Choosing the right breast cancer treatment is a tough decision for any woman diagnosed with the disease. From 2008 to 2012, a total of 8,471 women were diagnosed with breast cancer. That’s close to 1,700 new cases every year.

“Breast cancer remains the most common female cancer, but there has been a significant increase in survival rates among all breast cancer patients across ethnicities in the past four years, due to early detection and treatment,” says Dr Ho Gay Hui, Visiting Consultant, Department of Surgical Oncology, National Cancer Centre Singapore (NCCS), a member of the SingHealth group.

The treatment plan, best decided by a multi-disciplinary team, will depend on the type of breast cancer (in situ or invasive), its stage, grade and tumour size, the patient’s medical condition, and whether the cancer cells are hormone-sensitive, adds Dr Ho.

1. Surgery

There are two types of breast cancer surgery: lumpectomy and mastectomy.


In lumpectomy or wide excision, the surgeon removes the breast tumour as well as a margin of healthy breast tissue surrounding it. The surgeon will also perform a sentinel lymph node biopsy by removing a few lymph nodes under the armpit. If cancer is found in any of the sentinel nodes, more lymph nodes will be removed in a procedure called axillary node dissection.

Lumpectomy is a breast-conserving surgery suitable for small, localised, early stage breast cancer (stages 0, 1 and 2).

Radiation therapy usually follows lumpectomy to reduce cancer recurrence in the preserved breast.


In total mastectomy, the surgeon will remove the entire breast, including the nipple and areola. In a modified radical mastectomy, lymph nodes in the underarm are removed as well.

Mastectomy is recommended when:

  • the cancer is found in more than one area of the breast
  • the tumour is large relative to the breast size
  • the patient is not suitable for radiotherapy due to other medical conditions, or she does not want to undergo radiation therapy after surgery

2. Radiation therapy (including intra-operative radiotherapy)

As a breast cancer treatment, radiation therapy uses high-energy X-rays to destroy remaining cancer cells in the original cancer site after a lumpectomy or after a mastectomy if the tumour is larger than 5 cm and/or lymph nodes have been affected by the cancer. The treatment typically lasts five to six weeks although it may be shortened to three to four weeks in some patients.

Possible side effects are breast skin redness and soreness, as well as thickening of the skin.

Intra-operative radiotherapy (IORT) is a new treatment technique, available only in NCCS, for selected patients with small early stage breast cancer when they undergo lumpectomy. This treatment replaces the six-week treatment course with a single session of radiotherapy that is delivered during surgery over an average of 40 minutes. Equivalent in efficacy, IORT has the added benefit of sparing surrounding normal breast tissues and the underlying heart, lung and ribs from radiation exposure.

Read on for more treatment options.

Ref. R14