tips from SingHealth specialists on how to prevent breast cancer, also who is at risk
Breast cancer is the most common cancer among women in Singapore today, with one out of 13 women likely to be afflicted by it.
Breast cancer often happens in women with no risk factors, but you can help yourself by adopting the following habits all year long for optimum breast health: observe, self-examine, screen.
Although most lifestyle factors influence risk of breast cancer only to a minor extent, here are some tips to keep your breasts and your body healthy.
7 Tips for lifelong breast health
- Maintain a healthy body weight
Maintain a BMI less than 23 throughout your life. Weight gain and obesity may increase your risk of breast cancer.
- Make time for regular exercise
Adopt an active lifestyle. Aim for 30 minutes or more of moderate aerobic activity at least five days per week.
- Minimise or avoid alcohol
Alcohol is one of the most well-established dietary risk factor for breast cancer. Women who consume more than two glasses of alcohol a day are at higher risk.
- Eat more veggies
Consume more cruciferous vegetables (broccoli, cabbage, cauliflower), dark leafy greens, carrots, tomatoes, citrus fruits, berries and cherries.
- Target motherhood
Target to have your first child before 30. Mothers who breastfeed their babies for six months or longer may have a slightly lower risk of developing breast cancer.
- Early detection is your best protection
Breast self-examination is recommended once a month about 1 week from the first day of menses. For women who no longer menstruate, choosing a date each month is an easy way to remember. Be sure to notify your doctor any breast changes such as redness, swelling, presence of a lump, skin changes or discharge from the nipple. For how to perform breast self-examination, see below.
For women between the ages of 40 to 50: a mammogram every year after consultation with their doctor
For women above the age of 50: a mammogram once every two years
- Quit smoking (if you haven't)
The risk of many cancers, including breast cancer, and other health problems increases if you smoke.
Steps to perform breast self-examination
Look for changes in front of a mirror. First, with arms at your sides. Next, with arms raised above your head. Finally, with hands pressed firmly on hips and chest muscles contracted
In each position, turn slowly from side to side and look for:
- Change in size or shape of your breasts
- Dimpling of the skin
- Change in nipples
Feel for the changes lying down. Put a small pillow under your right shoulder. Place your right hand under your head
Use the pulp of your left fingers to feel for any lumps or thickening in your right breast. Feel for the changes lying down. First, feel the armpit. Then start on the outside edge of your breast and feel round the whole breast in smaller and smaller circles. Finally, feel behind the nipples itself.
Look for bleeding or discharge from the nipple. Squeeze the nipple gently to see if there is bleeding or any discharge.
Repeat step 2 and step 3 for the left breast.
Breast cancer screenings for Singapore Citizens and PRs
Here is a step-by-step on how to book for a mammogram screening through the national Screen for Life (SFL) programme.
1. Find out your screening eligibility
Subsidies for breast cancer screening are only available for women above the age of fifty, once every two years.
|||Pioneer Generation: The screening mammogram will be $25.|
|||: The screening mammogram will be $37.50. Merdeka Generation (with effect from 1 Nov 2019)|
|||Community Health Assist Scheme (CHAS) Cardholders - Blue or Orange: You will be able to enjoy further subsidies on your screening mammogram. Visit chas.sg for more information.|
|||: The screening mammogram will be $50. Community Health Assist Scheme (CHAS) Cardholders - Green / Singapore Citizens (with effect from 1 Nov 2019) / Singapore Citizens|
|||: The screening mammogram will be $75. Permanent Residents|
The screening can be paid using MediSave at approved centres. Click here to find out more about MediSave and the list of approved centres.
2. Book a screening
- An appointment is required for a mammogram.
- Make an appointment at your nearest polyclinics and public/private healthcare institutions.
- Schedule your appointment one week after the first day of your menstrual period.
- Bring your NRIC, CHAS/MG/PG card and relevant document(s) to the clinic for the screening appointment.
*Please call ahead to check before your appointment.
3. Prepare for screening
On the day of screening:
- Wear a two-piece outfit as you will need to undress from the waist up.
- Do not use any perfume, deodorant, powder or ointment on your underarms or breasts as this may affect image clarity.
4. After the screening
- If your results are normal (do not need to follow up at the hospital), continue to go for regular screening at the recommended frequency.
- If your results are abnormal, you will be referred to a hospital to have further investigations done. It is important for you to attend this follow up at the hospital.
What puts you at risk of breast cancer?
Dr Lim Geok Hoon, Senior Consultant for KK Breast Centre at KK Women's and Children's Hospital (KKH), a member of the SingHealth group, shares the risk factors for breast cancer.
As a woman, your risk of developing breast cancer is higher if you:
- Are > 50 years old
- Have a close relative (mother, sister or daughter) who has breast cancer or if you have a genetic mutation
- Have taken hormone replacement therapy for more than 5 years after menopause
- Have previous breast biopsies that have shown abnormal results
- Had specific types of radiotherapy for lymphoma.
Breast cancer risk is also increased, though less markedly, if a woman:
- Has never been pregnant or had her first pregnancy after the age of 30
- Began to menstruate before the age of 12, or reached menopause after the age of 55
Do bear in mind that breast cancer can affect anyone at any time, even in the absence of high-risk factors.
Early signs of breast cancer to watch out for
Early detection saves lives. When breast cancer is detected early, there are more treatment options, less radical surgery required and better chances of complete recovery.
The most common symptom of breast cancer is a lump in the breast. It is usually single, firm and often painless. Other tell-tale signs include:
- Swelling on a part of the breast or underarm;
- A previously protruding nipple that becomes inverted;
- A persistent rash at the nipple or areola;
- Bloodstained discharge from the nipple; and
- A change in the size or shape of the breast=
- A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling
Is preventive mastectomy advisable?
Back in 2013, famous Hollywood actress Angelina Jolie made headlines when had both her breasts removed to reduce her high genetic risk of developing breast cancer. How common is preventive mastectomy in Singapore?
"In Singapore, preventive mastectomy is performed for rare patients who carry specific mutated genes," explains Dr Lim.
"Carriers of mutations in the BRCA1 or BRCA2 genes have more than a 50 per cent risk of developing breast cancer in their lifetime. When that mutation is detected, one of the recommendations would be to perform a preventive double mastectomy, usually when the woman is in her 30s," Dr Lim added.