Breast Unit
Breast cancer is the commonest cancer amongst women in Singapore. In Tan Tock Seng Hospital, a multidisciplinary team of specialists comprising of breast surgeons, radiologists, pathologists, oncologists, reconstructive surgeons and breast care nurses work together to provide screening for breast cancer in asymptomatic women, assessment and accurate diagnosis of breast diseases, multi-modality management of breast cancer including surgery, chemotherapy and radiotherapy and professional nursing care for women newly diagnosed with this dreadful disease.
Screening for breast cancer is provided by mammogram, an X-ray of the breast which can pick up cancers that are small and in early stage. It may be augmented with ultrasound or MRI of the breasts. Percutaneous biopsy will be performed to provide an accurate diagnosis of the suspicious abnormalities. Screening had been shown to decrease the breast cancer mortality by 20%. Tan Tock Seng Hospital is one of three assessment centers that are taking part in the national BreastScreen Singapore programme to screen women for early breast cancers. This programme started in 2005 and has twice weekly clinics dedicated to breast screening.
The breast unit has thrice weekly symptomatic breast clinics which cater to patients with breast conditions. These clinics are organized under the ‘one-stop’ concept where majority of patients will get their imaging performed on the same day after consultation with the breast surgeons. Patients who are suspected to have cancer will also have the initial biopsy performed during this visit.
Surgery is the primary treatment modality in the majority of breast cancer patients. The two surgical options are breast conserving surgery and mastectomy and axillary clearance. Breast conserving surgery is the removal of the cancer without having to remove the whole breast followed by post operative radiotherapy. If the cancer is too large, the patient can undergo preoperative chemotherapy to shrink the cancer before breast conserving surgery is carried out. Breast conserving surgery removes the psychological trauma that a woman faces with the prospect of losing her breast. This is augmented by breast care nurses who provide professional counseling and emotional support to these patients. In our institution nearly two-thirds of breast cancer patients undergo breast conserving surgery.
Fig 1: Cancer of right breast after breast conserving surgery and radiotherapy
For the women who are not suitable candidates for breast conserving surgery, skin sparing mastectomy (removal of the breast tissue without removing the overlying skin) can be carried out with immediate reconstruction of her breast by using the woman’s own tissue in the abdomen or back. This new technique of breast reconstruction provides the best cosmetic result and minimizes the feeling of loss of body image felt by women who needs a mastectomy.
We have also embark on minimal surgery to the axillary lymph nodes. Traditionally, all the lymph nodes in the axilla (armpit) are removed in a patient with breast cancer. However for suitable patients, we are using the ‘blue dye’ to identify one or two lymph nodes which can tell us the status of the axilla and thus avoid full axillary dissection. Full dissection is thus reserved only for patients who have disease in the axilla.
Fig 2. ‘Blue’ sentinel lymph node harvested to avoid full axillary dissection
Additional treatment of breast cancer may include radiotherapy, chemotherapy and hormonal therapy, all of which are available within the hospital. Treatment options are discussed at weekly multidisciplinary cancer meeting and decision will then be made known to the patients before the initiation of the treatment regime. Close follow-up are provided for breast cancer survivors to monitor their treatment response and side effects so as to modify treatment regimes.
A multidisciplinary approach to breast cancer is a key feature of our management. The provision of multimodality treatment is tailored to the patient, which includes the emotional needs and cultural differences of each individual, to maximize the positive outcome of the treatment regime.
 | Designation :
Head of Breast Service & Senior Consultant Credentials :
MBBS, FRCS (Edin), FAMS Subspeciality :
General Surgery, Breast & Endocrine Surgery |
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Name :
Clin Prof Rajmohan Nambiar
Designation :
Sessional Consultant Credentials :
MBBS, FAMS, FRCS (Edin), FRCD (England), FACS, FACP (Hon), FRACP (Hon) Subspeciality :
General Surgery, Breast & Endocrine Surgery | |
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Name :
Chen Jia Chuan, Juliana
Designation :
Consultant Credentials :
MBBS (Singapore), MMEd(Surgery), FRCSEd (General Surgery), FAMS Subspeciality :
General Surgery, Breast & Endocrine Surgery. |
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Name :
Ho Wai Thong, Thomas
Designation :
Associate Consultant Credentials :
MBBS (Sydney), FRCSEd (Gen Surgery), AFRCS (Ire), MMed (Surgery), FAMS Subspeciality :
General Surgery, Endocrine, Head & Neck Surgery | |
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