Breast Cancer: Symptoms And Causes

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Breast cancer is the most common cancer among Singaporean women. More than 25% of all cancers diagnosed in women are breast cancers and between 2011 and 2015, about 1927 women were diagnosed with it in Singapore each year.

What is Breast cancer?

Breast cancer is the abnormal growth of cells in the breast. These cells grow and develop into a cancerous growth that can have the potential to spread to other parts of the body.

It usually originates from the cells lining the milk ducts and glands. When it is detected at this non-invasive or in-situ stage, treatment is easier and patients have a higher chance of recovery.

However, when cancer cells invade the surrounding tissue, known as the stroma, it can gain entry into the circulatory and lymphatic system, and hence, to other organs in the body, through the blood and lymphatic vessels found in the stroma. And when these cancer cells reach a new site, they may form a metastatic tumour. The organs most commonly affected by this are the lungs, bones, and liver.

Breast Cancer Signs & Symptoms

Symptoms of Breast Cancer may include the following:

  • Bleeding or unusual discharge from the nipple
  • Painless lump in the breast
  • Change in how the nipple looks
  • Armpit pain
  • Skin dimpling
  • Pull in nipple
  • Skin texture change
  • Skin irritation

Guidelines on Breast Screening for Normal Risk Women without Symptoms:

39 years and below
  • Monthly breast self-examination
40 – 49 Years
  • Monthly breast self-examination
  • Consider mammography screening once a year – discuss this with your doctor
50 – 69 years
  • Monthly breast self-examination
  • Mammography screening once every 2 years

Breast Cancer Risk Factors

There is no single cause of this cancer, however, there are a number of risk factors that can increase your chance of developing it including genetic, lifestyle, and environmental factors.

Breast Cancer

These may include:

  • Being female. Women are much more likely than men
  • Increasing age. Your risk increases as you age.
  • A personal history of breast conditions. If you’ve had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk.
  • A personal history of breast cancer. If you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
  • A family history of breast cancer. If your mother, sister or daughter was diagnosed with it, particularly at a young age, your risk of this cancer is increased. Nevertheless, the majority of people diagnosed with breast cancer have no family history of the disease.
  • Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of this cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. So that these genes can greatly increase your risk of breast cancer and other cancers, but they don’t make cancer inevitable.
  • Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk is increased.
  • Obesity. Being obese increases your risk.
  • Beginning your period at a younger age. Beginning your period before age 12 increases your risk.
  • Starting menopause at an older age. If you began menopause at an older age, you’re more likely to develop this cancer.
  • Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk.
  • Having never been pregnant. Women who have never been pregnant have a greater risk of this cancer than do women who have had one or more pregnancies.
  • Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk. The risk of breast cancer decreases when women stop taking these medications.
  • Drinking alcohol. Drinking alcohol increases the risk.

Types of breast cancer

These are many different types, some of which are common, while others are very rare. Some of these include:

  • Invasive ductal carcinoma (IDC) – IDC is the most common type. In the case of IDC, cancer began in the milk duct and has now spread through the duct wall to other breast tissue.
  • Invasive lobular carcinoma (ILC) – Rather than beginning in the milk duct, ILC originates in the milk glands (known as lobules) and invades nearby areas of the breast.
  • Inflammatory breast cancer (IBC) – Unlike other types of breast cancer, IBC does not involve a lump in the breast. Instead, the skin of the breast may become red, inflamed, thick or pitted (like an orange), your nipple may become inverted, and the breast may become swollen, hard, tender and painful, or itchy. IBC is a rare type and is more likely to be advanced upon diagnosis, as it is difficult to identify using a mammogram.


Following a diagnosis, further testing is then conducted to identify the receptor status of cancer. Cancers will be classified as hormone receptor-positive or negative depending on whether they have proteins that are estrogen or progesterone receptors. Your cancer may be classified as ER+ (has estrogen receptors), PR+ (has progesterone receptors), HR+ (has one or both of these receptors), or HR- (has neither of these receptors). And your cancer may also be classified as HER2 positive or negative. HER2 is a protein that promotes the growth of cancer cells and in HER2 positive, there are higher than normal levels of HER2.

  • HR-positive HER2 negative – This is the most common form of breast cancer. An HR+ HER2- classification means cancer has estrogen or progesterone receptors but does not overexpress the gene HER2. As a result, it is typically treated using hormone therapies.
  • HER2 positive  – 25% of all breast cancers are HER2-positive, which is more common in women below the age of 60. HER2-positive often spreads faster than other breast cancers but responds well to treatments that target the HER2 protein (known as targeted therapies).
  • Triple-negative  – Triple-negative breast cancer accounts for 15% of all breast cancer cases and is invasive. It is classified as triple-negative because it does not have the three proteins that are typically found on breast cancer cells: estrogen, progesterone, and HER2 receptors. It is more common in women younger than 40 or who have the BRCA1 gene mutation.


Diagnosis is based on:
  • Clinical examination
  • Mammography
  • Ultrasound scan of the breast

To confirm the diagnosis, a breast biopsy is performed to remove a piece of tissue for examination under a microscope.

Diagnosis of Breast Cancer

Common biopsy techniques include:
  • Fine Needle Aspiration (FNA)
  • Core Needle Biopsy
  • Excision Biopsy
  • Sentinel Lymph Node Biopsy (SLNB)

Where to get tested

You can arrange a clinic visit online at MaNaDr application to see a doctor if you are showing any symptoms.

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