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Breast cancer: what happens now

Breast cancer is the most common cancer in women in Singapore, so the pathways here are well established.

A diagnosis is a shock, and the first two weeks feel like chaos: appointments, scans, unfamiliar words, and big decisions while you are frightened. There is a normal sequence to this, and you do not have to figure it all out today.

Two things help most early: bring someone to every appointment for a second pair of ears, and ask for a Medical Social Worker early, because they handle the money and admin and unlock most financial help.

What the early appointments are for

  • Confirming the diagnosis: usually a biopsy plus lab tests, to identify exactly what type of cancer it is.
  • Staging scans: imaging such as CT, MRI, PET, or ultrasound to see the size and whether it has spread.
  • Meeting your specialist team: often a surgeon, a medical oncologist, and a radiation oncologist; complex cases are discussed by a multi-disciplinary tumour board.
  • The treatment-plan discussion: the appointment to come prepared for.

Understanding your stage

Stage is how much cancer there is and whether it has spread. A common system is TNM, combined into stages 0 to 4. Some cancers use their own system, shown on each cancer-type page.

Grade is how abnormal the cells look under the microscope, a hint at how fast they may grow.

  • Early or localized (the cancer is contained): treatment is often aimed at cure, and local treatments such as surgery or radiotherapy may be enough.
  • Locally advanced (spread to nearby tissue or lymph nodes): often a combination, for example surgery plus chemotherapy or radiotherapy.
  • Advanced or metastatic (spread to distant parts): the goal is more often to control the cancer and keep you well for as long as possible, usually with drug treatments. Advanced is not the same as untreatable: many advanced cancers are controlled for a long time, and a few such as some lymphomas can still be cured.

Two people with the same cancer can have very different plans, because the stage, the cancer's biology, and your general health all feed into the decision.

Ask your team to explain your specific stage in plain words and what it means for your goal of treatment. Avoid general survival statistics online: they are averages across very different people, often out of date, and not your prognosis.

How your stage is described for Breast cancer: Breast cancer uses the TNM system, grouped into stages 0 to 4. Your plan is also shaped by the receptor results (ER, PR, HER2), not the stage alone, which is why two people at the same stage can be treated differently.

Tests you are likely to have

  • Imaging of the breast: mammogram and ultrasound, sometimes a breast MRI.
  • Receptor testing on the biopsy: whether the cancer is fuelled by hormones (ER and PR status) and whether it has extra HER2 protein. These strongly shape treatment, so ask for them in plain words.
  • Sometimes genetic testing (for example BRCA), especially with a family history or younger age.

Treatments commonly involved

  • Surgery: removing the lump with a margin (breast-conserving) or the whole breast (mastectomy), often with a sentinel lymph node biopsy. Reconstruction may be an option.
  • Radiotherapy: common after breast-conserving surgery.
  • Chemotherapy: depending on the cancer's features and stage.
  • Hormone (endocrine) therapy for hormone-receptor-positive cancers, for example tamoxifen or aromatase inhibitors, usually taken for years.
  • HER2-targeted therapy for HER2-positive cancers, for example trastuzumab. Some are on the Cancer Drug List, so check coverage.

Questions to ask (all cancers)

  • What type of cancer is this, and what is my stage and grade?
  • What is the goal of treatment: to cure, to control, or to relieve symptoms?
  • What are my options, and what do you recommend and why?
  • What are the main side effects, and how long will treatment take?
  • Are any recommended drugs on the Cancer Drug List, and what will it roughly cost?
  • Is a clinical trial an option for me?
  • Who do I contact between appointments, and is there a 24-hour number if I feel unwell during treatment?
  • Can I see a Medical Social Worker about costs and support?

Questions specific to this cancer

  • What is my cancer's ER, PR, and HER2 status, and what does it mean for my treatment?
  • Is breast-conserving surgery an option for me, or is mastectomy recommended, and why?
  • Will I need radiotherapy, chemotherapy, hormone therapy, or HER2 treatment, and in what order?
  • If reconstruction is possible, what are my options and timing?
  • Should I have genetic testing, and what would it mean for my family?
  • If chemotherapy is likely and I may want children, can I see a fertility specialist before starting?

Money and support

The financial and admin load is heavy, and most help is unlocked by people, not websites. The single most useful early action is to ask for a Medical Social Worker. One assessment can open MediFund, hospital and charity cancer funds, subsidised-patient status, and caregiver grants. See the support directory for the full list.

Open the support directory

Support specific to this cancer

  • Breast Cancer Foundation: support, education, and a wig loan programme.
  • Singapore Cancer Society support groups and welfare aid.
  • Plus everything in the shared support directory.