Background Serum tumour markers, cancer antigen 15–3 (CA 15–3) and carcinoembryonic antigen (CEA) are not routinely recommended for detecting breast cancer recurrence and monitoring treatment. In this study, we aim to evaluate the diagnostic accuracy of absolute CA 15–3 and CEA levels and report on the clinical utility of tumour marker velocity in breast cancer surveillance. Methods 67 consecutive patients over a 15-year period (1998–2012) with available serial serum CA 15–3 and CEA measurements at recurrence were matched to a control group of patients. Tumour marker velocity was derived from the average change in consecutive tumour marker values over time, expressed in unit/year. Logistic regression analysis was performed to investigate the association between tumour characteristics, tumour marker velocity and disease recurrence. Results Using the Youden index values, the optimal cut-off values for absolute CA 15–3 and CEA corresponded to the normal assay reference range while tumour marker velocity values were derived to be 2.5U/mL/year and 1.2ng/mL/year respectively. CA 15–3 velocity > 2.5U/mL/year had the highest AUROC value of 0.85 than CEA velocity alone. When either tumour marker velocity exceeded threshold values, the sensitivity, specificity, negative predictive value and positive predictive value were 94.0%, 73.1%, 92.5%, and 77.8% respectively. In the multivariate logistic regression analysis, having both CA 15–3 and CEA velocity exceeding the cut-off values was shown to be a significant predictor for disease recurrence (p = 0.01). Conclusion These findings highlighted the clinical utility of serial tumour markers measurements and its velocity in breast cancer surveillance.

Background: Primary non-Hodgkin lymphoma is an extremely rare entity, and this condition represents less than 0.5% of all malignant lesions involving the mammary gland. As such, there has been a paucity of relevant clinical data arising from Southeast Asia. Aims:Our study aims to review the clinical presentation, diagnostic methods, treatment, and survival outcomes of all patients diagnosed with primary breast lymphoma in our institution between 2011 and 2017. Methods and results: Patients who had histologically proven lymphoma involving the breast were identified from a prospectively collected database in a single institution between 2011 and 2017. All seven patients were female, with a median age of 65 years old, and had presented with unilateral large breast or axillary masses. All the histological diagnosis was achieved with adequate tissue diagnosis either through core, incisional, or excisional biopsy. Five patients had diffuse large B cell lymphoma, one had marginal zone lymphoma, and the other had follicular lymphoma. Based on Ann Arbor classification, one patient had stage 1, three had stage 2, one with stage 3, and two patients with stage 4 disease. Five patients had received standard CHOP regimen with rituximab. At the time of analysis, patients who had nondisseminated disease had a median survival of 57 months. The overall mean survival time for all seven patients was 47 months. With the standard systemic chemotherapy treatment regimen, the estimated 3-year overall survival was found to be 64%. Conclusion: Primary breast lymphoma, though uncommon, may present in a similar manner as breast carcinomas, but the main treatment modality remains nonsurgical with systemic chemotherapy. Hence, it is prudent to obtain accurate histological diagnosis of primary breast lymphoma. In this study, our patients with nondisseminated breast lymphoma have demonstrated a fairly good survival outcome following chemotherapy.

Background Family history, and genetic and non-genetic risk factors can stratify women according to their individual risk of developing breast cancer. The extent of overlap between these risk predictors is not clear. Methods In this case-only analysis involving 7600 Asian breast cancer patients diagnosed between age 30 and 75 years, we examined identification of high-risk patients based on positive family history, the Gail model 5-year absolute risk [5yAR] above 1.3%, breast cancer predisposition genes (protein-truncating variants [PTV] in ATM, BRCA1, BRCA2, CHEK2, PALB2, BARD1, RAD51C, RAD51D, or TP53), and polygenic risk score (PRS) 5yAR above 1.3%. Results Correlation between 5yAR (at age of diagnosis) predicted by PRS and the Gail model was low (r=0.27). Fifty-three percent of breast cancer patients (n=4041) were considered high risk by one or more classification criteria. Positive family history, PTV carriership, PRS, or the Gail model identified 1247 (16%), 385 (5%), 2774 (36%), and 1592 (21%) patients who were considered at high risk, respectively. In a subset of 3227 women aged below 50 years, the four models studied identified 470 (15%), 213 (7%), 769 (24%), and 325 (10%) unique patients who were considered at high risk, respectively. For younger women, PRS and PTVs together identified 745 (59% of 1276) high-risk individuals who were not identified by the Gail model or family history. Conclusions Family history and genetic and non-genetic risk stratification tools have the potential to complement one another to identify women at high risk.

Background: In October 2019, surgeons from Changi General Hospital (CGH) Breast Centre delivered a series of health talk for its employees to assess the knowledge and perception of breast cancer screening and improve related knowledge of the institution’s healthcare workers. This is to enable CGH, a healthcare provider to not only care for our patients, but also look after its staff. Methods: 141 hospital staff attended a 40-minute talk followed by an open question and answer forum. Pre and post talk surveys were conducted to gauge knowledge, attitudes, beliefs and misconceptions towards breast cancer screening and treatment. Question domains were divided into 1) breast cancer knowledge, 2) breast cancer screening guidelines,3) attitudes and perception of breast cancer screening and treatment. Univariate and multivariate logistic regression analysis was used to examine the relationship between demographics and performance in question domains.Results: The overall response rate was 131 out of a total of 141 attendees (92.9%). The median age was 44 (range, 22 to 67), with nursing staff making up 40% of the cohort. Analysis showed statistically significant improvement in median score across all 3 domains. (p<0.05) after the forum. We found that respondents who were women ≥40 years (eligible age for screening), had higher income, lived in larger housing types, had attended previous talks, had served >10 years in healthcare and had personal encounter with breast cancer patients performed better. Surprisingly, being a nurse or having a university degree did not translate to better score. 99% of respondents find the forum beneficial and will recommend to others. Several knowledge gap about breast cancer screening and misconceptions were identified. Future campaign should focus on raising awareness of the national screening program BreastScreen Singapore. We advocate to reinforce its recommendations, promote on the affordability and ready accessibility. As healthcare personnel are ambassadors of the healthcare system, their knowledge would aid in providing accurate information to patients and public, enabling them to make wise healthcare choices.Conclusions: A simple Breast Cancer Awareness Month campaign targeted at healthcare workers was found to be effective at educating hospital staff on breast cancer, screening practices and improving perception of screening and treatment practices. This may empower them to not only care for themselves but help serve patients better.

Background In October 2019, surgeons from Changi General Hospital (CGH) Breast Centre delivered a series of health talk for its employees to assess the knowledge and perception of breast cancer screening and to improve the level of related knowledge amongst the institution’s healthcare workers. This was to enable CGH, a healthcare provider to not only care for our patients, but also to look after its staff. Methods 141 hospital staff attended a 40-min talk followed by an open question and answer forum. Pre and post talk surveys were conducted to gauge knowledge, attitudes, beliefs and misconceptions towards breast cancer screening and treatment. Question domains were divided into (1) breast cancer knowledge, (2) breast cancer screening guidelines and (3) attitudes and perception of breast cancer screening and treatment. Univariate and multivariate logistic regression analysis were used to examine the relationship between demographics and performance in question domains. Results The overall response rate was 131 out of a total of 141 attendees (92.9%). The median age was 44 years old (range, 22–67), with nursing staff making up 40% of the cohort. Analysis showed statistically significant improvement in median score across all 3 domains. (p < 0.05) after the forum. We found that respondents who were women ≥ 40 years (eligible age for screening), had higher income, lived in larger housing types, had attended previous talks, had served > 10 years in healthcare and had personal encounter with breast cancer patients performed better. Surprisingly, being a nurse or having a university degree did not translate to a better score. 99% of respondents found the forum beneficial and would recommend it to others. Several knowledge gaps about breast cancer screening and misconceptions were identified. Future campaigns should focus on raising awareness of the national screening program BreastScreen Singapore. We aim to reinforce its recommendations, promote on the affordability and ready accessibility. Conclusions A simple Breast Cancer Awareness Month campaign targeted at healthcare workers was found to be effective at educating hospital staff on breast cancer, screening practices and improving perception of screening and treatment practices. This may empower them to not only care for themselves but also to serve patients better.