Gynaecological Cancer Trends in Singapore

By Dr Jeffrey Low, Head & Senior Consultant
Gynaecological Cancer Centre,
KK Women's & Children's Hospital

The last half a century has seen our Singapore making great strides in economic progress. Socioeconomic improvements have translated into better healthcare. Life expectancy for women here have risen from 67 years old in 1957 to 81 years in 2002. Correspondingly, the leading causes of death have changed from pneumonia as the top killer in 1957, to cancer as the leading cause of death today.

Gynaecological cancers are cancers of the female reproductive tract. Statistics from the Singapore Cancer Registry show that cancers of the ovary, cervix and uterus are respectively the 4^th, 5^th and 7^th highest ranking cancers afflicting Singapore women today (Table 1).

Cervical cancer had been the commonest gynaecological cancer in Singapore, but over the past 30 years, its incidence has declined consistently (Chart 1). Nevertheless the rate in Singapore today continues to be higher than most of Europe and the USA. This is unfortunate, as cervical cancer is one of the most preventable cancers and countries where there are formal Pap smear screening programs have seen a substantial decline of this dreaded condition.

In August 2004, CervicalScreen Singapore was launched by the Health Promotion Board with the aim of screening all women aged 25-65 years every 3 years. Trials are also underway in many countries including Singapore, to develop a vaccine against the human papillomavirus, the virus responsible for most cases of cervical cancer. Trial reports indicate that the vaccines are almost 100% effective in preventing the acquisition of the virus types 16 and 18 which together account for nearly 70% of cervical cancer worldwide.

Ovarian cancer remains the most deadly of the gynaecological cancers. A steady increase has been observed in Singapore over the past three decades (Chart 1), and ovarian cancer now surpasses cervical cancer in prevalence. In Singapore, this is one of the few cancers for which Malays have a higher risk (on average 10-20% higher) than Chinese. The continuing poor outcome results from the nonspecific and late clinical presentation of ovarian cancer and the lack of reliable and cost effective methods of early detection. There is clinical evidence to suggest that ovarian cancer patients have better outcomes when operated upon and managed by trained gynaecological cancer sub-specialists. Research is being carried out to explore the emerging field of proteomics as a way to detect early stages of ovarian cancer.

The incidence of uterine cancer has also been steadily increasing over the last 3 decades, more than doubling from 4.1/100,000 in 1973-77 to 9.4/100,000 in 1998-2002. Fortunately 70% of endometrial cancers are Stage 1 or 2 at presentation with a favorable 5-year survival rate of 80%. We are seeing a good number of endometrial cancer patients under 30 years of age, with our youngest patient to date aged 22 years. Most of these patients have a high body mass index (BMI) and p opulation studies indicate that endometrial cancer is one where incidence and mortality are most affected by being overweight or obese. The alarming increase in obesity in Singapore may account for the increase in endometrial cancer locally.

Eliminating the suffering and death from gynaecological cancers should be a priority in Singapore. This will require collaborative efforts among our government, private organizations, health professionals and patients. Programs to promote healthy life styles, public outreach efforts, novel prevention and early detection strategies, and scientific research and improvements in the standard of practice are all vitally important to help us achieve this goal.

Table 1. Ten Most Frequent Cancers affecting Females

Chart 1. Trends in Gynaecological Cancers



Source: Singapore Cancer Registry (1998 – 2002)