Clinical Assistant Professor Faith Leong, Consultant in Breast Surgery, Department of Surgery at Sengkang General Hospital (SKH), answers your questions on the most common cancer affecting Singaporean women – breast cancer.
1 in 12* women in Singapore will get breast cancer.
Breast cancer is the most common type of cancer in women today and the leading cause of cancer mortality in Singaporean women.
The incidence of breast cancer in Singapore has
more than tripled over the last 50 years, with about 2,500 women diagnosed each year.
Given the gravity of the situation, it is pertinent that women are aware of their risk and take steps to protect their health.
With advances in surgical techniques and therapy, this dreaded diagnosis is no longer a death sentence.
The 5-year survival rates for women with breast cancer are:
Early detection is your best protection
The goal of screening is to detect cancers at an early stage before any symptoms develop, facilitating timely and effective treatment.
In addition to mammogram screening, each woman should perform
breast self-examination regularly (click the link to learn how to perform it correctly), looking out for new breast lumps, nipple discharge, as well as changes to the skin or nipple.
If any of these symptoms are present, it is critical to consult a medical professional for further advice. Lastly, women should endeavour to maintain a healthy weight, avoid tobacco and alcohol, and stay physically active through regular exercise to lower their risk for cancer development.
In this "Ask the Specialist" Q&A, don't miss the chance to ask Dr Faith Leong any question pertaining to the risk, prevention and treatment of breast cancer. Together, we can protect ourselves and our loved ones!
* source: According to the Singapore Cancer Registry Annual Report 2022.
About Clin Asst Prof Faith Leong
Clinical Assistant Professor Faith Leong is a Consultant in Breast Surgery, Department of Surgery of Sengkang General Hospital (SKH) and a member of the SingHealth Duke-NUS Breast Centre.
Her areas of clinical interest are in breast cancer and oncoplastic surgery, where emphasis is placed on balancing oncologic safety with cosmetic outcomes. She believes that patient care should be holistic and individualised to each patient through their treatment journey.
Questions and answers on breast cancer
1. Question by Mdm Phua
Dear Dr Leong,
My mum who is 71 years old was diagnosed with Stage 2 breast cancer on her right breast and non-cancerous lesions on her left breast in Nov 2024. She had her full right breast removed and partial removal of left breast (extraction of lesions) in Feb 2024.
She was recommended to go for Oncotype scan after her surgery. Is it a standard protocol for all breast cancer patients? She did not opt for Oncotype hence her doctor out her on 5 years hormone therapy only. She needs not have to go for radiotherapy nor chemotherapy.
We went to 2 different hospitals, one hospital recommended both breasts removable while another hospital recommended only right breast removable and partial left breast lesions extraction. Is there a standard protocol to follow when it comes to breast cancer treatment?
Thank you.
Answer by Clin Asst Prof Faith Leong
Dear Mdm Phua,
Thank you for your questions. Breast cancer treatment is increasingly complex and must be tailored to each patient’s condition and wishes. The oncotypeDx test is a widely employed and validated test which aids in our decision-making for breast cancer treatment. This test is not recommended for everybody, as only certain patients who fit criteria will be suitable. I urge you to discuss this in greater detail with your breast specialist or oncologist who can advise you and your family about this.
Unfortunately, there is no one standard protocol for the surgical treatment for breast cancer. The pros and cons of a partial vs full removal of the breast should be discussed with a breast specialist to find out which option is best suited for the patient’s clinical condition.
2. Question by Serene
Dear Dr Leong,
Should I consult a doctor if I experience pain in the breasts?
Answer by Clin Asst Prof Faith Leong
Dear Serene,
Breast pain, also known as mastalgia, is a very common condition experienced by women.
Fortunately, breast pain alone is usually not a sign of breast cancer, but other non-cancerous conditions.
Cyclical breast pain, which presents as pain worse in a week prior to the period and improves after the period starts, is due to normal changes in hormone levels in a woman’s body. Pain that is not affected by the menstrual cycle, also known as non-cyclical breast pain, can be from the breast or the muscles, bones or joints of the ribcage.
You should seek medical attention if your pain is persistent or associated with other symptoms like a breast lump, nipple discharge or changes to the appearance of the skin or nipple.
3. Question by Devi
Dear Dr,
I would like to know more details on benign condition turning into cancer.
The reason is because my mother and her youngest sister passed away after getting breast cancer.
As advised by my company doctor, I have been doing mammogram every year. However the last year doctor advised me to do mammogram alternate years and told to do scan for the year not doing mammogram.
My condition for the past years are benign. However I have contact hand pain similar to my late mother before she had breast cancer.
The pain had been a constant worry for me. Appreciate your advice. Thank you.
Answer by Clin Asst Prof Faith Leong
Dear Devi,
I am sorry to hear about your family members who had breast cancer.
In accordance with Singapore’s guidelines, women can start screening for breast cancer with a mammogram at the age of 40. A mammogram, which is an x-ray of your breasts, is currently the most reliable screening tool for breast cancer. For those aged 40 – 49 years, a mammogram can be performed once a year. For those who are 50 years old and above, a mammogram should be performed once every 2 years.
Given your family history, it is natural to be concerned that you might have a higher than average risk for breast cancer. I would urge you to talk to your doctor to consider a referral to our genetic counselling service at the National Cancer Centre for a risk assessment for hereditary breast and ovarian cancer syndrome. Genetic testing can be considered to find out if you have an inherited genetic mutation which may warrant heightened surveillance for breast cancer.
I do want to reassure you that breast pain alone is not typically a symptom of breast cancer. However, if your pain is persistent or associated with other symptoms like a breast lump, nipple discharge or changes to the appearance of the skin or nipple, please do consult a breast specialist for further evaluation.
4. Question by Pavai
Dear Dr Faith Leong,
I am 47 years old. August 18th, I went for community drive Mammogram. And results showed no issues and all good.
But from September 1st I got a left side chest pain and underarm pain. Which spread to my hand too. Still haven’t recovered.
Already check heart and done full blood test which is normal.
So I thought chest pain is due to muscle pain so went for TCM massage. Yesterday TCM doctors said while do massage they found few lumps in my upper breast. So ask me to go check.
Please advise whether I have to go for Mammogram again? Or I can wait and monitor?
Answer by Clin Asst Prof Faith Leong
Dear Pavai,
Thank you for your question. You raise an important point that women with left sided pain may have pain arising from a heart condition instead of the breast. It is good that you have undergone evaluation for your heart which is normal.
Many of our patients do have pain arising from the muscles, bones and joints of the chest wall.
However, the concern raised by your TCM of breast lumps should be thoroughly evaluated by a breast specialist. While mammograms are the best modality for screening for breast cancer, no screening test in medicine will be 100% sensitive or accurate.
Hence, any new breast symptoms, especially lumps, nipple discharge and nipple changes, should prompt a visit to your doctor for further examination and investigations.
5. Question by Michelle
Dear Hi Dr Leong, hope all is well for you.
I have the following questions on breast care:
a) I am a Chinese lady at an age of 36. How can I take proper care of my breast?
b) Understand that I will need to do a mammogram from age 40 onwards and have hear of frightening stories that the screening can be quite painful. May I know what are the ways to lessen the pain?
c) What type of food and exercise should I do to give proper tender loving care to my breast 😊
d) Lastly, any additional information I should be aware of when it comes to breast care?
Hope to hear from you soon and God bless. Thanks.
Answer by Clin Asst Prof Faith Leong
Dear Michelle,
Thank you for your questions. You are right that mammograms are recommended from age 40 and onwards. For those younger than 40 years old, it is important to perform breast self examinations once a month. This is best done 1 week after the first day of your menstrual period. You can learn more about breast self examination by
visiting this page on the SingHealth website.
Mammograms can be uncomfortable for women due to the compression applied in order to get a clear image. The experience is different for each woman. For reduced discomfort, you can consider scheduling your mammogram 7 to 10 days after the start of your period when your breasts will be least sensitive. You can also consider taking some painkillers e.g. paracetamol before the procedure.
A balanced diet and regular exercise are indeed important in maintaining general health and lowering your risk of cancer development. To learn more about what constitutes a healthy diet, you can refer to
Health Promotion Board’s (HPB) My Healthy Plate informative website.
One thing to limit consumption of will be alcohol, as that has been shown to be associated with an increased risk of breast cancer.
Physical activity is also an important lifestyle modification to reduce your risk of breast cancer. Adults should aim for 150 to 300 minutes a week of moderate to intense physical activity. For more information on Singapore’s physical activity guidelines, you can
visit this page on HPB.
6. Question by Catherine
Hi Dr,
I am 67 years old. What food should I avoid or eat to prevent having breast cancer?
I had a breast biopsy done a month ago and it is negative. Thank you and best regards.
Answer by Clin Asst Prof Faith Leong
Hi Catherine,
Good to hear that your biopsy is negative for cancer. Do continue to go for your regular mammogram screenings (every 2 years for those 50 years old and above) in the future too!
There is no one food that directly causes breast cancer. However, one thing to limit will be alcohol consumption as alcohol intake has been shown to be associated with increased risk for breast cancer.
A balanced diet is important for maintenance of a healthy weight, as excess weight increases the risk of breast cancer. The foundations of healthy eating include increasing the proportion of fruit, vegetables and wholegrains in your diet and choosing lean meat or plant-based proteins.
You can refer to the
Health Promotion Board’s (HPB) My Healthy Plate website for more information.
7. Question by SP Teo
Dear Dr Leong,
I know of many friends who dislike the mammogram screening due to their weight. They are thin and slim. The agony of the compression process during a mammogram is the main deterrent.
a) May I know is there an alternative as going for an ultrasound instead of mammogram?
b) If a patient, aged 60 and above who had undergone surgery of the breast 20 years ago, and the result was benign and also the result of the yearly screening for the past years were all negative. Does it mean that she can be declared clear of potential attack of breast cancer?
c) Breast cancer is commonly found in which age range and at which age is women unlikely to suffer from breast cancer?
I look forward to hearing from you. Thank you and with regards.
Answer by Clin Asst Prof Faith Leong
Dear SP Teo,
Thank you for your questions.
The concerns that your friends raise regarding the discomfort of a mammogram are very real and common amongst women. However, that compression applied is essential in order to get a clear image of the breasts. The experience is different for each woman.
For reduced discomfort, you can consider scheduling your mammogram 7 to 10 days after the start of your period when your breasts will be least sensitive. You can also consider taking some painkillers e.g. paracetamol before the procedure.
Ultrasounds can be added on to a mammogram for supplemental screening in some scenarios. However, it does not replace a mammogram as a common sign of early cancer (microcalcifications) are often only seen on mammogram. Screening with only ultrasound may miss this sign of early cancer, and hence mammograms, despite their limitations, remains the best modality for screening in breast cancer.
Unfortunately, no woman can ever be cleared of breast cancer risk despite having previous benign conditions and normal mammograms. The risk of breast cancer increases with age, hence we encourage women of all ages to continue mammogram screening as long as they are in good health. Women less than 40 years old are less likely to be diagnosed with breast cancer than women above the age of 40.
However, there is an increasing trend of women diagnosed at a young age and hence symptoms such as breast lumps, nipple discharge, nipple or skin changes over the breast should never be dismissed.
8. Question by Evelyn
Dear Prof Leong,
I was recently diagnosed with stage O carcinoma-in-situ breast cancer. May I know if there is any food or supplements that I should avoid consuming? I am currently taking Letrozole. Thank you.
Answer by Clin Asst Prof Faith Leong
Dear Evelyn,
Stage 0 breast cancer is the earliest stage of breast cancer with extremely good prognosis if treated.
I assume that you have had surgery to excise the cancer and you are taking the medication letrozole after surgery because the tumor cells are positive for hormone receptors.
The most important thing to avoid is medication or supplements that contain estrogen or progesterone, such as hormone replacement therapy sometimes prescribed for menopausal symptoms.
Unfortunately, there is not enough information to say that alternative treatments or supplements are safe to be taken together with letrozole as many of them are not tested the same way as prescription medications. If in doubt, do clarify with your oncologist or prescribing physician.
Ref: H24
