Breast cancer is the most common cancer diagnosed among women in Singapore and it is therefore important for women to be aware of treatment modalities. Surgery is an essential component of breast cancer treatment, and it is done in combination with adjuvant treatment.  Adjuvant therapy may include radiotherapy, chemotherapy, hormonal treatment, etc depending on each patient’s unique condition. Selection of therapy are based on several factors, such as tumour size and histology, staging, systemic involvement, patient’s age, comorbid conditions, and menopausal status.

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Surgery remains the mainstay of early breast cancer treatment. There are two broad categories of surgical treatment for women with breast cancer:

• Breast-conserving surgery (lumpectomy)

Preservation of uninvolved tissue after removal of the diseased portion of the breast.

• Mastectomy

Total removal of the breast. 

There is a prevailing misconception that mastectomy offers lower risk of recurrence.  However, several studies comparing breast-conserving surgery and mastectomy showed improved survival and at least equivalent, if not lower local recurrence when patients underwent breast conservation. Moreover, women who had mastectomy are also found to have lower quality of life in the long term.

One possible reason for the erroneous concept that mastectomy provides improved outcomes is that historically, prior to the 1970s, there was no other way to treat breast cancer than to perform a mastectomy. Medical techniques have advanced since, and it has been repeatedly demonstrated that breast conservation treatment (breast-conserving surgery combined with chemotherapy and/or radiotherapy) results in women having better survival rates when compared with those who undergo mastectomy for early-stage breast cancer.

Early-stage breast cancer refers to women with Stage 0-II. The majority of women with such cancers are candidates for breast conservation treatment.  Even when the cancer is larger, chemotherapy may be applied before surgery to shrink the size of the tumour to make it amenable for breast conservation. This strategy may also be offered to patients with later-stage breast cancer. 

Remember to always consult with your treating physician to consider all factors and treatment options for your unique situation. Discuss all the pros and cons of different breast cancer treatment options, including differences in survival rates and long-term outcomes.

This article was verified medically by Dr Mona Tan, formerly Consultant in General Surgery at Mammocare The Breast Clinic (Singapore) and Surgery at Mount Elizabeth Novena Specialist Centre (Singapore), but no longer in active clinical practice.