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Cancer Screening

(中文版)

Cancer is the leading cause of death in Singapore. Leading an active lifestyle with healthy diet and behavior as well as having appropriate vaccinations (such as Hepatitis B, HPV) can reduce one’s risk of getting cancer. However, despite these measures, cancer may still occur and many cancers are often advanced and incurable by the time they are symptomatic.

What is cancer screening?

Cancer screening is the process of detecting cancer before symptoms appear. The goal of cancer screening is to identify cancer in its early stages and when it is still curable. However it is important to remember cancer screening should always go hand in hand with adopting an active healthy lifestyle and is not a replacement for it.

What are the benefits of cancer screening?

Cancer screening may allow some cancers to be detected in their early stages when they are still curable. When a cancer is detected early, the treatment may also be less aggressive.

For example, mammography screening may detect breast cancer when it is still in its early stages (e.g. stage 0 or 1), instead of when it has become symptomatic in stage 3. The treatment for some early stage breast cancers may only be a lumpectomy (in which only the affected part of breast is removed) while a stage 3 breast cancer may require a mastectomy (removal of the entire breast) as well as additional treatment such as chemotherapy.

What are the downsides to cancer screening?

As with all medical tests, cancer screening is not perfect. It may sometimes miss a cancer (this is called false negative) and sometimes it may even falsely label a normal tissue as potentially cancerous (this is known as false positive). The latter may then lead to additional unnecessary tests.

In addition, there is now also evidence to suggest that sometimes screening may detect cancers that are very slow growing or indolent that may not actually require any treatment. This is known as overdiagnosis bias. This unfortunately may then lead to treatment that is not necessary.

What cancer screening should I undertake?

There is currently a huge proliferation of cancer screening packages available in the market that are neither consistent with guidelines nor supported by evidence. Many of these offer a panel of cancer marker blood tests that claim to be able to detect cancers early. Unfortunately, there is no evidence to support this. Instead, some of these screening packages may potentially lead to more harm than good.

It is therefore important to undertake cancer screening that is appropriate, evidence based and recommended by accepted guidelines.

The Singapore Ministry of Health has published guidelines to help guide physicians and the public as to which cancers in what group of people are appropriate for screening. These guidelines are in keeping and similar to the World Health Organization and majority of the developed world’s recommendations.

For the average risk person without symptoms (i.e. those without symptoms or family history of the cancer being screened for), the following cancer screening is recommended:

Colorectal Cancer

For those age 50 and above,

  • Faecal occult blood testing once a year OR
  • Colonoscopy once every 10 years OR
  • CT colonography once every 5 years

For additional information on colorectal cancer screening, click here.

Cervical Cancer

Cervical cancer is rare among females who have never been sexually active and routine screening in this group is not recommended.

In those who have ever been sexually active, the following is appropriate:

From age 25-29: Pap smear every 3 years

From age 30 and above: HPV DNA test every 5 years

The method of collection between Pap smear and HPV DNA test is the same (the difference is only in the way the test is performed in the laboratory).

For additional information on cervical cancer screening, click here.

Breast Cancer

The standard for breast cancer screening is mammography. However, no test is perfect and there are potential downsides as well as benefits to breast cancer screening. Speak to your healthcare provider about the pros and cons of mammography screening and if appropriate, the following is recommended:

From age 40-49: Mammography screening once a year

From age 50-69: Mammography screening once every 2 years

For additional information on breast cancer screening, click here.

What about cancer screening for other tumor types?

The above recommendations only apply to those with average risks and no symptoms. If you have additional risk factors such as family history, it may be appropriate to undergo additional tests. For example, if you have a first degree relative with nasopharyngeal cancer (nose cancer) it may be appropriate to undergo screening for this by seeing an ENT specialist and having a blood test. Or if you have a history of cirrhosis or chronic hepatitis B infection, you may be suitable for liver cancer screening with ultrasound and blood test.

However, for the average risk Singaporean, having additional screening beyond the guidelines listed above is not appropriate or recommended.

Speak to your healthcare provider for more information on these testing if you have these additional risk factors.

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For counselling, cancer information and registration for public education programmes, loaning of wig, as well as request for publications, please call the Cancer Helpline at (65) 6225 5655 or email to cancerhelpline@nccs.com.sg