Know These Breast Cancer Warning Signs

Breast cancer is the most common cancer among women in developed countries today. In Singapore, more than 1400 women are being diagnosed with breast cancer every year and the incidence is rising.
The good news is that even though breast cancer is very common, it is very treatable and many women continue to live normal fulfilling lives after treatment. The key strategy is early detection and treatment of breast cancer.

Common symptoms of breast cancer

1. Breast lump
   The most common finding is a breast lump that is felt by the woman herself, or felt by the doctor during a routine examination.
   Of course, most breast lumps will not be cancerous, but additional tests such as mammography, ultrasound or a biopsy may be necessary to confirm what type of breast lump it is.
   Cancerous breast lumps are usually not painful, so the absence of pain does not mean the lump can be ignored.
2. Nipple discharge
   Occasionally women may notice they have whitish or milky nipple discharge from the breasts. This can be considered normal if the amount of discharge is very small, or it may be due to hormonal changes. Usually this occurs in both breasts.
   If the discharge is seen to be bloody, clear or transparent, or coming from a single duct opening from the nipple (as opposed to multiple duct openings), then the cause may be an underlying tumour and other tests will need to be done.
3. Nipple rash
   An uncommon form of breast cancer occurs as a rash that involves the nipple and sometimes the areola. It is a dry scaly rash that is not itchy and not painful. This is called Paget’s disease and usually occurs in women >50 years old. It may or may not be associated with other symptoms such as a lump.
4. Inflammation
   An even rarer form of breast cancer is inflammatory breast cancer or IBC. This presents as an insidious onset of redness, swelling and sometimes pain in one breast and these symptoms persist despite antibiotics. It often occurs in younger women before menopause.
5. No symptoms
   Early breast cancer may not have any symptoms at all. Hence it is important to undergo routine screening to detect early cancer changes in the breasts, before the onset of significant symptoms.

Breast cancer screening

Age < 40 years old
Monthly breast self examination, optional yearly ultrasound of the breasts if breasts are lumpy and self or clinical examination is difficult.

Age 40-49 years old
Monthly breast self examination, yearly mammogram with or without ultrasound. Ultrasound is useful if the breasts are lumpy or if they are dense as the accuracy of mammogram is slightly lower in dense breasts. But ultrasound cannot completely replace mammography.

Age 50 years old and above
Monthly breast self examination. Mammogram with or without ultrasound can be done 2 yearly in the absence of any risk factors such as significant family history, personal history and use of hormone replacement therapy.

Lifestyle recommendations
To reduce one’s risk of breast cancer, consider adopting the below changes to your lifestyle.

1. Eat Healthy
   Dietary factors may contribute to breast cancer risk. Limit intake of processed and red meats and increase your proportion of fresh fruits and vegetables. Opt for whole grains instead of refined grains.
2. Cut down on alcoholic beverages
   Excess alcohol intake doubles breast cancer risk in women.
3. Avoid excessive weight gain
   Being overweight is a risk factor for breast cancer, as well as a host of other cancers and ailments including heart disease, stroke and diabetes. Maintain a healthy BMI (body mass index) especially when entering menopause.
4. Have an active lifestyle
   Regular exercise at least 5 times a week reduces breast cancer risk - even brisk walking or yoga has its benefits. Try to clock at least 30-45 minutes of exercise each time. Exercise is also a great way to help you cope with stress that can lower your immunity and is more important as one grows older.
5. Reduce hormone replacement therapy (HRT)
   HRT is given to counter-act menopausal symptoms. However certain preparations of HRT may increase risk of breast cancer after prolonged intake. Check with your doctor and if you do need HRT, avoid treatment durations of more than 5 years.

Dr Tan Yah Yuen
MBBS, FRCS (Edin), FRCS (Glasg), FRCSEd (Gen), FAMS, GDipHML

Visiting Consultant – Breast Surgery
Thomson Women Cancer Centre Pte Ltd
Novena Medical Centre, #09-15/16
10 Sinaran Drive, Sqaure 2, Singapore 307506
Tel. 65918218, Fax: 65918210
Email: twcc@thomsonmedical.com