Dr. Rebecca Dent is the Senior Consultant in the division of Medical Oncology at National Cancer Centre Singapore. She is the founder and co-chair for the Asia-Pacific Breast Cancer Summit. Her primary research interest in the field of breast cancer, primarily focus on locally advanced breast cancer and triple negative/basal-like breast cancers.
1. What inspired you to start Asia-Pacific Breast Cancer Summit (APBCS)?
I was in Singapore 5 years ago and quickly realized that there is a very strong breast cancer community in Singapore but we need to bring the breast cancer community together to ensure we provide better collaboration and care. The other reason is I recognized that Singapore potentially could be a leader in the field and I also have an opportunity to create collaborations with other countries within the Asia Pacific area. One of my co-chairs, Shaheenah Dawood, had a similar meeting in Dubai, hence we thought it is a great way to even further expand the borders of Asia-Pacific area and build it together. In our first year, we don’t know if it’s possible to just focus on the topic of breast cancer. How are we going to get the funds to support it? Will people come? It turned out that the first meeting was actually a big success and it surprised a lot of people, and every other year we take it to another country to gain momentum and awareness. The 1st year was in Singapore, 2nd year was in KL, Malaysia, 3rd year was back in Singapore, 4th year was in Australia, and this year is the fifth year of APBCS with other workshops like oncoplastic workshop, and also for the very first time, we have a nursing workshop and patient advocacy session. We’re very excited. That is always my dream, to realise that medical oncologists can’t do it on their own. We need help from our collaborators, surgeons and radiation oncologists and all the other sub-specialties as well, to enhance the cancer-care level.
2. What are the early signs of breast cancer and what are the most obvious symptoms to watch out for?
In general, there isn’t that much to watch out for, but the most important thing is, as we get older, women should be doing a monthly breast exam, ideally the same time in the month, because it could change with your menstruation.
And then it is very controversial, the issue of mammography screening. I am from Canada originally, where screening is recommended at 50. If you’re 50 or older or with a strong family history, for example, if your mum has had breast cancer, we generally recommend starting younger at 40. Hence it is recommended to do a soft breast exam for any notable new lumps or changes in their breasts once a month.
3. What would be the criteria for selecting participants in clinical trials for breast cancer treatment?
Sometimes we don’t know if we have a choice, because we have numbers of trials ongoing coherently in NCCS, NUH, Hopkins and Tan Hock Seng etc. At NCCS, we have large number of trials which are always changing. Sometimes we have curative situations or the patients had received chemotherapy or just receiving tablets, and we may be adding something to improve the chance of cure. Sometimes we give new treatment to patients whose cancer has spread in order to prolong their life or improve their symptoms. So it really depends on the situations of patients and matching the suitable trial to them. During the last couples of years, patients are now coming to us to say “Have you got something new?” or “Have you got a new clinical trial?” It is not like the used-to-be “guinea pig” anymore, usually there is a standard of treatment as the general theme of trial. It is a very different situation than even 10 years ago that we were in, but I will say a final thing is we are now doing deeper interrogation of a particular person’s tumor with the idea of precision medicine.
“Your breast cancer has relapsed. Why has your particular breast cancer relapsed? Do we have specific trial that might work better for you?” We’re not quite there yet, but certainly we’re getting there and truthfully, lung cancer is very successful in doing that match. In breast cancer, we had been successfully doing it in hormone positive and HER2 positive breast cancers but now we are looking for the next new markers.
We try to improve the treatment so that it is better than we currently give. Sometimes we need some new medications. Most of the new trials I am looking at involve the targeted chemotherapy, which generally has fewer side effects and easier to take. A lot of new treatments are pills and often you don’t lose your hair, and we are hoping they would be more precise.
We have trials in the entire spectrum so where we are really looking at right now, we call it preoperative setting. Traditional chemotherapy in breast cancer is given after the patients have the surgery but we know that certain patients benefit from chemotherapy before surgery to make the actual surgery easier or potentially less invasive. That is the added opportunity to evaluate what treatment works sooner, and to find out the ideal situation to try new potential options or new therapies. Phase I trial is where the drug at its earliest point of development and no much information about it. It is an option to try out whether the drug worked and all drugs have to go through that process. For individual patients, it really comes with their health condition: some have other significant health problems like strokes or diabetes; we try not to put them on our studies because all these treatments might interact with their existing health concerns.
4. Could you briefly explain different surgery techniques to remove breast cancer?
I am not a surgeon... (laughing) However, in general, the ability to do better surgeries has improved dramatically. In fact, we have devoted to what we call oncoplasty, which is the idea to improve the cosmetic outcome of breast surgery in this APBCS meeting. Historically you can either remove the lump, and do radiation or you can remove the entire breast and potentially not getting radiation.
But as I said, lots of patients nowadays get preoperative therapy. They get the clip inserted and so the cancer melts away, we still know where to go to remove the potential little lump that might still be there, so those are the major categories of surgery.
5. What do you think is the most effective way to increase awareness for breast cancer prevention?
Overall I think there has been a lot of changes in Singapore, advocating for prevention whether it is exercise, diet or other things that need to be infiltrated through all the polyclinics. I think what probably might work in Singapore and Asia is getting celebrities or people who have been through it, to share their experience. Someone like, “You know I have done a mammogram or I always check every month. I took breast cancer chemo and it wasn’t that bad.” I think there is a lot of misconception about how hard the treatment is. Truthfully, it is not easy but for the most part we can get people through treatment with lesser side effects that it is going to be. It does require the entire family coming together. I think people sharing experiences sometimes in the public eye or sometimes people just talking about their experiences, it’s just like helping each other.
The medications we give really work well. Make sure that you do self-examination and try to go for mammogram, some people may find it uncomfortable but certainly finding it early does make it different. Breast cancer is very curable, in fact more and more people don’t need chemotherapy. That is an equally important message, breast cancer is not a death sentence. There are a lot of great treatments. And eventually people end up living a very normal, healthy life.