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3. Chemotherapy

Chemotherapy involves administering powerful anti-cancer drugs over several months, usually intravenously.

Chemotherapy is recommended in most cases of invasive breast cancer, even at stage 1. It is done after surgery to reduce the risk of recurrence. It may also be used to shrink large tumours pre-operatively to facilitate surgery.

Selected women may become eligible for a lumpectomy after a course of chemotherapy despite presenting with a larger tumour.

Side effects vary from person to person and may include nausea, vomiting, fatigue, hair loss and numbness in the fingers and toes.

4. Hormone therapy

Patients with hormone-sensitive breast cancers, i.e. tumours that have oestrogen receptors (ER) and/or progesterone receptors (PR), are treated with hormone therapy to lower the risk of cancer recurrence.

Hormone therapy which affects the female hormone oestrogen may be used in all stages of breast cancer. The pills are taken daily for five years, and up to ten years in some women.

Anti-cancer pills like Tamoxifen block hormones from attaching to breast cancer cells, thus depriving them of fuel for growth. Possible side effects include hot flushes, vaginal discharge or dryness and irregular menstrual periods.

Another type of medication called aromatase inhibitors (e.g. anastrozole, exemestane and letrozole), is used in postmenopausal women to stop oestrogen production. Potential adverse effects include muscle aches, joint pain or stiffness and osteoporosis.

5. Targeted therapy

This form of therapy uses antibodies or small molecules that bind to specific sites on cancer cells to prevent growth and multiplication of the cells.

Trastuzumab, also known as Herceptin, is a targeted therapy used to treat both early and late stage breast cancer with overexpression of HER2 (Human Epidermal Growth Factor) receptors.

It is used in combination with chemotherapy and is given weekly or every three weeks. Patients may experience fever and chills; rarely, weakening of the heart muscles may occur.

A word about preventive mastectomy

More Singaporean women with breast cancer are opting for preventive mastectomy where the non-cancerous breast is removed along with the cancerous breast.

“Removing the healthy breast together with the cancerous breast may bring peace of mind, but it could be an unnecessary move. At NCCS, female patients who do not have a BRCA gene mutation but request for preventive mastectomy must undergo counselling by the surgeon, breast-care nurses and sometimes even a psychiatrist as it is an irreversible decision,” says Dr Ho Gay Hui, Visiting Consultant, Department of Surgical Oncology, National Cancer Centre Singapore (NCCS), a member of the SingHealth group.

Ref: R14