Breast Cancer in Singapore – 7 Facts You Must Know

This article is from Lucence Diagnostics.

October is Breast Cancer Awareness Month, with pink ribbons galore! As doctors, we are commonly on the receiving end of all kinds of queries: “Doctor, will I get breast cancer?”, “Doctor, how can I reduce my risk?”

So here are seven interesting facts that might help you answer those questions better.

A large prospective study started right here in Singapore in 1993, involving over 28,000 women¹. Nearly twenty years later in 2012, the study reported that the commonly used Gail model for cancer risk didn’t work very well in Singapore.

Not unexpectedly, an Asian-American model was determined to model individual cancer risk better. Full disclosure: our medical director was a senior author on that work then.

Singapore’s best-known health correspondent summarized it best: “A Singapore woman with a mother, sister or daughter with breast cancer is four times more likely to get it too, compared to someone with no such family history… Previously, based on the Western yardstick, those with a family history were thought to have double the risk.”²

Good news and bad. Mortality from breast cancer in Singapore has been stable over the last couple of decades. The not-so-good news? We have the highest per capita incidence of breast cancer in Asia.³

Sometimes, it’s helpful to reflect on how far we’ve come. In 2009, 91% of surveyed women in Singapore were aware that early-stage breast cancer is curable. This climbed up from 39% in a 1994 survey⁴. We think that’s something worthwhile!

Between 2011 and 2014, cancer genetics consults in Singapore here shot up three times⁵! There’s actually a name even for this phenomenon: it’s called the Jolie effect⁶, and it was observed worldwide. The needs for better advice and tests continue to rise, as some new anti-cancer drugs have been shown to work better in these patients.

Specialized knowledge of ethnicity and genetics helps better genetic testing. In fact, a founder mutation specific to Malays was first discovered right here in Singapore in 2003^7,8! As a lab headquartered right here, we’re focused on better understanding of genetics in a multi-racial region, Together with our scientific partners, we continue to publish work in top journals discovering even newer genetic markers of breast cancer. ⁹

People hunger for sensible and practical advice. So here’s the makan advice, backed by a cohort study of 35,303 Singaporean post-menopausal women. Increased vegetables, fruit and soy intake are linked to reduced breast cancer risk¹⁰. Not a randomized trial, but you try making people eat celery or taking away their bak chor mee over five years!

So here you have it. Seven facts for this month. We hope this has been useful to you and your breast cancer patients!

REFERENCES

1. Chay, W. Y. et al. Validation of the Gail model for predicting individual breast cancer risk in a prospective nationwide study of 28,104 Singapore women. Breast Cancer Res. BCR 14, R19 (2012).

2. Khalik, Salma. Asians’ breast cancer risk different: study. The Straits Times (2012).

3. Teo, M. C. C. & Soo, K. C. Cancer Trends and Incidences in Singapore. Jpn. J. Clin. Oncol. 43, 219–224 (2013).

4. Sim, H. L., Seah, M. & Tan, S. M. Breast cancer knowledge and screening practices: a survey of 1,000 Asian women. Singapore Med. J. 50, 132–138 (2009).

5. More patients in Singapore looking for genetic counsellors. Channel NewsAsia Available at:. (Accessed: 15th October 2017)

6. Evans, D. G. et al. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Breast Cancer Res. BCR 16, 442 (2014).

7. Lee, A. S. G. et al. Founder mutation in the BRCA1 gene in Malay breast cancer patients from Singapore. Hum. Mutat. 22, 178 (2003).

8. Sng, J.-H. et al. BRCA1 c.2845insA is a recurring mutation with a founder effect in Singapore Malay women with early onset breast/ovarian cancer. J. Med. Genet. 40, e117 (2003).

9. Chan, C. H. T. et al. Identification of Novel Breast Cancer Risk Loci. Cancer Res. 77, 5428–5437 (2017).

10. Butler, L. M. et al. A vegetable-fruit-soy dietary pattern protects against breast cancer among postmenopausal Singapore Chinese women. Am. J. Clin. Nutr. 91, 1013–1019 (2010).