More than 2,000 women in Singapore are diagnosed with breast cancer each year. Therefore, regular screening is important. Early detection of the cancer often leads to a better chance of survival.

Myth: Women do not need to go for mammogram screening often

Fact: For women aged 50 and above, it is recommended that they have a screening mammogram every two years. Intervals between screenings are longer because women aged 50 and above have breasts that are usually more fatty and thus less likely to obscure cancer on a mammogram. For women aged 40–49, they are advised to discuss with their doctor about the pros and cons of a mammogram. Should they decide to have a mammogram screening, they should be performed every year.

Myth: Mammograms are painful, invasive and inconvenient

Fact: A mammogram is an x-ray of the breast; it is performed on one breast at a time. During the procedure, the breast is placed between two plates, compression will be applied for just a few seconds and an x-ray image will be captured. Adequate compression is required to avoid errors. Firm compression may cause mild discomfort during the procedure but will not result in permanent injury.

Myth: Mammograms expose women to large amounts of radiation and risks

Fact: Mammography equipment produces high-quality images with low doses of radiation. The radiation dose from a conventional two-dimensional mammogram is equivalent to the dose of radiation that we receive just over seven weeks from the natural surroundings. It is higher than the radiation dose received from a chest x-ray but lower compared to a computed tomography (CT) scan. The radiation received from a routine mammogram screening will not put one at a higher risk of developing breast cancer.

Information above by Dr Lim Sue Zann, Consultant, SingHealth Duke-NUS Breast Centre, adapted from North-East Community Development Council’s video on myths about mammogram.

Advanced surgical techniques for patients

In the event of breast cancer detection, discuss with your healthcare team about the type and stage of breast cancer, treatment options (see below) and side effects.

Conventionally, if a woman has been diagnosed with advanced breast cancer that has spread to the lymph nodes in the armpit, she would need surgery to remove the breast cancer as well as a complete removal of the lymph nodes in the armpit. This can lead to complications such as lymphedema, a swelling of the arm resulting from lymphatic fluid build-up caused by damage to the lymphatic system.

Reduced invasiveness and cost of lymph node surgery

KK Women’s and Children’s Hospital (KKH) has a technique, Skin Mark clipped Axillary nodes Removal Technique (SMART), for women with advanced breast cancer.

A/Prof Lim Geok Hoon, Head and Senior Consultant, KK Breast Department, KKH, shares that it is effective in removing superficial identified lymph nodes in the armpit of patients with advanced breast cancer after chemotherapy. This avoids the cost and complications associated with other techniques involving localisation devices that are used to aid the removal of the clipped lymph node during surgery for testing of cancerous cells.

SMART involves inserting a clip measuring a few millimetres into a woman’s lymph node in the armpit to mark the cancerous lymph node so that it can still be identified after chemotherapy. Then, before surgery, a radiologist places a marking ‘X’ on the skin above the site of the clipped node, thereby eliminating the need for a localisation device. The breast surgeon will then remove the marked lymph node during the surgery, based on the marking made by the radiologist. The identified lymph nodes will be examined by a pathologist to check for any remnant cancerous cells. If there are no remaining cancerous cells, the patients will not require total removal of the lymph nodes in the armpit.

This technique is suitable for women with superficial lymph nodes, and not suitable for women with deeper affected lymph nodes.

Targeted axillary dissection (following neoadjuvant chemotherapy) is also offered at Changi General Hospital (CGH), Sengkang General Hospital (SKH) and Singapore General Hospital (SGH), and National Cancer Centre Singapore, via skin marking, wire, radar and magnetic seed localisation techniques.

Aesthetic and functional preservation for breast cancer patients

CGH, SKH and SGH’s breast and plastic surgery offer minimally invasive skin and nipple-sparing full breast removal (mastectomy) with reconstruction for suitable breast cancer patients. This minimally invasive approach allows for smaller, less conspicuous incisions, and close-to-ideal breast restoration.

Surgeons can make incisions as small as four centimetres in discreet locations such as the underarm or bra line. Conventional nipple-sparing mastectomy usually involves scars on the breast, nipple and areola region, or lengthy scars along the bra line or lateral breast. In addition to the aesthetic benefit, smaller ‘off-the-breast’ incisions also result in less pain, minimal operative scarring and decreased nipple, skin and wound complications.

“With over 70 per cent of cancers being diagnosed at an early stage and significant improvement in survival, breast specialists today prioritise not just treating the cancer, but also aesthetics, quality of life and longterm function to preserve patients’ body image and sexual identity. The greatest value of the minimally invasive breast surgery (MIBS) approach is the principle of ‘aesthetically scarless’ breast surgery, where incisions and scars are minimised or hidden yet the procedure remains within the range of oncologic safety,” said Assistant Professor Sabrina Ngaserin Ng, Head and Consultant, Breast Service, SKH.

On top of more commonly utilised reconstruction options associated with MIBS, SKH also performs immediate abdominal free flap reconstruction, which is muscle -sparing and function-preserving for a patient’s abdominal core musculature.

Assistant Professor Mok Chi Wei, Consultant, Division of Breast Surgery, CGH, echoed Asst Prof Ng’s opinion and added, “With more institutions offering MIBS to their patients, suitable patients have an alternative that offers aesthetic outcomes and patient satisfaction while remaining oncologically safe. In addition, with the conclusion of the first robotic mastectomy trial in Singapore by CGH in September 2023, we are optimistic that robotic mastectomy would be a great addition to the range of MIBS options available as the trial demonstrated safety and feasibility with improved patient satisfaction.”