Breast cancer amongst Singaporeans: What are the causes?

The National Institutes of Health (NIH) has identified three potentially novel reasons in the development of breast cancer among Singaporean residents (rapid urbanization, improvement in socio-economic status, and adoption of a western lifestyle). All three reasons will be used and explored in this very article in more detail in hopes of acting as an alternative form in investigating how these reasons may be sources of breast cancer developments within the nation. All credit is ascribed accordingly.

Nobody enjoys going to the doctor; from dull-colored fixtures to the abnormally-sharp instruments atop the medicine trolley. But for women, the sojourn can be slightly more formidable. The annual check-up is a day most women dread, and not necessarily due to discomfort of mammograms or prolonged waiting times of ultrasounds, but due to the nescience of what the results could reveal. This experience has been shared by several women across the globe, and in Singapore alone, cases of breast cancer are rigorously on the rise. According to SingHealth, “Breast cancer is the most common type of cancer among women in Singapore today. 1 out of every 13 women in Singapore is likely to be afflicted by breast cancer.” These figures, not only, offer alarming insight into the clambering cases of breast cancer within the nation but spotlight a critical need for re-evaluation and alternation to Singaporean lifestyles. But for what reasons are breast cancer cases so prevalent and what existing risk factors are compounded with this?

Singapore is a briskly developing city-state, and for the most part, this has been a productive advancement in society and the general manner of living among Singaporean residents. But what some fail to heed, are the miscalculations of what rapid urbanization has generated. For starters, Singapore is an incredibly dense and compact nation. This leads to factories, construction sites, and power plant stations situated in close proximity to residential areas and workplaces. The consequence of this, evidently being pollution. Outside research has shown a link between constant exposure to air pollution and a higher risk of developing breast cancer, “We identified seventeen studies evaluating the risk of breast cancer associated with air pollution. A higher risk of breast cancer has been associated with nitrogen dioxide (NO2) and nitrogen oxides (NOx) levels.” (NIH).

Singapore is also no stranger to pollutant remnants traveling from its neighboring country, Indonesia, due to the practice of shifting cultivation within the region— contributing to an even greater amount of pollution within Singapore. The NIH added that, not only does prolonged exposure to air pollution elevate risk of breast cancer, but a spike in breast cancer across distinct ethnic groups has also been documented, “In the multiethnic population of Singapore, it has been noted that rising breast cancer incidence is consistent across all three ethnic groups (Chinese, Malays, and Indians). Singapore has among the highest breast cancer incidence in Asia.” (NIH) Which is an informative, novel piece of data that will help future researchers in better understanding the development of breast cancer— especially those who belong to particular ethnic groups.

Another important piece to mention is that Singapore eagerly attempts to mimic its western counterparts. New York City and Los Angeles, which would be classified as metropolitans, report less extreme cases of pollution than in Singapore. But the differences lie in the city’s substantial land masses. So while pollution does exist within these well-admired cities, its effect on population is far more indirect and gradual, unlike Singapore, which has a land area that is far smaller (728.6 km²). This point links us to the next potential reason, Singapore’s adoption of western lifestyles. As Singapore began to urbanize and become a technologically advanced city, it also began to emulate similar trends and customs, exhibited in the latter megacities. Perhaps this is a common theme across developed countries, or a pure coincidence, regardless, Singaporean residents have begun to manifest similar lifestyle habits like diet and leisure activities to western citizens. Diet and mass consumption of processed foods, for instance, are one of the four mirrored lifestyle habits that have been recorded.

According to the Food Export Association of the Midwest USA, “Singapore imported US$537 in U.S. processed food exports in 2020, an increase of 9%. Top exports of processed foods to Singapore in 2020 included: Fats And Oils, Processed/Prepared Dairy Products, Processed Vegetables & Pulses. Snack Foods, Alcoholic Beverages, and Chocolate And Confectionery. The sudden soar in processed food consumption amongst Singaporeans, has invariably presented a linkage with breast cancer-specific developments, as investigated by Lifespan, “The BMJ study showed that a 10 percent increase in the proportion of ultra-processed foods in the diet was associated with a 12 percent risk of overall cancer and an 11 percent risk of breast cancer. These findings add to the strong body of evidence linking poor diet with overweight/obesity and cancer risk.” Eating these types of foods, also known as a “Western type” diet, contribute to weight gain, overweight, obesity and 12 specific cancers.”

Much of western lifestyle is credited to such chaos because Americans are always on the go, According to InterChange, “It seems they [Americans] are often running from one appointment to the next, going to and from work, picking up kids, running errands, and going to business meetings and social outings. Because Americans are regularly on the move, there is often not enough time to have a formal, sit-down meal.” This could explain why western diet is so poor, and the assumed ‘Hustle Culture’ that has been crafted amongst society, has now been absorbed by other Asian countries, including Singapore. Which in turn, has created an integration of westernized customs and habits among Asian culture.

The population of wealthier individuals residing in Singapore has risen exponentially, and in 2021, it has been verified that there were 28 billionaires in Singapore. (Tatler) But the sudden increase in the wealthier population of Singapore, has actually resulted in negative results for their health. SingHealth has accumulated a few reasons as to why, “According to the experts, much of it boils down to people being spoilt for choice and opting for convenience over health. In other words, people are more likely to grab dessert or a snack between meals, just because they can.” While the improvement in socioeconomic status sounds inherently positive, seemingly it has led to overindulgence of unhealthy food and meal options, and as expressed in the latter, the likelihood of breast cancer development is quite high.

Mass alcohol consumption, similar to mass processed food consumption, is yet another mirrored lifestyle habit that has been discerned. In fact, such a strong correlation between consumption of alcohol and development of breast cancer has been detected, that the World Health Organization (WHO) has found that, “The risk of breast cancer increases with each unit of alcohol consumed per day. More than 10% of alcohol-attributable cancer cases arise from drinking just 1 bottle of beer (500 ml) or 2 small glasses of wine (100 ml each) every day.” And in just 2020 alone, WHO held alcohol responsible for more than 40,000 new cases of breast cancer. Dr Marilys Corbex, Senior Technical Officer for Noncommunicable Diseases at WHO/Europe, stated that, “Many people, including women, are not aware that breast cancer is the most common cancer caused by alcohol among women globally. People need to know that by reducing alcohol consumption they can reduce their risk of getting cancer. It doesn’t matter what type, quality or price alcohol is.”

The focal concern with this being Singapore’s expeditious increase rate in alcohol consumption. Movendi International reported that, “In Singapore binge alcohol use is on the rise. A survey by the Ministry of Health found that 10.5% of respondents said they engaged in binge alcohol use in 2020, up from 8.8% in 2017.” Similarly, smoking has effects that cause an increased risk of breast cancer, another habit practiced by westerners that is subsequently being replicated by Singaporeans. Some other lifestyle habits that have been commonly associated with the western lifestyle include: elevated levels of stress and lack of adequate sleep levels.

While there are currently no studies that prove there is a correlation between breast cancer and stress, some studies have been able to deduce that stress does induce cancer recurrence. Likewise, no study has been able to evince the relationship between lack of adequate sleep or poor rest with breast cancer, but once again, a few studies have reported that lack of adequate sleep levels may cause lower melatonin levels which disrupt the patterns of breast cell growth and could cause breast cancer to redevelop—assuming one has already had breast cancer.

With that said, there are no absolutes or guarantees. Cancer research—let alone breast cancer research—must still undergo thorough experimentation and investigation before we can prescribe the most ideal treatment option or make definitive claims. But until then, it is imperative to stay well-informed as well as collect and distribute the research we have now, to a wider audience in order to combat the disease. So ladies, what can you do to stay well-informed about breast cancer mitigation? Next time during your annual check-up, be sure to ask your local doctor any questions or concerns you may have, because being as open and upfront as possible will relieve some of the anxieties you could be experiencing. Stay vigilant and healthy!

– By Lynn Robchinsky for TaraBliss

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