Breast cancer in Singapore: some perspectives

Abstract

Breast cancer is the commonest malignancy among Singapore women, accounting for 29.7% of all female cancers, with an age-standardized rate of 54.9 per 100,000 per year. It has been the most frequent cancer in Singapore women for the last 30 years, with the highest rates previously reported in those aged between 45 and 49 years, but with a more recent observation of a change in peak age group to women in their late 50s. About 1,100 new cases are diagnosed annually and approximately 270 women die in Singapore each year from breast cancer. In the multiethnic population of Singapore, it has been noted that rising breast cancer incidence is consistent across all three ethnic groups (Chinese, Malays, and Indians). Singapore has among the highest breast cancer incidence in Asia. Possible explanations include rapid urbanization, improvement in socio-economic status, and adoption of a western lifestyle. Our experience with the Singapore breast screening pilot project (1994-1997) and the national breast-screening program (BreastScreen Singapore) has led to increased understanding of this disease in the country. Data from the pilot project showed that breast screening is just as effective in a predominantly Asian population as in the west. Early breast cancer accounted for most breast cancers detected, with pre-invasive ductal carcinoma in situ (DCIS) comprising 26% of all screen-detected cancers in the pilot study. In the currently on-going BreastScreen Singapore, DCIS forms >30% of all breast cancers among pre-menopausal women, a relatively high proportion probably accounted for partially by the greater participation of women aged between 40 and 49 years. Despite the ready availability of subsidized mammographic screening, there are still women in Singapore who present with locally advanced breast cancer. Clinical management of an increasing number of women with breast cancer embraces a multidisciplinary team-based approach, with regular discussions of therapeutic strategies at tumor boards. In order to improve breast cancer diagnostics and therapeutics in our country, it is important that there are continual breast cancer and breast disease-related educational activities for medical professionals engaged in diagnosing and managing breast cancer. The role of public education in raising awareness is also essential.

Time trends of cancer incidence in urban Beijing, 1998–2007

“…Recent studies show that, similar to the countries and regions that had rapid socioeconomic growth, western lifestyle, mental stress or anxiety, early age at menarche, late age at menopause, non-breastfeeding and the history of benign breast diseases might be the risk factors for the higher incidence rate of breast cancer in urban Beijing [15][16][17][18] .…”

The hOGG1 Ser326Cys polymorphism and breast cancer risk: a meta-analysis

“…Breast cancer is one of the most frequently diagnosed cancers in women [13], and the mortality rate was high in the worldwide women [14,15]. It is well-established that breast cancer was induced by many endogenous and exogenous factors, such as the level of hormone, the capacity to repair damaged DNA, and different genetic background [16].…”

Systematic Review of Emerging Models of Cancer Care: Implications for the Health Industry

“…In a Singapore study looking at women with breast cancer, the screening program, BreastScreen Singapore, adopted several factors including weekly multidisciplinary review sessions, to improve breast cancer detection rates [33]. It was discussed that there are logistical and cost barriers to implement collaboration.…”

“…It was reported that more specialized surgeons participated in a greater amount of collaborative communication because they were more willing and/or had greater opportunities to invest in same day appointments and weekly tumor board meetings. Surgeons with a smaller breast cancer patient load would better benefit from virtual tumor boards [32,33].…”