How does Covid-19 affect breast cancer and is the vaccine safe for patients?

If you haven’t been giving yourself a breast examination on the regular, it’s time to put it high on your priority list.

While breast cancer is a serious health condition that has affected many women, the onslaught of Covid-19 has only exacerbated the situation, what with delayed diagnosis, treatments, and complications.

According to the Breast Cancer Foundation (BCF), invasive breast cancer was consistently ranked as the leading cancer among females in the past fifty years in Singapore (Singapore Cancer Registry’s 50th Anniversary Monograph published in 2019).

Between 2013-2017, there were 10,824 new cases of invasive breast cancer diagnosed (nearly six cases per day) and 2,180 deaths (slightly more than one death per day). And most recently, the World Health Organisation announced that for the first time, that breast cancer has overtaken lung cancer as the most common cancer globally.

Sandra Leong, General Manager of Breast Cancer Foundation (BCF), shares with us the impact of Covid-19 and its vaccines on breast cancer, common misconceptions and more.

How does Covid-19 further complicate or pose serious risks for people diagnosed with breast cancer?

From diagnosis, treatment, and follow-ups, the pandemic has affected patients globally.

“Diagnosis was delayed as some women decided to postpone their mammograms due to the pandemic,” says Sandra. “In 2020, some healthcare facilities had to pause mammogram screening and this may lead to a delayed diagnosis and treatment.”

For patients who are on treatment such as chemotherapy, targeted therapies, and immunotherapy, their immune systems are weakened, making them more susceptible to infection, and may be at higher risk of serious complications should they develop Covid-19.

Are Covid-19 vaccines safe or recommended for breast cancer patients?

Based on the recommendations of the Expert Panel on Covid-19 vaccination appointed by the Ministry of Health, cancer patients who are immuno-compromised, should hold off receiving Covid-19 vaccines until more data becomes available.

“These include patients on chemotherapy or on any immunosuppressive treatment and patients with active breast cancer (with or without treatment). Patients with early-stage cancer who are only on hormonal treatment are safe to be vaccinated,” shares Sandra.

“It is also important to highlight any history of anaphylaxis or severe allergies before getting vaccinated. It is important to discuss with your treating doctor first to get better clarification.”

Common misconceptions about breast cancer

One main misconception is that breast cancer is an older women’s disease. Sandra tells us, “Our survey in 2017 found that most women aged under 45 had expressed limited knowledge on breast cancer incidence. Younger women may think that breast cancer is something that happens to their mums or older relatives, so cancer awareness remains low on their list of priorities.”

“The fact is one in six breast cancer cases in Singapore are diagnosed in women under age 45 yet two in five young women don’t do regular breast checks and may miss early cancer detection. We recommend all women from the age of 20 to start monthly breast self-examinations.”

Also, not having any family members with breast cancer doesn’t mean you aren’t at risk. “The truth is, 80 per cent of women with breast cancer do not have any risk factors, including family history of breast cancer,” she adds on.

Are the ages of women getting breast cancer getting increasingly younger?

Breast cancer does mostly affect women of older ages but that doesn’t mean you shouldn’t be concerned.

“While most breast cancer cases still occur in women over 50, it does account for about 11 per cent of all breast cancers in women younger than 45. Breast cancer in young women tends to be more aggressive and has a higher risk of metastases,” Sandra points out. “Breast cancer risk is also higher in women with a family history of breast cancer, or if they have a genetic mutation that increases the risk of cancer.”

“Women under age 40 are generally too young to begin screening unless they are deemed to be at higher risk of developing breast cancer. It is, therefore, crucial to be vigilant of breast cancer symptoms, do breast self-examination regularly, and start screening from the age of 40.”

What are the ways to help reduce breast cancer risk?

While there’s no surefire way to prevent breast cancer, these general guidelines can help in reducing the likelihood of getting breast cancer. It’s still important to be vigilant and to check yourself at home if you’re 20 years old and to do regular mammograms after 40.

• Maintain a healthy weight. Women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
• Be physically active. Exercise and regular activity may help to lower breast cancer risk by delaying the onset of menstruation and helping to maintain a healthy weight. Each of these can help decrease the total amount of oestrogen a woman is exposed to in her lifetime.
• Eat a balanced diet. Eat fresh, nutritious food with lots of vegetables and fruits and avoid processed food.
• Limit hormone exposure. Breast cancer has been associated with the prolonged use of hormone
  replacement therapy after menopause (five years or more). Do discuss with your doctor the risks and benefits of hormone therapy and explore options to manage your symptoms with non-hormonal therapies and medications. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.
• Avoid alcohol. Several studies have shown a link between excessive alcohol intake and an increased risk of contracting breast cancer. Alcohol may increase risk by altering the way a woman’s body metabolites oestrogen.
• Don’t smoke. Smoking increases the risk for many types of breast cancer, including breast cancer.

What are the support systems available for women with breast cancer?

You don’t have to go through breast cancer alone. Apart from loved ones and friends, there are various support groups and services to call on, including those at the Breast Cancer Foundation:

• Befriender Programme. This is a one-to-one support where you’ll be matched with a survivor with similar demographics and medical conditions. You can ask questions about what to expect during treatment or seek advice on the course of treatment (e.g. lumpectomy vs mastectomy) or share difficulties that you’re experiencing.
• You may consider joining BCF’s various support groups – English, Mandarin, Young Women and Advance, Metastatic Support Groups as well as the Caregivers Support Group for those who are taking care of loved ones with breast cancer. The support group is a safe space where you get to be around other women with the same condition and know what you’re going through and who may be able to shed light on some of your questions.
• There’s a Wig Loan service for those who have lost their hair due to treatment. The service is complimentary for all BCF members.
• Healing Through The Arts is a programme specially for those who are on the road to regaining their physical strength and well-being after they have been diagnosed with and treated for breast cancer. You can find a list of physical as well as arts therapy-based activities such as yoga, qigong, art class, crochet.
• Support Line: If you prefer support via the phone, you may call the BCF support line at 63560123.

For more information, visit www.bcf.org.sg or call 6352 6560.

This article was first published in The Singapore Women's Weekly.