Breast Cancer

, 17:23 | Cite as

Breast cancer in Singapore: some perspectives

  • Ana Richelia Jara-Lazaro
  • Shyamala Thilagaratnam
  • Puay Hoon Tan
Special Feature Breast pathology in Asia

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.

Keywords

Breast cancer Ductal carcinoma in situ Asia Screening Pathology 

References

  1. 1.
    Singapore Cancer Registry Interim Report. Trends in Cancer Incidence in Singapore 2002–2006, National Registry of Diseases Office.Google Scholar
  2. 2.
    International Agency for Research on Cancer. Cancer incidence in five continents volume, vol. VIII. Lyon: IARC; 2002.Google Scholar
  3. 3.
    Wang H, Seow A, Lee HP. Trends in cancer incidence among Singapore Malays: a low-risk population. Ann Acad Med Singapore. 2004;33:57–62.PubMedGoogle Scholar
  4. 4.
    Sim X, Ali RA, Wedren S, Goh DL, Tan C-S, Reilly M, et al. Ethnic differences in the time trend of female breast cancer incidence: Singapore, 1968–2002. BMC Cancer. 2006;6:261.CrossRefPubMedGoogle Scholar
  5. 5.
    Chia KS, Lee JJM, Wong JLL, Gao W, Lee HP, Shanmugaratnam K. Cancer incidence in Singapore, 1998 to 1999. Ann Acad Med Singapore. 2002;31:745–50.PubMedGoogle Scholar
  6. 6.
    Wee SB. The case for breast cancer screening in Singapore. Singapore Med J. 2002;43(5):221–3.PubMedGoogle Scholar
  7. 7.
    Wang SC. The Singapore National Breast Screening Programme: principles and implementation. Ann Acad Med Singapore. 2003;32:466–76.PubMedGoogle Scholar
  8. 8.
    Ng EH, NG FC, Tan PH, Low SC, Chiang G, Tan KP, Seow A, Emmanuel S, Tan CH, Ho GH, Ng LT, Wilde CC. Results of intermediate measures from a population-based randomized trial of mammographic screening prevalence and detection of breast carcinoma among Asian women: the Singapore Breast Screening Project. Cancer. 1998;82(8):1521–8.Google Scholar
  9. 9.
    Tan PH, Chiang GS, Ng EH, Low SC, Ng FC. Screen-detected breast cancer in an Asian population: pathologic findings of the Singapore breast-screening project. Breast. 1999;8(3):120–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Tan SM, Evans AJ, Lam TP, Cheung KL. How relevant is breast screening in the Asia/Pacific region? Breast. 2007;16(2):113–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Jara-Lazaro AR, Tan PH. Patterns and spectrum of morphology referrals in breast pathology. Pathology. 2008;40(6):564–72.CrossRefPubMedGoogle Scholar
  12. 12.
    Wu AH, Koh W-P, Wang R, Lee H-P, Yu MC. Soy intake and breast cancer risk in Singapore Chinese Health Study. Br J Cancer. 2008;99:196–200.CrossRefPubMedGoogle Scholar
  13. 13.
    Inoue M, Robien K, Wang R, Van Den Berg DJ, Koh W-P, Yu MC. Green tea intake, MTHFR/TYMS genotype and breast cancer risk: the Singapore Chinese Health Study. Carcinogenesis. 2008;29(10):1967–72.CrossRefPubMedGoogle Scholar
  14. 14.
    Ali AB, Iau PT, Putti TC, Sng JH. BRCA1 disease-associated haplotypes in Singapore Malay women with early-onset breast/ovarian cancer. Breast Cancer Res Treat. 2007;104:351–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Wu AH, Seow A, Arakawa K, Van Den Berg D, Lee H-P, Yu MC. HSD17B1 and CYP17 polymorphisms and breast cancer risk among Chinese women in Singapore. Int J Cancer. 2003;104(4):450–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee HP, Gourley L, Duffy SW, Esteve J, Lee J, Day NE. Dietary effects on breast-cancer risk in Singapore. Lancet. 1991;338(8760):186–7.Google Scholar
  17. 17.
    Duffy SW, Jakes RW, Ng FC, Gao F. Interaction of dense breast patterns with other breast cancer risk factors in a case-control study. Br J Cancer. 2004;91:233–6.PubMedGoogle Scholar
  18. 18.
    Jakes RW, Duffy SW, Ng FC, Gao F, Ng EH. Mammographic parenchymal patterns and risk of breast cancer at and after a prevalence screen in Singaporean women. Int J Epidemiol. 2000;29:11–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Lim SE, Back M, Quek E, Iau P, Putti T, Wong JEL. Clinical observations from a breast cancer registry in Asian women. World J Surg. 2007;31:1387–92.CrossRefPubMedGoogle Scholar
  20. 20.
    Tan BK, Lim GH, Czene K, Hall P, Chia KS. Do Asian breast cancer patients have poorer survival than their western counterparts? A comparison between Singapore and Stockholm. Breast Cancer Res. 2009;11:R4. doi:10,1186/bcr2219.CrossRefPubMedGoogle Scholar
  21. 21.
    Tey J, Baggarley S, Lee KM. Cancer care in Singapore. Biomed Imaging Interv J. 2008;4(3):e38.CrossRefGoogle Scholar
  22. 22.
    Seow A, Koh WP, Chia KS, Shi LM, Lee HP, Shanmugaratnam K. Trends in cancer incidence in Singapore 1968–2002. Singapore Cancer Registry 2004.Google Scholar

Copyright information

© The Japanese Breast Cancer Society 2009

Authors and Affiliations

  • Ana Richelia Jara-Lazaro
    • 1
  • Shyamala Thilagaratnam
    • 2
  • Puay Hoon Tan
    • 1
  1. 1.Department of PathologySingapore General HospitalSingaporeSingapore
  2. 2.Health Promotion BoardSingaporeSingapore

Personalised recommendations