5.OCT.2018 5 MIN READ | 5 MIN READ

Did you know that mammography is the most effective method of breast screening?

Around the world, breast cancer is the most common cancer among women, and the disease is on the rise. In Singapore, the incidence of breast cancer has almost tripled over the last 4 decades. According to the Singapore Cancer Registry, more than 9,000 women were diagnosed with breast cancer between 2011 and 2015. That’s nearly 2,000 new cases each year.

Early detection is key

Breast cancer screening - Early detection
The good news is that early detection and treatment of breast cancer can significantly improve outcomes. When cancer is diagnosed early, more treatment options are available and there is a better chance of survival. More than 90% of women diagnosed with breast cancer at the earliest stage remain well and disease-free after 5 years or more, compared to around 15% for women diagnosed at the most advanced stage.

Screen regularly even if you feel well

Currently, the most reliable screening tool for breast cancer is the mammogram. Mammography can detect tiny lumps of early cancer in the breasts before you or your doctor can feel them by hand. That is also why the Singapore Health Promotion Board (HPB) recommends that women above the age of 50 go for mammograms regularly, even if they feel well. You can use your health insurance, such as an Integrated Shield Plan*, to cover the costs for your mammogram.

How mammography is done

Breast cancer screening - Mammography
Mammography is essentially an x-ray examination of the breast. Using low-energy x-rays, the machine captures an image of the breast with any underlying abnormalities within.

The 2 main types of mammography are film-screen mammography and digital mammography, (also known as full-field digital mammography). The main difference between them is how the image of the breast is captured – on photographic film or digitally on a computer.

For both types of mammography, the examination procedure is the same. First, a skilled technologist positions and gently compresses the breast between 2 clear plates. Next, a specialised x-ray equipment takes 2 pictures of each breast from 2 angles. Compression of the breast is necessary to reduce the thickness of the breast, which improves the picture quality by reducing overlapping shadows.

Is a mammogram painful?

Different women may experience varying levels of discomfort, and those with firm and dense fibrocystic breasts are more likely to experience some mild pain.

How can you reduce the discomfort?

Breast cancer screening - Reduce discomfort
Women can schedule their mammograms a week after their menstrual period. This avoids the period of increased breast sensitivity and tenderness that tend to occur just before and during a menstrual period.

You can take a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, about 45 – 60 minutes before the procedure.

You can also ask the hospital if cushioning will be provided during your procedure. Cushioning between the breasts and plates can help to reduce discomfort to a significant extent.

Who should go for a mammogram?

Early breast cancer does not usually have any symptoms. The HPB recommends mammography screening once every 2 years for women aged 50 and above. Women aged between 40 and 49 should seek a doctor’s advice on the benefits and limitations of mammography. If a screening is performed, the HPB advises it to be done annually.

If you experience symptoms or changes in your breast, you should consult a doctor to find out if you need to go for a mammogram.

Symptoms to look out for include:

  • A lump or mass in the breast
  • Swelling of all or part of a breast (even if no distinct lump is felt)
  • Skin irritation or dimpling (sometimes resembling an orange peel)
  • Breast or nipple pain
  • Nipple retraction (turning inwards)
  • Redness, scaliness, or thickening of the nipple or breast skin
  • Nipple discharge (other than breast milk)

Screening is also recommended for women who are at higher risk for breast cancer, such as those with a family history of the disease. Consult a physician who can help you assess your risk.

Benefits of mammography

Breast cancer screening - Benefits
Mammograms have minimal side effects. The discomfort experienced during the procedure differs from person to person, and also depends on factors such as the timing of the examination in relation to your menstrual cycle, and the skill of the technologist. The compression of the breast should not cause bruising, and most women do not feel lingering pain afterwards.

If you are concerned about the safety of x-ray exposure, rest assured that modern mammography machines use low doses of radiation. The American Cancer Society estimates that a screening mammogram gives the same amount of radiation a woman would be exposed to in her natural surroundings over a period of about 7 weeks.

Local health authorities say that the benefits of mammography outweigh radiation risks. Importantly, the mammogram enables your doctor to detect early-stage breast cancer before you feel any symptoms. It allows your doctor to spot changes in the breast, such as small white spots (calcifications), lumps or tumours (masses), and other suspicious areas (densities) that could signal cancer. The mammogram can also help your doctor decide if more testing is needed.

In Singapore, doctors are concerned that there are still breast cancer cases that are detected only at advanced stages. More women need to be aware of the benefits of regular screening. When breast cancer is discovered early, the treatment is less radical and costly. Moreover, the chances of a full recovery with a complete return to a normal lifestyle are higher.

Considering your options

For your comfort and privacy, you may choose to do your mammogram at a private hospital, where you may use your MediSave to help offset the costs. At Mount Elizabeth Hospitals, the procedure is treated as a day case so you need not stay overnight. The mammogram takes only about 20 minutes, and the results of your scan will be available within the same day when collecting your results in person. A specialist will then explain the findings to you within the same day, or at your soonest preferred date. Doctors advise you review your results as soon as possible to allay any anxiety.

Fixed priced packages are available at Mount Elizabeth Hospitals so you’ll know exactly what to expect. If you have an Integrated Shield Plan that covers private hospitals and a full rider*, you may be fully covered for the mammogram package. Call +65 6812 3776, WhatsApp +65 8799 7787, or email askme@parkwaypantai.com to find out if your insurance plan covers you for Mount Elizabeth Hospitals.

*Terms and conditions apply. Valid for full riders purchased before 1 April 2019. For more information, visit checkmyhealthcoverage.sg or contact the numbers listed above.

 

Article reviewed by Dr Wee Siew Bock, general surgeon at Mount Elizabeth Hospital

References

American Cancer Society Recommendations for the Early Detection of Breast Cancer. (n.d.). Retrieved September 12, 2018, from https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html

Breast cancer. (n.d.). Retrieved September 12, 2018, from https://www.healthhub.sg/a-z/diseases-and-conditions/20/breastcancer

Breast cancer. (n.d.) Retrieved September 12, 2018, from http://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/

Breast cancer signs and symptoms. (n.d.). Retrieved September 12, 2018, from https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html

HPB marks 10th anniversary of breast screening programme with Singapore’s largest pink ribbon formation. (September 29, 2012). Retrieved September 12, 2018 from https://www.hpb.gov.sg/article/hpb-marks-10th-anniversary-of-breast-screening-programme-with-singapore's-largest-pink-ribbon-formation

Leong, L., Tan, A., Choo, S.P., & Tan, P.H.. (June 23, 2018). Mammogram benefits outweigh disadvantages. Straits Times. Retrieved September 12, 2018, from https://www.straitstimes.com/forum/letters-on-the-web/mammogram-benefits-outweigh-disadvantages

Mammogram Basics. (n.d.). Retrieved September 12, 2018, from https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/mammogram-basics.html

Mammography Technique and Types. (n.d.). Retrieved September 12, 2018, from https://www.breastcancer.org/symptoms/testing/types/mammograms/types

Singapore Cancer Registry Annual Registry Report 2015. (June 19, 2017). Retrieved September 12, 2018, from https://www.nrdo.gov.sg/docs/librariesprovider3/Publications-Cancer/cancer-registry-annual-report-2015_web.pdf?sfvrsn=10

Watson, K. (n.d.) Do Mammograms Hurt? What You Need to Know. Retrieved September 12, 2018, from https://www.healthline.com/health/womens-health/mammogram-pain

What is a mammography? (n.d.). Retrieved September 12, 2018, from http://www.parkwayhealthradiology.com.sg/services/diagnostic_services/breast_imaging_services/mammography/

Why is early diagnosis important? (n.d.). Retrieved September 12, 2018, from https://www.cancerresearchuk.org/about-cancer/cancer-symptoms/why-is-early-diagnosis-important

5.OCT.2018
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Wee Siew Bock
General Surgeon
Mount Elizabeth Hospital

Dr Wee Siew Bock is a general surgeon practising at Mount Elizabeth Hospital, Singapore. He specialises in the diagnosis and treatment of breast disorders, with an emphasis on minimally invasive diagnostic techniques and early treatment of breast cancer with breast conserving surgery.