Singapore Breast Cancer: Deaths Fall Despite Rising Cases – What’s Behind the Trend?

Singapore is seeing a complex trend in breast cancer: whereas the number of new cases has risen significantly over the past three decades, the number of deaths from the disease has actually fallen. New research published in The Lancet Oncology on March 2nd reveals this encouraging development, attributing it to earlier diagnoses and improvements in treatment protocols. This contrasts with global trends, where both cases and deaths from breast cancer are projected to increase in the coming years.

Understanding the Numbers in Singapore

The study detailed a nearly 50% increase in breast cancer incidence in Singapore between 1990 and 2023, climbing from 41.58 cases per 100,000 women to 62.33 per 100,000. However, over the same period, the mortality rate decreased by 23.4% to 12.47 deaths per 100,000 women – a rate lower than the global average of 16.14 per 100,000. This suggests that while more women are being diagnosed with breast cancer, they are increasingly surviving the disease. You can find more information about global cancer statistics at the World Health Organization.

The Role of Early Detection

A key factor driving this positive trend is the increased rate of early-stage diagnoses. According to data from the Singapore Cancer Registry, more than 57% of local breast cancer cases are now detected at Stage 1. Associate Professor Marie Ng from the NUS Yong Loo Lin School of Medicine, a senior author of the study, explains that a Stage 1 diagnosis significantly improves prognosis. “Once you’re diagnosed at Stage 1, your prognosis is much better,” she stated. This highlights the importance of regular screening and being vigilant for potential symptoms.

Beyond Screening: Contributing Factors to Rising Incidence

While improved detection and treatment are responsible for the decline in mortality, several factors may be contributing to the rise in breast cancer cases. Professor Ng points to increased longevity as one reason, as cancer risk generally increases with age. Changes in lifestyle factors, such as rising rates of diabetes and obesity, could also play a role. Similar to trends observed in other high-income countries, later pregnancies and fewer births in Singapore may be linked to increased risk factors. The National Cancer Institute provides a comprehensive overview of lifestyle factors and cancer risk.

A Leading Cancer Among Singaporean Women

Breast cancer remains the most common cancer diagnosed among women in Singapore, accounting for approximately 30% of all cancer diagnoses in this population. Globally, the picture is more concerning. Worldwide breast cancer rates have increased by about 149% since 1990, with approximately 2.3 million cases recorded in 2023. Deaths from the disease also rose by around 110% during that time, reaching 764,000. Projections indicate this upward trend will continue, with over 3.5 million new cases, and 1.4 million deaths expected by 2050.

Global Disparities and the Burden on Low-Income Countries

The study emphasizes a concerning disparity in breast cancer burden. The increase in cases and deaths is expected to be disproportionately borne by low- and lower-middle-income countries. This is attributed to later-stage diagnoses, limited access to quality care, and higher death rates in these regions. Kayleigh Bhangdia, the lead author of the study from the Institute for Health Metrics and Evaluation (IHME), notes these critical challenges.

Modifiable Risk Factors: What We Can Control

The research also identified several modifiable risk factors contributing to the global breast cancer burden. In 2023, approximately 28% of global cases – equivalent to 6.8 million years of healthy life lost – were linked to six key factors: high red meat consumption, tobacco use, high body mass index, high blood sugar, high alcohol use, and low physical activity. High red meat consumption was found to be linked to almost 11% of all healthy life lost. While the impact of tobacco and alcohol use has decreased since 1990, other factors haven’t shown the same progress. This aligns with findings from the World Health Organization, which estimates that almost four in ten cancer cases worldwide in 2022 were linked to preventable causes, including smoking, drinking, and air pollution. Read more about the WHO’s findings here.

Singapore’s Proactive Approach and Future Steps

Addressing the growing burden of breast cancer requires a multi-faceted approach, encompassing effective public health policies and promoting healthier lifestyle choices. Dr. Alicia Ong, an adjunct lecturer from the family medicine division at NUS Medicine, emphasizes the need for prevention, early detection, and access to care to work in tandem. Singapore is already taking steps in this direction. On March 5th, Health Minister Ong Ye Kung announced the expansion of subsidized genetic testing for hereditary breast and ovarian cancer, associated with mutations in genes like BRCA1 or 2. Combined with existing subsidies for breast cancer screening, access to these vital services is becoming increasingly affordable for Singaporeans.

Looking Ahead: Continued Vigilance and Resource Utilization

Professor Ng expresses optimism that Singapore can continue to buck the global trend of rising breast cancer mortality, provided more individuals are diagnosed at earlier stages. She strongly encourages residents to capture advantage of the screening services and resources available. “Breast cancer has turn into a very treatable condition, and so (the chance of) survival is very, very high if we catch it early.” Ongoing surveillance, coupled with continued investment in research and treatment advancements, will be crucial in maintaining this positive trajectory.