Women's Health

Women’s Cancers

16 Dec 2019

Dr Lee Guek Eng, Senior Consultant and Breast Medical Oncologist, ICON Cancer Centre Singapore, and Dr Germaine Xu, General Surgeon and Breast Oncoplastic Surgeon of One Surgical – Breast and General Surgery Clinic, share the hard facts and the good news about women’s cancers – breast cancer, which tops the list of cancers among women in Singapore, and gynaecological cancers that originate in the female reproductive system.

A SNAPSHOT OF SINGAPORE
The Singapore cancer registry, which documents the incidence of cancers in the local population, cites the incidence for the total number of female cancer patients as 338.5 per 100,000 person-years for the period 2011-2015. (A person-year takes into account the number of people in a given study and the amount of time each person spends in that study. For example, a study that followed 1,000 people for one year would contain 1,000 person-years of data.)

In descending order, the most common types of women’s cancers were breast cancers at 29.1 percent, uterine cancers at 6.9 percent, ovarian cancers at 5.4 percent and cervical cancers at 3.1 percent. For the same period, breast cancer accounted for one in three cancers in females, making it the most common cancer diagnosis in women.

Alarmingly, the incidence of breast cancer has risen almost threefold from 24.6 per 100,000 person-years in 1976-1980 to 65.3 per 100,000 person-years in 2011-2015.

“The good news is that cancers that are discovered in the early phase are usually highly treatable and curable,” said Dr Lee.

FOCUS ON BREAST CANCER
While breast cancer is not strictly speaking a gynaecological or women’s-only cancer, Dr Xu shared that for every 100 women who get breast cancer, there will be one man or even fewer diagnosed with it.

Though breast cancer causes the greatest number of cancer-related deaths in Singapore and worldwide, it is a stealthy and often symptom-free disease, especially in its early stages.

“Many patients with early breast cancers do not have any symptoms. These patients appear completely normal and do not have any palpable lumps, nipple discharge, rash, or skin changes. The aim of breast screening using mammograms is to pick up early cancer in such patients with no signs of breast cancer,” said Dr Xu.

Dr Xu pointed out that another group of breast cancer patients do have symptoms, of which the most common is a lump in the breast. Less commonly, some patients feel a lump under the armpit. Others may observe skin changes such as rash around the nipple, a dimple appearing in the breast or new onset nipple retraction. Some patients present with one-sided nipple discharge. In later stages, there may be tumour invasion into the skin, muscles or bones. Loss of weight, bone pain, blurred vision, headaches can happen if the cancer has spread. Surprisingly, pain is seldom symptomatic of breast cancer and usually caused by other factors such as premenstrual pain, heavy large breasts or other musculoskeletal causes.

While inherited risk factors cannot be modified, as well as early menarche before 12 years old and/or a late menopause after the age of 55 years, other risk factors can be addressed.

“Having no pregnancy or a first live birth after the age of 30 and no sustained period of breastfeeding – which stops the monthly hormonal flux, all increase a woman’s risk of breast cancer,” explained Dr Xu. It strengthens the argument in favour of not putting off motherhood and breastfeeding a child for as long as is practically possible.

According to Dr Xu, consumption of external sources of oestrogen, be it from hormone replacement therapy (HRT) or oestrogen-rich foods, also increases the risk. Also, patients who have dense breast tissue have a five to six times higher risk of breast cancer than women with normal tissue. A high body mass index (BMI), alcohol intake and a sedentary lifestyle all increase the risk of breast cancer.

There is also an inherited risk. Women found to have a genetic mutation such as BRCA may have a 60 to 80 percent lifetime risk up to the age of 75 years. Having a relative with male breast cancer or a strong family history of breast or ovarian cancer also increases risks.

Breast cancer, when detected early and treated promptly, has the best survival rate of all gynaecological and women’s cancers.

In descending order, the most common types of women’s cancers were breast cancers at 29.1 percent, uterine cancers at 6.9 percent, ovarian cancers at 5.4 percent and cervical cancers at 3.1 percent. For the same period, breast cancer accounted for one in three cancers in females, making it the most common cancer diagnosis in women.

Alarmingly, the incidence of breast cancer has risen almost threefold from 24.6 per 100,000 person-years in 1976-1980 to 65.3 per 100,000 person-years in 2011-2015.

“The good news is that cancers that are discovered in the early phase are usually highly treatable and curable,” said Dr Lee.

WHAT CAUSES CANCER
In general, cancers are caused by accumulated damage to genetic material that leads to the autonomous growth of cells.

The causes can be broadly divided into biological factors such as age, gender and genetic predisposition; environmental factors such as exposure to radiation, bacterial and viral infections; and lifestyle factors such as smoking and excessive alcohol intake.

Early Warning Signs for Women’s Cancers

BreastUterineOvarianCervical
Breast lump/lumps under the armpit

Asymmetry or changes in breast shape

Nipple discharges/bloody discharges

Skin changes over the breast

Breast pain

Signs of abnormal vaginal bleeding

• Post-menopausal
• Intermenstrual
• Prolonged
spotting
• Pinkish
discharge

Pelvic pain

Pain during intercourse

Abdominal distension/discomfort

Backache or ache in legs

Urinary complaints

Change in bowel habits

Abdominal vaginal bleeding

• During sexual intercourse
• In between periods or after menopause

Foul smelling vaginal discharge

Risk Factors for Women’s Cancers

BreastUterineOvarianCervical
Early menarche

Late menopause

Obesity

Alcohol intake

Physical inactivity

Radiation to chest at young age

Hereditary condition such as BRCA1/2 mutation
carrier

Early menarche

Late menopause

Obesity

Nulliparity

Polycystic ovary syndrome

Tamoxifen use

Diabetes

Lynch syndrome

Obesity

Nulliparity

Lynch syndrome

Hereditary condition such as BRCA1/2 mutation carrier

Human papillomavirus (HPV) infection

Predisposing factors to HPV infection
• Sexual intercourse at
an early age
• Multiple sexual partners

Five-year Survival Rates for Women’s Cancers by Stage*

TypeBreastUterineOvarianCervical
Local99%96%92%92%
Regional85%70%75%56%
Distant27%18%30%17%

*Statistics from Cancer.net and American Cancer Society

PUTTING HEALTH FIRST
Dr Lee urges all women to take responsibility for their own health.

“In today’s modern society, women tend to take on multiple roles. They are required to be wives, mothers, daughters and leaders at work, so much so that they may overlook their health,” empathised Dr Lee.

At the risk of stating the obvious, when a serious health problem like cancer arises, a woman may find herself unable to perform well in any of her roles, let alone all of them.

“To lower your risk of developing cancer, start by targeting modifiable risk factors such as limiting your alcohol intake, quitting smoking and maintaining a healthy weight,” suggested Dr Lee. “In addition, take part in age-appropriate health screening programmes as well as vaccination programmes. Lastly, do pay attention to your body and conduct regular breast self examination so that any changes can be picked up in their early stages.”

YET MORE GOOD NEWS

In addition to a growing awareness of the importance of a healthy lifestyle, coupled with more widespread screening programmes, innovative new treatment options are becoming available.

“Immunotherapy and other targeted therapy such as Cyclin-dependent kinase inhibitors for triple negative breast cancer and hormone receptor positive breast cancers respectively are very promising for the treatment of breast cancers,” shared Dr Lee. “There has been significant improvement in the breast cancer outcomes associated with these emerging therapies and these will translate into tangible benefits for our patients.”

Ladies, the message is clear. Do watch your diet and lead a healthy lifestyle. Be aware of your inherited risk factors for women’s cancers and go for regular cancer screenings. Be attuned to changes in your body. And if cancer should strike, remain hopeful. The outcomes are getting better all the time.

Article contributed by Dr Lee Guek Eng and Dr Germaine Xu, accredited doctors at Mount Alvernia Hospital.

This article is taken from our MyAlvernia Magazine Issue #39. Click here to read the issue on our website or on Magzter.