Mammogram
2. Breast Ultrasound

Mammogram

A mammogram screening is an x-ray of the breasts and is the most reliable screening tool for early breast cancer and other breast diseases.

Screening refers to a process to check for early disease when there are no signs or symptoms yet. A mammogram can detect tiny lumps or calcium spots in the breasts, which may be a sign of early breast cancer, or caused by non-cancerous reasons.

During the x-ray, a female radiographer will place your breast between two flat plastic plates and compress it for a few seconds. This is performed on one breast at a time. Patients may experience some discomfort when the breast tissue is compressed for a clearer image. Additional angles and views may also be taken for closer examination.

The patient will be exposed to a low dose of radiation during the procedure (equivalent to exposure to environmental background radiation for two months), so the overall radiation risk is low. As such, the potential benefits outweigh the risks.

If there is an abnormal mammogram result, your doctor may recommend further tests in your medical report. It is important to note that age and breast density can affect the accuracy of the mammogram screening test, which are also possible reasons for additional tests. For example, younger women tend to have denser breast tissue, which could mean that abnormalities will not appear during the mammogram and is ineffective in detecting cancer.

Breast Ultrasound

An ultrasound of the breasts is safe, non-invasive, and painless, and is the same technology used to monitor a baby during pregnancy. The procedure helps to detect lumps and determines if a lump is solid or cystic.

However, an ultrasound cannot detect calcium spots. Therefore, your doctor may order an ultrasound-guided biopsy to confirm what type of lump it is. An ultrasound may also supplement a mammogram for ladies with dense breasts.

If you have breast implants or a family history of breast cancer, talk to your doctor to ask about MRI screening.

For patients where breast cancer screening picks up an abnormality, consult your doctor, and they will advise if you need a biopsy.

HPB Screen For Life Breast Cancer Screening

The Screen For Life Breast Cancer Screening programme by the Singapore Health Promotion Board (HPB) offers subsidised mammogram screenings for women aged 50 and above, or women between the ages of 40 to 49, who decided to make a mammogram appointment after consulting their doctor.

You may get a subsidised mammogram screening test at participating Breast Screening Centres verified by the Health Promotion Board and the Singapore Cancer Society. Thomson Medical Centre is a participating centre under the Screen For Life programme.

To be eligible for the screening, you must not have the following breast symptoms:

• painless lump
• persistent rash around nipple
• bleeding or unusual discharge from nipple
• swollen or thickened skin
• dented inwards or folded outwards skin
• retracted nipple

For women over 50, you haven't gone for a mammogram within the past two years. For women aged 40 and 49, you haven't gone for a mammogram within the past year.

FAQ

At what age should you get a cancer screening?

Women aged 40 to 49 are recommended to go for a mammogram every year due to the higher breast cancer risk. However, for women aged 50 and above, screenings can be reduced to once every two years.

For younger women below the age of 40, a screening mammogram is not recommended. However, if you have a high risk of breast cancer due to family history or hereditary genetic mutations, you should speak to a breast specialist early, and they will recommend when you should start breast cancer screening.

In addition to screening, all women aged 18 and above should do monthly breast self-examinations (BSE). This examination helps you be familiarised with the look and feel of your breasts. As a result, you can detect any changes and abnormalities in your breast tissues more efficiently and increase the chances of early detection.

If you notice a change in your breasts that seems abnormal or if one breast is different from the other while doing a BSE, you should seek immediate medical advice from your doctor.

Is a mammogram painful?

The whole mammogram procedure is not necessarily painful but you may experience discomfort due to the compression of the breasts between two plates. If it gets too uncomfortable, please do not hesitate to inform your radiographer.

What are the major risk factors for developing breast cancer?

Some women are at higher risk of developing breast cancer. Here are some of the risk factors:

• Having one or more close relatives with breast cancer
• Personal history of breast cancer
• Age: breast cancer risk increases as one gets older, especially after menopause
• Being overweight
• Being physically inactive
• Drinking alcohol regularly
• History of ovarian cancer
• Early-onset of menstruation, or
• Long-term use of combined hormone replacement therapy (of more than five years)

Regular mammograms are essential, even more so for women with these risk factors. Note that not having any risk factors does not mean you will not develop breast cancer. It simply means your breast cancer risk is lower than others. Therefore, it is recommended that you go for a mammogram screening in Singapore even if you do not detect any abnormalities in your breast tissue.

What happens after the diagnosis of breast cancer?

Once your doctor confirms a breast cancer diagnosis, the first process involved is staging. This will help determine the extent of the disease and prognosis. It is also used to plan treatment options.

Breast cancer is typically classified into Stage 0, I, II, III, or IV. These stages are based on the tumour size, the involvement of lymph nodes, and whether it has spread to other body parts.

The presence of tumour markers like estrogen progesterone receptors and proliferation factors (HER2) are also analysed during the staging process, as they may affect the sequence of treatment for surgery versus systemic therapy.

What are the most common treatments for breast cancer?

Once staging is done, your doctor will advise on the ideal treatment options. The course of treatment will highly depend on your overall health, breast cancer type, stage, grade, size, sensitivity to hormones, and your personal preference.

The most common treatment options are Surgery (Lumpectomy or Mastectomy), Chemotherapy, Radiation Therapy, and Hormonal Therapy.

Here’s what you need to know about the treatments for breast cancer:

Lumpectomy

This procedure is a form of “breast preservation” or “breast-conserving” surgery. Only the tumour and a small portion of healthy tissues surrounding the tumour are removed in this surgery. After the surgery, you may expect a scar and/or dimple, and changes in breast shape and size. To further eliminate cancer cells that may remain after lumpectomy or “breast-conserving” surgery, most patients undergo radiation therapy for a week after the surgical wounds have healed.

Mastectomy

This procedure is the surgical removal of the whole breast. Generally, the surgeon will remove all the breast tissues from the breast. If patients opt for reconstruction surgery, this may be performed, and we will preserve the skin in the breast region, or maybe even the nipple if suitable. Reconstruction of the breast is done with tissue taken from another part of the body. Skin-saving and nipple-sparing mastectomy can only be performed when the breast under the skin or nipple is free from tumour cells.

Radiation therapy

With the use of high-powered protons and X-rays, this procedure is used to kill cancer cells by focusing on the part of your body where the malignant tumour is located and making it shrink. This type of treatment may last between one to three weeks.

Chemotherapy

This is the administration of cancer drugs intravenously (IV) to reduce the risk of cancer coming back. The risk of recurrence is linked to the stage of your cancer. The side effects of chemotherapy include nausea, rash, fever, and hair loss, but the frequency and severity vary from patient to patient.

Hormone-blocking therapy

There are breast cancers that are progesterone (PR positive) or estrogen receptor-positive (ER-positive). Such hormone-sensitive cancers are suitable for this treatment in the form of a daily tablet. It also helps decrease the chances of breast cancer recurring.

Targeted therapy drugs

Some cancers have overexpression of HER2 (Human Epidermal Growth Factor 2). This receptor (sensor) makes a cell grow very fast. Targeted therapy drugs can be taken orally or given intravenously (IV). In targeted therapy, only HER2 cells are attacked, and healthy cells are spared compared to chemotherapy, wherein both cancer cells and healthy cells are attacked.

Immunotherapy

Immunotherapy uses your body’s immune system to fight off cancer cells. It is not a first-line treatment for breast cancer. However, for rare cancers that do not respond to usual chemo/targeted treatment or in cases of cancer recurrences, the doctor may recommend immunotherapy. It is one of the most expensive treatment options for cancer.

Sentinel lymph node biopsy

During the operation, this procedure is done to check the first few “guarding” lymph nodes. Breast cancer usually spreads to the axilla lymph nodes (armpit) since it is closest to the breast. If the sentinel lymph node biopsy is normal, nothing further is done. If the sentinel lymph node biopsy shows a cancer spread, your doctor will proceed with axillary lymph node dissection.

Axillary lymph node dissection

This is a procedure done to remove all visible fat (which contains the lymph nodes) in the axilla.

Palliative or supportive care

For patients with stage 4 cancer, palliative care aims to improve the quality of life of the cancer patient. In combination with other treatment options, palliative care focuses on alleviating the symptoms experienced by the cancer patient.