Five Things You Should Know About Detecting Breast Cancer Early

As we step into October and into the month of Breast Cancer Awareness, it's another reminder that there are other health crises aside from COVID-19 — especially ones that have been around for decades.

One in 14 women is diagnosed with breast cancer every year, and six women are diagnosed with breast cancer every day. Yet Breast Cancer Foundation found that only 62 per cent of women have ever done a breast exam.

Doing a breast self-exam might seem unnecessary or intimidating to some. But regularly examining your breasts is incredibly important to detecting breast cancer early. It's a useful tool, especially when combined with regular physical exams, and in some cases ultrasound and or MRI. But doing a breast self-exam is one of the most convenient (not to mention free) ways of detecting breast cancer early.

We spoke to Dr Tan Yia Swam, a General Surgery specialist with an interest in Breast Surgery, and asked her to share the easy steps of doing a breast self-exam at home, plus details like how often we should be doing this and what breast cancer signs to look out for.

How do you conduct a breast examination at home on yourself?

Try to do it in the shower — it's convenient and there's probably a mirror in the room.

Put your hands on your hips and look out for changes in breast shape, skin surface, and nipple abnormalities. Raise the left arm above your head to look for changes (especially dimples) on the underside of your breast. Use two to three fingers from your right hand to press into the breast tissue, in a systematic manner.

Start from the top (12:00 area), press down and massage in a circular manner, Gradually move around the breast to cover all areas, and from outmost, towards the nipple.

The last step is to squeeze the nipple gently to check for nipple discharge. Then repeat on the left. Aside from this, you should also look out for painless lumps, unusual nipple discharge (e.g. bloody/greenish/yellowish fluid; not milk), retracted nipples, a persistent rash around the nipple, dimpled and puckered skin, or swollen and thickened skin.

How often should women go for their breast checkups?

If you're pregnant or breastfeeding, you cannot do a mammography exam, so you should opt to perform frequent breast self-examinations. If you feel a lump, go to a doctor for an ultrasound.

For women under 40, there's no routine screening needed. But please consult a specialist to discuss other modes of screening if you are at a high risk of breast cancer.

For women aged 40 or older, consider a yearly mammography screening, with a supplementary ultrasound. For women aged 50 and above, it's strongly encouraged to have these twice a year instead.

It's never too early to start, either — it's always encouraged to begin conducting breast self-exams from age 18 onwards. Get familiar with your own body so that any new changes can be easily detected in the future.

What are some of the factors that place women at higher risk for breast cancer?

Everyone, both men and women, are at risk of breast cancer. A person has an increased risk of cancer if she has the following:

• Being 50 years of age or older; and/or
• Having a first-degree relative with breast cancer: mother, sister or daughter
• Having a male relative with breast cancer
• Having a personal history of breast cancer, or an abnormal breast biopsy (please bring the previous results to the consultation)
• A history of ovarian cancer

Some other milder risk factors are as below:

• Early onset of menstruation
• Late menopause
• Having your first child after the age of 30
• Having fewer children or never having children
• Being on hormone replacement therapy
• Weight gain, especially after the menopause

Why should we also go to the doctor for regular checkups?

Other than monthly breast self-examination, it's still good to see a doctor once a year for a check, especially if you are above the age of 40. Screening for illness refers to the process of identifying a very early stage of the disease process, such that the disease may be prevented or cured. Tests that are used for screening have been rigorously studied to make sure that they are user-friendly, accurate, and cost-effective.

For women, there are effective screening tests for breast and cervical cancers. The absence of risk factors does not mean protection against breast cancer. Regular screening yearly is important for the early detection of breast cancer, as the early stages may not have any symptoms. So, a physical examination may be normal, but a mammogram may see the early abnormality.

Even if cancer develops, the best protection we have is for early detection. The good news is, early detection can increase your chances of survival. Hence, every woman aged 40 and above should be screened regularly for breast cancer.

Finding support

The Breast Cancer Foundation is the only social service agency dedicated to breast cancer advocacy and support in Singapore. 23 years strong, their mission and purpose are just as relevant and their key programmes have expanded. Some of these include:

• Befrienders Programme: This vibrant network of volunteer befrienders-survivors of breast cancer is committed to sharing their experiences with caregivers and women diagnosed with breast cancer by offering their assistance and support via hospital visits (suspended currently with COVID-19 outbreak) and phone calls.
• Support Groups: Support groups go a long way in reminding those afflicted with breast cancer that they are not alone in their journey. There are also separate groups conducted in English and Mandarin and virtual sessions are also conducted weekly online.
• Young Women Support Group: This support group is available for women aged 45 years old and below, diagnosed with breast cancer. Younger women often face unique concerns upon diagnosis, like fertility, career concerns or guilt at having to inform their parents of their condition.
• Positive Appearance Scheme & Wig Loan Programme: The Positive Appearance Scheme provides sponsorship of prostheses and bras for low-income women who are diagnosed with, or are survivors of, breast cancer. Whereas BCF’s Wig Loan programme loans members wigs for free when they start their treatments and experience hair loss during the process.
• Healing Through The Arts: Life continues beyond breast cancer and BCF believes in being an advocate of this reminder. Through shared activities in sports and arts such as dragon boating, crochet, and ukulele, this programme helps breast cancer survivors bond together through creative means The programme is exclusive to breast cancer survivors and features recreational and therapeutic activities aimed at rebuilding their physical and mental well-being for short- and long-term recovery. With COVID-19, some HTTA sessions are now conducted online instead. You can visit www.bcf.org.sg/bse for more information.