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In-house breast imaging unit at KK Breast Centre.

Busting the Fear for

Breast Cancer
by

Yah Yuen Tan

Consultant Surgeon, KK Breast Centre
KK Womens and Childrens Hospital, Singapore

Sze Yiun Teo

Consultant Radiologist, Diagnostic Imaging
KK Womens and Childrens Hospital, Singapore

www.asiabiotech.com Volume 12 > Number 7 > 2008 49


Radiologist helping patient to position the breast in preparation for digital mammography.
One in 17 women above the age of 40
will be diagnosed with breast cancer.
Breast cancer is the number one cancer
affecting Singapore women. Because
of this, KK Womens and Childrens
hospital has a specialized team of
doctors, nurses and paramedical staff
dedicated to the early detection and
treatment of breast cancers all
of whom are housed within the KK
Breast Centre.
T
he KK Breast Centre is a one-
stop centre fully dedicated to looking
after breast Health. The centre
uses state-of-the-art breast imaging
to provide digital mammography,
breast ultrasonography, surgical
consultation, minimally invasive
biopsies and procedures all under one
roof, with quick turnaround time.
We take a look at two key
cutting-edge technologies available
at the centre.
50 Volume 12 > Number 7 > 2008 www.asiabiotech.com
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Digital Mammography
Many women are not aware that
regular screening for breast cancer
allows the cancer to be detected early;
located in the armpit. Typically, when
and early detection and treatment
increases the likelihood of a cure.
Having a mammogram
which essentially is an X-ray of
all armpit nodes) to check for the
the breasts done on an outpatient
basis is key in picking early stage
abnormalities in the breast. With
the help of a radiographer (the
healthcare professional performing
the mammogram test), the patient
positions her breast for a gentle
compression from the mammogram
equipment. This compression is
necessary to examine maximum
breast tissue. Having a mammogram
done on a one- to two-yearly basis
is important when a woman is more
than 40 years old.
At KK Womens and
Childrens Hospital, the
KK Breast Centre is the
worlds first to provide
FDA-approved digital
mammography services that
leverages on the synergy of
computer radiography and
computer-aided detection.
This synergy of technologies
enables the radiologist to manipulate
the mammogram images in real-time,
be it zooming in or magnifying the
image. It can also highlight breast
abnormalities to the radiologist for
further interpretation.
Digital mammography has been
proven superior to film mammography
for women with dense breasts, pre
and peri-menopausal women and
women younger than 50 years old.
Sentinel Lymph Node Biopsy
When breast cancer cells move or
metastasize to other parts of the
body, the first lymph node that they
will travel to is the sentinel lymph
node one of the many lymph nodes
a patient is diagnosed with breast
cancer, they must undergo axillary
lymph node dissection (removal of
spread of cancer. This process helps
to stage the cancer to check for
how advanced the cancer cells have
grown. Removal of armpit nodes,
however, would sometimes lead to
chronic swelling of the arm.
To prevent unnecessary removal
of armpit nodes and hence needless
chronic swelling of the arm, sentinel
lymph node biopsy is performed. Two
medicines are first injected into the
breast to track the drainage of fluid
from the breasts into the armpit.
These include a medicine with a very

The radiologist uses computer aided detection to help magnify or zoom into the mammogram images.
tiny amount of radioactivity (only
one-sixth of which is used in a normal
bone scan) and a blue dye. At the
time of operation only the sentinel
nodes are retrieved with the help
of those two medicines and will
then be examined immediately. If
these nodes are free of cancer, no
further nodes are removed from the
armpit. Conversely, if the sentinel
nodes are not affected, the surgeon
then continues to do a complete
removal of underarm nodes.
Because of the benefits for the
patient, the sentinel lymph node
biopsy is becoming the standard
of care in the management of early
breast cancer.
Having performed more
than 200 sentinel lymph
node biopsies, breast
surgeons at the KK Womens
and Childrens Hospital have
also helped to train other
doctors in this aspect.
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[ Special Feature ]
With the advent of modern
medical science, screening methods
are now less invasive and more
accurate, translating into obvious
benefits for patients. The high
incidence rate of breast cancer should
not cause panic amongst women,
but should serve as a reminder
for women to start regular breast
screening at an appropriate age;
because early detection of breast
cancer is highly treatable with good
clinical outcomes.
Breast Cancer Facts:
The Basics
Causes
Breast cancer, like cancer originating
in other parts of the body, can occur
because the cells in the tissue have
undergone an irreversible change.
This change has given the cells the
ability to continue growing and
multiplying in an uncontrolled
manner.
It is not clear how this change
has come about. One theory is that
it is the accumulative effect of an
unhealthy diet and lifestyle over
a long period of time. This may
explain why the number of women
diagnosed with breast cancer is higher
in Western developed countries and
modern societies, compared to the less
developed and rural regions. There is
no evidence that antiperspirants,
underwire bras, previous injury or
yearly mammograms cause breast
cancer.
In 5% to 10% of women, breast
cancer occurs because of a genetic
abnormality. This abnormality may
occur spontaneously in the woman,
or it may have been inherited from
her ancestors. If it is an inherited
genetic abnormality, there often will
be other members of her extended
family who may have breast cancer,
ovarian cancer or other types of
cancer. However, more than 80%
of newly diagnosed women do not
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but as the cancer grows, the following
symptoms may appear:
a persistent lump or thickening
in the breast or armpit area,
changes in the color or skin of the
breast, areola or nipple (example
dimpling or puckering),
nipple retraction or changes, or
blood or discharge from the
nipple.
Clinical Outcomes of
KK Womens and Childrens
Hospital for Breast Cancer
The average five-year survival rates of
each of these stages are as follows:
Ultrasound of breasts is sometimes done
so that the doctor can accurately locate the Stage Clinical Outcome
abnormality. 0 99%
I 96%
II 85%
have a family history of breast or III 54%
other cancers.
IV 20%
childrens hospital in Asia to have
received accreditation from the Joint
Commission International.
In 2007, more than 35,000
international patients came to seek
medical treatment at KK Womens
and Childrens Hospital. International
patients come for any of the 45
subspecialties the hospital provides
for both women and children, and
need not worry about logistical
arrangements. The International
Medical Services Department at
the hospital provides assistance
such as suitable doctor referral,
medical appointments, medical
evacuation, travel arrangements,
transport and accommodation and
language translators. n

Risk Factors However, it is important to note that

There is a higher risk of getting breast
cancer if one is:
above 40 years old and female,
have a close relative like mother,
sister or grandmother who has
breast cancer,
have taken hormone replacement
therapy for more than five years
after menopause, or
have previously had certain types
of abnormal breast biopsy.
these numbers are averaged figures.
Each patient is unique with multiple
factors contributing to her final
survival. With rapid improvements
in breast cancer treatments, it is
expected that these figures are
improving even as you read this.
These figures further emphasize
that detection of breast cancer at an
early stage offers the best chance of
cure and survival.

Breast cancer can, however, affect
anyone at anytime, with or without
the risk factors. It is therefore
important to perform monthly breast
self-examination, yearly mammogram
and clinical breast examination by a
medical professional.
Signs and Symptoms
There is usually no pain or symptom
when breast cancer is its early stages,
International Patients at
KK Womens and Childrens
Hospital
KK Womens and Childrens Hospital
is the only teaching hospital for
pediatrics in Singapore. Focusing on
subspecialty care for only women
and children makes it possible for
the hospital to constantly achieve
excellent clinical outcomes. The
hospital is also the only womens and
Contact Details:
KK Womens and Childrens Hospital
Address: 100 Bukit Timah Road
Singapore 229899.
Appointments for international
patients, please contact us at:
Tel: +65 6394 8888
(24-hour hotline)
Fax: +65 6292 5145
Email: international@kkh.com.sg
URL: www.kkh.com.sg

52 Volume 12 > Number 7 > 2008 www.asiabiotech.com

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Picture courtesy of A.D.A.M Medical Illustration

Location of sentinel lymph node KK breast surgeon, Dr Yah Yuen Tan, consulting a patient.

About the Authors

Dr Yah Yuen Tan (MBBS, FRCS (Edin), FRCS (Glasg), FRCSEd (Gen Surg), FAMS)
developed a keen interest in breast diseases and cancer very early on during her training years at
the Singapore General Hospital and the Tan Tock Seng Hospital. This interest has grown over the
years and today she passionately believes that the standard of care for breast cancer patients in
Singapore can be equivalent to that of international renowned cancer centers around the world,
after spending training stints in both the US and Japan. Dr Tan is also a Fellow of the Royal College
of Surgeons (Edinburgh and Glasgow).

Dr Tans sub-specialty interests include minimally invasive breast biopsy methods, sentinel lymph
node biopsy for breast cancer and mammary ductoscopy.

Dr Sze Yiun Teo (MBBS, FRCR (UK)) is a consultant radiologist from the Department of
Diagnostic Imaging, KK Womens and Childrens Hospital. She specializes in breast imaging,
image-guided breast biopsy and womens imaging. She is actively involved in patient care and
clinical research in these areas. In addition to her role as Fellow of the Royal College of Radiology
(UK), Dr Teo is also a member of the Singapore Radiological Society as well as the American
Roentgen Ray Society.

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