Saving the breast in cancer: Guide to surgical options and making friends with chemotherapy

News Hour:

Some of the cancers that most often affect women are breast, colon, endometrial, lung, cervical, skin, and ovarian cancers. Knowing about these cancers and what you can do to help prevent them or find them early (when they are small and easier to treat) may help save your life.

Breast cancer is the most common type of cancer women suffer from. Dr See Hui Ti, a Medical Oncologist at Parkway Cancer Centre, Mount Elizabeth Hospital and Dr Tan Yah Yuen, a Senior Consultant, Breast Surgery at Mount Elizabeth Medical Centre, Singapore shared some views with News Hour on breast cancer.

 
Dr See, who is a member of the International Gynecologic Cancer Society, American Society of Clinic Oncology and the Singapore Medical Association, said that it is often difficult to predict who is getting cancer. Worldwide, one in three women may get cancer. It is estimated that in a women’s lifetime, one has approximately 48% chance of getting cancer.

Some cancers are preventable, whereas unfortunately some are not. We are exposed to carcinogens all around – food, radiation, sunlight, smoking, pollution and many other things can cause cancers. So it is utmost important to be aware of how we can prevent cancers.

As October is the Breast Cancer Awareness Month, Dr See discussed more about breast cancer. Breast cancer is rapidly becoming the commonest cancer globally. Unlike cervical cancer – which is largely preventable by awareness, pap smear test, and recently by vaccination for Human Papilloma Virus (HPV) infection – breast cancer is not totally preventable.

There are many factors that can cause breast cancer. Lifestyle, lack of exercise, rich food, obesity – all these are some risk factors of breast cancer. So the only protection that we can have against breast cancer is early detection and knowing what can be done, not fearing it, seeking early help to get cure.

In many cases, the question comes what could be done using systemic treatment if surgery is not performed at the beginning; how can we had chemotherapy; how to get the most advantage of chemotherapy.

In a reply to the question, if surgery facilitates chemotherapy which runs in many patients’ minds, Dr See explained that many times patients come to doctors presenting a breast lump when it is not sure if the lump is cancerous or not – then usually doctors proceed to biopsy (an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease). After the biopsy, doctors proceed for a full body scan that tells about the complete situation. Dr See said, “The only things that we don’t try to do is performing an extensive surgery for large inflammatory breast cancer, because if the tumour is very large and aggressive, sometimes surgery is associated with a negative outcome.” So, in case of aggressive inflammatory advance form of cancer, conservative treatment is applied first for down-staging of the condition.

Regarding side effects of chemotherapy, Dr See advised women with strong family history to get routine checkup even if they don’t have cancer. At the same time, she gave hope that nowadays, there are many good medication with very less side effects. Additionally, women should improve their lifestyle e.g. regular exercise, proper diet etc. that helps reducing the side effects of cancer chemotherapy.

Dr See particularly underscored on yoga that has tremendous benefit over reducing the side effects. Diet low in saturated fat, low sugar and carbohydrate, more vegetables also help in this regard.

There is some misconception about the use of oral contraceptive and its association with breast cancer. Dr See explains that oral contraception may worsen the situation in case of a patient already having breast cancer, but for healthy women, there is no direct association between breast cancer and oral contraceptive; rather it helps reducing ovarian cancer.

Dr See advised that we can reduce the chance of getting breast cancer by 40 per cent just by changing the lifestyle mentioned earlier. Understanding more about the cancer can help us a lot in prevention.

 
Dr Tan Yah Yuen, a Senior Consultant, Breast Surgery at Mount Elizabeth Medical Centre, Singapore informed that more than half of the breast cancer patients come to the doctors during the early stage, as it is an outer organ and easy to examine.

She advised women to perform self-examination to become watchful about any doubtful condition and seek professional consultation. She also advised to get mammogram done at least every three years.

Dr Tan, who is currently a member of the International Society of Surgeons and Breast Surgery International, was asked about the association between breast cancer and breast implant. She replied negative that there is no such association, as it usually remains separate from the breast; the implant does not interfere performing any diagnostic tests even.


ABOUT THE DOCTORS:
Dr See Hui Ti

Dr See Hui Ti

Dr See Hui Ti is a Medical Oncologist at Parkway Cancer Centre, Mount Elizabeth Hospital. She was previously a Consultant in Medical Oncology at the National Cancer Centre as well as a Visiting Consultant at the KK Women’s and Children’s Hospital specialising in adult breast and gynecologic cancers.

She is registered with the General Medical Council (UK), and worked at Queen Elizabeth Hospital in Birmingham, UK, before continuing her internal medicine training at the Singapore General Hospital. She has recently obtained her fellowship from the college of physicians (FRCP) from Edinburgh.

Dr See was awarded the Singapore Government HMDP fellowship in 2002 after completing advanced oncology training at the National Cancer Centre. From 2003 to 2004, she furthered her training in Medical Oncology at the M.D. Anderson Cancer Center in Houston, Texas.

Dr See is a member of the International Gynecologic Cancer Society, American Society of Clinic Oncology and the Singapore Medical Association. She served as an executive committee member of the Singapore Society of Oncology from 2001 to 2007.

Dr Tan Yah Yuen is a Senior Consultant, Breast Surgery at Mount Elizabeth Medical Centre, Singapore.

She has clinical focus on breast disorders including breast lumps, nipple discharge, breast biopsies and breast cancer and procedure focus on breast cancer surgery, sentinel lymph node biopsy and minimally invasive breast biopsies, surgery for benign breast disorders.

 

Dr Tan Yah Yuen

Dr Tan Yah Yuen

Dr Tan Yah Yuen is a General Surgeon with more than 10 years experience in the field. Her practice is solely in the field of breast surgery. She provides specialised care in the treatment of the entire spectrum of breast disorders including breast lumps, nipple discharge, breast biopsies and breast cancer at her clinics at Mount Elizabeth Novena, Mount Elizabeth and Parkway East Hospitals. She also specialises in minimally invasive techniques in breast surgery, including ultrasound guided vacuum assisted needle biopsies.

Upon her graduation from the Faculty of Medicine at the National University of Singapore (MBBS, 1995), she underwent basic training and then completed specialty training in General Surgery (FRCS Edinburgh and Glasgow, 1999). Then, through the Health Manpower Development Programme (HMDP) Award, she attended a one-year fellowship programme at the University of California San Francisco in 2004 and honed her skills in breast and endocrine surgery.

She was inducted as a Fellow of the Royal College of Surgeons, Edinburgh in 2003 as well as of the Academy of Medicine of Singapore, General Surgery in 2005. Before establishing her private practice, Dr Tan was a senior consultant at the Breast Surgery Department at KK Women’s and Children’s Hospital. During her tenure, she pioneered the Sentinel Lymph Node Programme for early breast cancer using dual radionuclide and blue dye technique. She had set up the same programme in Tan Tock Seng Hospital prior to that. This procedure is now the standard of care for women with early breast cancer.

Research is an aspect of medicine that Dr Tan likes to set aside time for. Most recently, she was the Principal Investigator of a three-year trial which studied the usefulness of mammary ductoscopy in the diagnosis of abnormal nipple discharge and breast cancer.

Dr Tan’s interest in the field of breast surgery extends beyond the hospital and her patients. She is currently a member of the International Society of Surgeons and Breast Surgery International. She also has various publications to her name such as the World Journal of Surgery and the Annals of Surgical Oncology. A passion for public education has also led her to give numerous talks to increase awareness of breast cancer in the community.

But ultimately service to her patients is what Dr Tan values most. For her dedication, she has been awarded several awards for service excellence, including the Excellent Service Award (Star) by Spring Singapore in 2009 and the KKH CEO Heart Award in 2008.

Tareq Salahuddin

Dr. Tareq Salahuddin is a Special Correspondent of News Hour. He is a Public Health Professional working in development sector. Dr. Tareq, a medical graduate, is a member of Public Health Association of Bangladesh and a Member of the Governing Council of World Federation of Public Health Associations (WFPHA), a J2J Fellow on HIV/AIDS and a member of the International AIDS Society. To know more about Dr. Tareq, please visit his personal website or simply Google his name.
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