Breast cancer, also known as carcinoma of the breast, is the most common type of cancer in women. It is a malignant tumor that starts from the cells of the breast. Breast cancer may start from the ducts, lobules, or from other tissues within the breast. The first signs and symptoms of breast cancer include a lump in the breast, changes to the skin around the nipple, swelling or blurring of the breasts, dimpling of the skin, redness or flaky skin on part of one areola, heat radiating from the swollen area or even an inverted nipple.
Breast cancer is the most common cancer in women, however, in Singapore, breast cancer rates are lower than in other countries. Nevertheless, early detection and treatment are still important for successful outcomes. This article will provide an overview of breast cancer treatment in Singapore, including surgery, chemotherapy, and radiation therapy.
Surgery
All patients with breast cancers are offered surgery to remove the tumor. Breast-conserving surgery (or wide local excision), where part or all of the breast is preserved, may offer cosmetic benefits compared to mastectomy without compromising on overall survival. Furthermore, it has been shown that women who choose this option tend to have better psychological well-being psychologically after their surgery when compared with those who chose mastectomy. Also known as lumpectomy, the use of breast-conserving surgery has been shown to improve overall survival in ductal carcinoma in situ (DCIS) or early-stage invasive disease. Despite this evidence, only a small proportion of patients choose this option compared to mastectomy.
The decision between breast-conserving surgery and mastectomy depends on many factors including tumour size, type of tumour, patient preference, medical comorbidities, and presence of personal or family history of cancer. These factors should be considered together and discussed with the patient before deciding on a suitable breast cancer treatment in Singapore.
Chemotherapy/radiation therapy
Most patients also receive chemotherapy or radiotherapy after their surgery depending on whether they have lymph node involvement or not. This aims to prevent the recurrence of disease in the regional lymph nodes. Lymph node involvement is further classified as N1 (tumour within 2 cm of the nipple), N2 (tumour within 4 cm of the nipple), or N3 (tumours involving skin and chest wall muscles). With the modern chemotherapy regimes, complete response rates to neoadjuvant chemotherapy are good for N0/N1 patients. For those with larger primary tumours or involved lymph nodes, more intensive combination treatments such as mastectomy followed by chemoradiotherapy (TCHAP) have been shown to improve outcomes.
Radiation therapy also has an important role in adjuvant treatment after breast-conserving surgery. It can be used postoperatively or even in cases where the patient opts to undergo mastectomy instead. Radiotherapy has been shown to improve local control, disease-free survival, and overall survival for patients having breast cancer treatment in Singapore.
Chemotherapy Regimes
The most commonly used chemotherapy regimens are doxorubicin with cyclophosphamide (AC) alternating with paclitaxel or epirubicin alternating with cyclophosphamide (EC). AC is given 4-weekly for 6 cycles while EC is given 3-weekly for 6 cycles. Studies have shown that AC is more effective than EC, although the difference is small. Doxorubicin has become less common due to its cardiotoxicity; options include epirubicin, docetaxel, and capecitabine. Docetaxel has been shown to be as effective as cisplatin in metastatic breast cancer. When docetaxel is combined with gemcitabine, it significantly improves overall survival in metastatic breast cancer when compared with gemcitabine alone.
The role of chemotherapy after surgery is to reduce the risk of breast cancer treatment in Singapore. It ensures that no cancer cells are left behind. Recent studies have shown that neoadjuvant chemotherapy before surgery offers better outcomes than adjuvant chemotherapy given after surgery. This is because there are generally more cancer cells throughout the body after preoperative treatment which allows for more selective delivery of drugs during the surgical procedure. Neoadjuvant therapy has been found to be effective in locally advanced or inflammatory breast cancer
Closure!
The three main treatment options for breast cancer are surgery, radiation therapy, and chemotherapy. Each of these treatments has its own advantages and disadvantages, which must be considered when deciding on a treatment plan. Surgery is the most common treatment option, but it can be invasive and may not be suitable for all patients. Radiation therapy is less invasive than surgery and can be used in combination with chemotherapy. Chemotherapy is the most aggressive form of treatment, but it can also be very effective in treating breast cancer. When choosing a plan of breast cancer treatment in Singapore, it is important to consider the individual patient’s needs and preferences.
