Screening could save your life

Do you know that most people wait until they feel a lump, have pain or bleeding before they even think about cancer screening? This is a problem because many cancers don’t show symptoms until they are more advanced. When cancer is advanced it is difficult to cure and more aggressive treatments that have severe side effects are needed, resulting in poorer quality of life for the person affected.  

“Cancer screening uptake in Singapore remains relatively low at below 40%, but the truth is early detection through screening programmes is crucial for achieving better treatment outcomes. By improving screening uptake, we can detect cancers early, significantly improve survival rates and increase the chances of cure for our patients,” shared Professor Ravindran Kanesvaran, Chairman and Senior Consultant, Division of Medical Oncology, National Cancer Centre Singapore (NCCS).

Singapore offers three major national screening programmes for early detection of breast cancer, colorectal cancer and cervical cancer. The aim is to detect and treat these cancers early.  Research is also currently being conducted to study the feasibility of lung cancer screening in Singapore.

Breast Cancer:  Women should get screened every 2 years after the age of 50

In Singapore, women aged 40 to 49 are recommended to go for a mammogram annually.

Breast cancer is the most common cancer and leading cause of cancer death among women in Singapore. Between 2018 and 2022 [1], breast cancer accounted for more than 13,000 new cancer cases in women and more than 23,000 of overall cancer deaths.

Early-stage breast cancer shows no signs or symptoms, which is why screening is crucial. While all women are at risk of breast cancer, the risk increases with age, particularly if you're 50 or older, or if your mother, sister or daughter has had breast cancer.

Who should get screened:

• It is recommended that women aged 40 to 49 should be screened once a year. However, younger women typically have denser breast tissue and abnormalities may not be visible on mammograms. Therefore, women should consult their doctor about the benefits and limitations of mammogram screening at this age.
• For women 50 and above with no symptoms, screening every two years is recommended.

Where to get screened:

• To check your screening eligibility and book an appointment for a mammogram at a participating CHAS GP clinic, visit the National Health Appointment System at https://book.health.gov.sg/healthiersg-screening or call your nearest polyclinic to make a screening appointment.
• Free mammograms are also available for valid Blue or Orange CHAS cardholders at the Singapore Cancer Society Clinic @ Bishan, call 1800 727 3333 to find out more.

Colorectal Cancer: Men and women should get screened yearly after the age of 50

Regular screening using the Faecal Immunochemical Test (FIT) detects hidden blood in stool samples, which may be an early sign of polyps or cancer. (Credit: iStock.com/Carolina Rudah)

In Singapore, colorectal cancer is the second most common cancer for both men and women [2]. More than 12,000 new cases were diagnosed from 2018 to 2022. Though typically diagnosed in people over 50, it is increasingly being diagnosed in younger individuals. However, colorectal cancer is one of the most preventable cancers when caught early.  Regular screening can detect polyps before they turn cancerous or detect the cancer early when it is easier to treat.

Who should get screened:

• Colorectal cancer screening is recommended from age 50 for people with no symptoms. Those with a family history should discuss with their doctor if they should start screening earlier.

Screening methods:

• A Faecal Immunochemical Test (FIT) is used to detect the presence of hidden blood in stool samples, which may be an early sign of polyps or cancer. If blood is found, additional tests are needed to confirm the source and determine if cancer is present. FIT should be done once a year.
• A colonoscopy is a procedure that uses a thin flexible camera, inserted through the anus, to examine the entire colon. During the procedure, doctors can also remove small polyps and perform biopsies of any abnormal areas. A colonoscopy is recommended once every 5 to 10 years.

Where to get screened:

• If you are enrolled in Healthier SG, contact your enrolled Healthier SG clinic to enquire about your eligibility for a subsidised FIT kit.
• If you are not enrolled in Healthier SG, contact your CHAS GP to enquire about subsidised FIT kit availability.
• For enquiries regarding Healthier SG FIT kits, please contact: HPB HealthLine at 1800 223 1313 or visit www.healthiersg.gov.sg/contact-us

Cervical Cancer: Regular screening recommended for all women 25 to 69 years old 

In Singapore, women, aged 25 to 69 who are or have been sexually active, are recommended to have a Pap smear or HPV test every 3 to 5 years. (Credit: iStock.com/SewcreamStudio)

In Singapore, cervical cancer is the 10th most common cancer and 10th leading cause of cancer death in women [3], with over 200 new cases diagnosed annually. The good news is that cervical cancer is highly preventable and curable when detected through regular screening and treated early. 

Who should get screened:

• Singapore's National Cervical Screening Programme recommends regular screening every 3 to 5 years for all women aged 25 to 69 who are or have been sexually active.

Screening methods:

• Screening involves either a Pap smear or Human papillomavirus (HPV) test every 3 to 5 years, as advised by your doctor. A pap smear is a quick, simple and painless procedure where cells are gently scraped from the surface of the cervix during a vaginal examination, the sample is then sent to the lab to test for pre-cancer or cancer.

The HPV vaccination provides additional protection and is available for females aged 9 to 45. The complete course involves three doses delivered over six months and is available at polyclinics and GP clinics. The vaccine works best when given between ages 9 to 26, ideally before sexual activity begins. While it provides long-lasting protection and is highly effective against HPV-16 and HPV-18 strains and, it does not cover all HPV types. Hence regular cervical cancer screening remains important even for vaccinated women to provide the strongest protection.

Where to get screened:

• To check your screening eligibility and book a screening appointment at a participating CHAS GP clinic, visit Health Appointment System at https://book.health.gov.sg/healthiersg-screening or call your nearest polyclinic to make a screening appointment.

• Free Pap smear tests are available for females aged 25 to 29 who have not done a test in the last three years, and free HPV tests are available for females aged 30 to 49 who have not done a test in the last five years. Both tests are available at the Singapore Cancer Society Clinic @ Bishan, call 1800 727 3333 to find out more.

Tackling lung cancer, the silent killer

SOLSTICE studies the feasibility and effectiveness of using low-dose computed tomography (LDCT) scans to screen for lung cancer in local populations. (Credit: iStock.com/mr.suphachai praserdumrongchai)

In Singapore, lung cancer is the third most common cancer for both males and females, and the leading cause of cancer deaths for males [4]. The disease typically shows no symptoms until it is advanced, making it much harder to treat. While most cases in the West stem from smoking, nearly half of Singapore's lung cancer patients have never smoked, with many developing non-small cell lung cancer (NSCLC) caused by genetic mutations in the EGFR gene rather than tobacco exposure.

SOLSTICE (SingapOre Lung cancer Screening Though Integrating CT with other biomarkErs) is Singapore's first local lung cancer screening study. It uses low-dose CT scans to detect lung cancer early in high-risk groups such as smokers and non-smokers aged 50 to 80 who have a family history of the disease. The study aims to determine whether low-dose CT screening is feasible and effective for Singapore's diverse population.

To find out more about SOLSTICE, please visit https://for.sg/solstice.

[1], [2], [3], [4] Singapore Cancer Registry 2022 Annual Report