Speech by Parliamentary Secretary for Health, A/Professor Muhammad Faishal Ibrahim, at the National University Cancer Institute, Singapore, World Cancer Day Family Carnival at West Coast Park, 2 Feb 2013

Mr Choo Eng Chuan, Chairman, Singapore Cancer Society

Mr Albert Ching, CEO, Singapore Cancer Society

Professor John Wong, Director, National University Cancer Institute, Singapore

Ladies and gentlemen

1. I am very pleased to be here with you at the launch of Singapore’s celebration of World Cancer Day 2013. World Cancer Day falls on February 4 every year and is celebrated around the world to improve general knowledge around cancer and dispel myths and misconceptions about the disease.

Burden of Cancer

2. According the World Health Organisation (WHO), cancer is responsible for close to 13 per cent of deaths globally, accounting for 7.6 million deaths in 2008. In Singapore, cancer is the leading cause of death, accounting for up to 30 per cent of total deaths in 2011.The top two leading cancers for the period from 2006 to 2010 were colorectal and lung cancer among Singapore males and breast and colorectal cancer among Singapore females¹.

Cancer Screening

3. One of the great myths of cancer is that it cannot be avoided or prevented as it is part of a person’s destiny. The truth is that the number of cancer cases can be reduced and many cancer deaths can be prevented. You can reduce your cancer risk by consuming a diet rich in fruits and vegetables and less animal fat, not using tobacco, limiting alcohol use, maintaining a healthy weight and being physically active.

4. Going for age appropriate screening for early diagnosis is also important in reducing the number of deaths caused by cancer. Cancer screening helps detect either precancerous lesions, or diagnosing a cancer at an early stage. Diagnosing cancer early is important as early-stage cancer is easier to treat. In contrast, delaying diagnosis until such time the cancer has progressed to its later stages, usually results in more complications and poorer survival rates as the cancer might be difficult to treat or will require more aggressive treatment.

5. Based on recent reports from the Cancer Registry in Singapore, 96% of breast cancer cases diagnosed at stage one survived 5 years compared to 88% at stage two, 68% at stage three and only 25% for those at stage four^2,3. Similarly for colorectal cancer, the survival is better with earlier diagnosis. For colorectal cancer cases, the 5 year survival rate was 79% for colorectal cancer cases diagnosed at stage one compared to 68% in stage two, 50% at stage three and only 7% at stage four^4,5. Unfortunately for Singaporeans, the majority of the colorectal cancer cases were diagnosed at stage two or later⁵.

6. Appropriate screening together with appropriate management can improve health outcomes and the chances of survival, delay or prevent dependence, and reduce the financial and emotional burden on the individual, family members and friends in the long term. I strongly urge everyone to go for age appropriate screening to detect cancer early for easier management.

Cancer Screening Programmes

7. The Health Promotion Board (HPB) runs established screening programmes for breast cancer, cervical cancer and colorectal cancer. These programmes provide subsidised screening for eligible Singaporeans.

8. However, less than half of Singaporeans have gone for the recommended cancer screenings. According to the National Health Survey (NHS) 2010, only two in five Singaporean women aged 50 to 69 years had undergone mammography within the last two years. For cervical cancer screening, only 48% of Singapore women aged 25 to 69 years had a Pap smear within the past three years.

9. As for colorectal cancer screening, the NHS survey results in 2010 showed that only one in five Singaporeans aged 50 to 69 had a Faecal Occult Blood Test (FOBT) within the past one year or a screening colonoscopy within the past ten years. We hope to see an increase in the uptake for colorectal cancer screening in future, with the implementation of the National Colorectal Screening Programme in July 2011 as part of the Integrated Screening Program (ISP). I strongly encourage Singaporeans aged 50 years and above to go for colorectal cancer screening.

10. The Ministry of Health has programmes in place to reduce barriers to health screening. The faecal immunochemical test (FIT) screening test for colorectal cancer is provided free for eligible individuals aged 50 years and above at Chronic Disease Management Programme (CDMP)-registered GP clinics under HPB’s Integrated Screening Programme (ISP). Individuals aged 50 years and above going for screening colonoscopies may also use their Medisave to offset the cost of the procedure.

11. Singapore women aged 50 and above are strongly encouraged to go for two-yearly screening mammography for breast cancer. Subsidised mammography for eligible women is provided at the polyclinics. Medisave may also be used to offset the cost of screening mammograms.

12. For cervical cancer screening, eligible Singapore women can enjoy subsidised Pap smears at polyclinics. For those aged 40 and above, there is also the option of being screened at CDMP-registered GP clinics.

13. In the past, receiving a cancer diagnosis was like receiving a death sentence. But today, this could not be further from the truth. Advances in understanding cancer risk and prevention, early detection and treatment have revolutionised the management of cancer leading to improved outcomes for patients. The key is early detection through age appropriate screening. I strongly encourage all of you to take advantage of these affordable screening programmes. Remember, early detection saves lives. MOH will continue to work with partners and stakeholders to spread this message and explore how to make screening more pervasive.

NCIS Achievements

14. Whilst our colleagues in HPB and the community focus on prevention and early diagnosis, our colleagues in the tertiary institutions have not been resting on their laurels either. Clinicians and researchers in Singapore are working hard to find more effective and safer ways to treat cancer as well as to improve service delivery to patients.

15. At the National University Cancer Institute, Singapore (NCIS), suitable patients with certain types of cancers are now given the option of receiving stem cell transplants on an outpatient basis, reducing and in some cases totally eliminating the need for a hospital stay. This is a win-win situation. Outpatient treatment costs less than inpatient care, and very importantly, patients are able to recover in the comfort of their own homes. Outpatient care also frees up more beds and requires less manpower, which permits the hospital to redeploy such resources more effectively.

16. Researchers at NCIS have also made discoveries such as new drug combinations that increase the effectiveness of chemotherapy on tumours. These innovations in cancer care would not have been possible without close cooperation between doctors, nurses, allied health professionals, healthcare administrators and the pharmaceutical industry. It highlights the importance of collaboration in healthcare.

Closing

17. Cancer care is a spectrum that spans awareness, prevention, early screening and good clinical care. I commend NCIS, the Health Promotion Board and the Singapore Cancer Society for coming together to organise this World Cancer Day event as well as various outreach activities to raise awareness of cancer in the community. I hope to see more of such campaigns in the future.

18. I would also like to thank all the residents of the North West and South West Community Development Council who have shown their strong support for the cause by being here today. Your presence makes this event all the more meaningful and lively.

19. Thank you and I wish everyone a pleasant evening.

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¹ Singapore Cancer Registry Interim Annual Registry Report: Trends in cancer incidence in Singapore 2006 – 2010, National Registry of Diseases Office (NRDO)

² Observed 5-year survival rate for breast cancer cases diagnosed in the period 2006 to 2010.

³ Health Factsheet: Trends of Female Breast Cancer in Singapore 2006-2010, National Registry of Diseases Office (NRDO).

⁴ Observed 5-year survival rate for colorectal cancer cases diagnosed in the period 2003 to 2005.

⁵ Health Factsheet: Trends of Colorectal Cancer in Singapore 2006-2010, National Registry of Diseases Office (NRDO).