​Breast cancer is the most common cancer affecting women. Associate Professor Tan Su-Ming is the Head of Breast Surgery, Director of Breast Centre and Senior Consultant at Changi General Hospital (CGH), a member of the SingHealth group, provides the answers to frequently asked questions.


Posted by HCW (Republished by Forum Admin)

Hi,

I am a 42 yrs old breastfeeding mum, both my breasts have multiple cyst, a ultrasound of breasts or mammogram can I do to screen my breasts for breast cancers?

Tks

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH) 

Women 40 years and above may consider doing a mammogram for screening. There are changes in a lactation breast, hence you should inform the radiographer that you are breast feeding before the mammogram. The milk in the breast may also make it difficult to detect abnormalities. Hence, it may be useful to also have an ultrasound of the breasts. To get the best images, try to “empty” the breasts just before the mammogram &/or ultrasound.


Posted by susan (Republished by Forum Admin)

If there’s occasional pain or throbbing on the right side of breast after an upper body massage, is that a cause for concern?

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

Breast cancer does not usually present with pain. Hence if there are no other symptoms, the pain may be due to other causes. Commonly throbbing pain is due to muscle ache or strain. A large muscle called the Pectoralis Major is situated across the chest and behind the breast. This muscle is in use when you lift loads like grocery, laundry or when mopping the floor. Straining this muscle may give rise to throbbing pain. However, if in doubt, please see a doctor.


Posted by Jasmine (Republished by Forum Admin)

Does large/daily consumption of grapefruit increase a person's risk of breast cancer?

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

The link between grapefruit and a potential increase in breast cancer risk came about from an article in 2007. There are limitations & flaws in this article as pointed out by various British & American Healthcare experts. Hence, there is no scientific evidence that grapefruit increases the risk of breast cancer. It is advised that you have a healthy balanced diet consisting of carbohydrates, proteins, fat & fibre. Together with regular exercise and adequate rest, it would help you to maintain a good immune system.


Posted by SOORIA365

Dear Doctor, one of my friend's wife aged 40 yrs has been diagnosed with breast cancer (initially stage 3) since August 2018. She has been given many sessions of chemo & harmone therapy since then and in addition surgery is made on her left breast. Last month she was diagnosed with metastasis (stage 4?) spreading to her bones and lungs. With utmost desperation and anxiety they are seeking second medical opinion on her further treatment and survival rate. We therefore seek your advise Doctor. Thank you very much.

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

I am sorry to know of your friend’s wife’s condition. Breast cancer in young women tend to be aggressive and can progress despite being on treatment. With the cancer having spread to the lungs and bones, she would benefit from treatment that is systemic ie delivered throughout her body. Depending on the features of the cancer, different strategies may be applied. Consultation with a medical oncologist would be more appropriate.
This is a difficult time for your friend & his wife. Other than medical treatment, emotional support is important, which can come from friends & family. I wish them all the best.


Posted by Betty (Republished by Forum Admin)

I just had a mammogram done. Is there any cause for concern if vascular calcifications are noted in my right breast? I had cancer in my left breast about 15 years ago.

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

Vascular calcification are deposits of calcium within the wall of blood vessels. They do not affect the breast tissue and therefore are not a risk factor for breast cancer.


Posted by Diana (Republished by Forum Admin)

Hi,

I have a question here:

  1. What is suspicious Ductal carcinoma in-situ?

  2. Histology shows cores of breast tissue and small free lying fragments of atypical epithelial cells (negative staining and diffuse ER positivity) focally associated with necrosis and calcification. Absence of any intact ducts precludes assessment of architecture. The appearances are suspicious, but not diagnostic, of DCIS, intermediate and low nuclear grade.

What does the above means? Do they mean that it is confirmed as DCIS and is it serious?

Thank you.

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

The above statement appears to suggest that there are abnormal (atypical) cells that are suspicious of DCIS but not enough evidence to be confirmatory.

DCIS (ductal carcinoma-in-situ) is a non-invasive form of breast cancer, which with proper treatment can give almost 100% cure rates. DCIS if left untreated may progress to invasive cancer, which has poorer prognosis.

Hence, further evaluation would be advised to establish if indeed the diagnosis is DCIS, if so then you may have early treatment to get the best cure rates. This may involve requesting for a re-look at the histology slides or obtain more tissue to assess by doing a repeat core biopsy or an excision biopsy.


Posted by CL (Republished by Forum Admin)

Hi,

I did a mammogram last month and ultrasound a week after the test.

Result -
Followed up test for MAMMOGRAM.
Cysts found on both of the breasts for ultrasound. 

Question is do I need to go for follow up test for the mammogram?
Since I did the ultrasound test. 

Thank you.

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

What was the reason for performing the ultrasound a week after the mammogram?

If it was to assess an area of shadow detected on mammogram, which then correlates (on ultrasound) it to be cysts, then it depends on the nature of the cysts. If the cysts were reported to be simple, then the next mammogram could be done, following the guidelines, depending on age: 40-49 years, annually, 50 and above, once every 2 years.

However, if the ultrasound did not address the issue that requires follow-up with a mammogram, then a repeat mammogram would be necessary.


Posted by CL (Republished by Forum Admin)

Hi,

I am 42 years old.
Did a mammogram last month, felt pain and discomforted much later after the test. Ultrasound results are cysts on both breasts. 

I will still feel the pain and discomfort ever now and then. What should I do?

  1. To see a doctor but under which Specialist?

  2. Will this link to finger (last) numb (a bit)?

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

It is unlikely that the discomfort from a mammogram can last so long. There are many causes of breast pain. If your mammogram & ultrasound done last month did not reveal any worrisome features, it is an unlikely symptom for breast cancer. If you have a regular family doctor, you may approach him/her for an assessment, alternatively, you may see a breast surgeon.


Posted by L Chong (Republished by Forum Admin)

Hi, I am a 38 year old mum. I had mammogram and ultrasound done and the diagnosis was likely to be intraductal papillomas. Can you recommend a specialist in government hospital?

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

An intraductal papilloma is a growth arising from the inner lining of the milk duct (tube). Further assessment is usually advised, as most breast cancer arises from the milk ducts. The breast surgeons in the various SingHealth Hospitals (CGH, SGH, NCC, SKH) would be able to address your problem.


Posted by K Ng (Republished by Forum Admin)

Discharge from the nipple is often a sign of abnormality. Does it usually happen with no other symptoms or with lactation symptom for example breasts feeling engorged on and off but never prolonged?

Answered by Assoc Prof Tan Su-Ming, Head of Breast Surgery and Director of Breast Centre and a Senior Consultant at Changi General Hospital (CGH)

There are many causes of nipple discharge. It may or may not be associate with other symptoms. All nipple discharge should be properly evaluated to exclude underlying problems with the breast.


See previous page for information on Assoc Prof Tan Su-Ming.

Ref: M19