SPEECH BY SENIOR MINISTER OF STATE (HEALTH), DR AMY KHOR, AT THE NATIONAL UNIVERSITY CANCER INSTITUTE, SINGAPORE’S WORLD CANCER DAY PUBLIC SYMPOSIUM ON 7 FEBRUARY 2015

Professor John Eu-Li Wong,

Chief Executive, National University Health System

Dr Lim Siew Eng,

Organising Chairman and Associate Director (Clinical – Education),

National University Cancer Institute, Singapore (NCIS)

Ladies and Gentlemen

A very good morning to one and all

大家早上好

Selamat Pagi

1.            I am delighted to be here today at the World Cancer Day Symposium 2015 organised by the National University Cancer Institute, Singapore (NCIS). It has been three years since the inaugural World Cancer Day Celebration was organised by NCIS in 2012. This year, the NCIS’ World Cancer Day Public Symposium has an interesting theme, which is “What’s Cancer Got to Do with Food”. I think this theme surely connects or resonates with many Singaporeans, and all of you here too, I am sure, as we are very passionate about food as a nation, and many of us will brave weather and distance to visit our favourite eating outlets! Am I right?

World Cancer Day

2.            Globally, cancer is among the leading causes of mortality. In 2012, an estimated 8.2 million deaths resulted from cancer[1]. World Cancer Day takes place every February to raise awareness about the disease and to unite the world’s population in the fight against this.

Cancer trends

3.         In Singapore, cancer is the leading cause of death, accounting for about 1 in 3 deaths. Indeed, when I was sharing with Dr Wong earlier that I do visit the wakes of my residents in my constituency, and actually, from my experience, very often I feel that it is more than 1 in 3 because when I ask what is the cause of death, very often, many will tell me it is cancer and it affects different ages. Their loved ones discovered their cancer late. Colorectal cancer is the leading cancer among men while breast cancer is the leading cancer for women.[2] When cancer progresses to later stages, it is more difficult to treat, there are more complications, and survival rates are lower. Between 2009 and 2013 about 80% of colorectal cancer cases diagnosed at stage one were still alive at least five years compared to about 70% at stage two, about 50% at stage three and about 10% at stage four[3]. Unfortunately, the majority of colorectal cases were diagnosed at stage two or later. Early stage cancers do not usually present with any signs or symptoms. Hence, it is important for us to go for regular screening to facilitate the early detection of the disease.

4.         There are currently effective and evidence-based screening tests for breast, cervical and colorectal cancer, and I would encourage eligible persons to be screened regularly for these cancers. At the moment, 53% of Singaporean women in the recommended age group screened regularly for cervical cancer. For breast cancer, the proportion is lower, at 38%. Colorectal cancer screening was introduced in 2011, so while the coverage has been low, the uptake has been increasing gradually since 2011, from 27% to 34% in 2013[4]. Our current cancer screening coverage still leaves room for further improvement, but with all our relevant stakeholders from Voluntary Welfare Organisations (VWOs) to Health Promotion Board (HPB) and healthcare family working together, I have hope that we can achieve much better screening results.

Importance of Diet – Relating to Cancer

5.         “Prevention is better than cure”. Beyond early detection, treatment and care for cancer, we should also go further upstream and promote a healthy lifestyle. This emphasis on healthy eating is important as dietary factors have a proven and significant effect on the incidence of cancers, with different dietary elements either increasing or reducing the risk of cancer. A high-calorie, high-cholesterol diet, physical inactivity and obesity have been shown to co-relate with up to 30-35% of cancer deaths. Over-eating is by far the most significant dietary cause of cancer and is the reason we must adopt a healthy diet[5].

6.         This is something not many are aware of but this is a significant cause. What I have just said is of course maybe well-known among some of you but not so commonly known to others. We have heard these warnings and advice from our doctors. But beyond the pun, eating well should be more than just food for thought. We must now put what we know into practice. I am a firm believer in the importance of eating healthily and living a healthy lifestyle.

7.         Studies have shown that making healthier choices in your diet such as more fruits and vegetables, more whole-grains, less sugar-sweetened beverages and foods that are lower in animal fats may help to reduce cancer risk. It is also important to lead a healthy lifestyle by exercising regularly, maintaining a healthy body weight, not smoking and drinking less.

8.         Singaporeans do have hectic schedules, but we can in small ways, introduce healthier choices in our lifestyles. For example, for myself, I try to take home-cooked meals whenever possible, and I must share that I feel I am very lucky that my mum is a great cook, so there is every incentive to go back for home-cooked meals. I make a conscious effort to use healthier cooking methods such as steaming and boiling when I cook and get my mother to do more steaming and boiling too. And we healthier ingredients, healthier cooking oil, like canola oil for instance. Instead of white rice, we take brown rice. You can also have short bouts of exercises at different times of the day, or find ways to incorporate physical activity like taking the stairs instead of the lift.

NCIS’ work in public education and non-clinical programmes

9.         Cancer care is not only about having effective treatment and good clinical care; it is also about awareness and prevention.

10.       To encourage the adoption of a healthy lifestyle by all, the HPB adopts general health promotion efforts and also designs targeted programmes to address specific needs within the community. For instance, we have a programme specifically for taxi drivers as they are at risk of different illnesses from driving for long hours. Some of these targeted initiatives include physical activity programmes and bringing healthier food options to the community. In addition, the HPB’s Screen For Life provides a comprehensive and established suite of health screening programmes that are available to Singaporeans at participating Community Health Assist Scheme (CHAS)-GPs and polyclinics so it is quite easily accessible.[6]

11.       I note that the NCIS has also put in a lot of effort into raising awareness of cancer and with that, the importance of a healthy diet, as well as attending regular screening and the necessary follow up. NCIS has also place great importance on educating cancer patients, survivors and their caregivers, teaching them to handle emotional stress and manage their loved ones’ diet. For example, the NCIS is working with celebrity chef Eric Neo from the InterContinental Singapore. I understand that he who is here at the Symposium today as a special guest to demonstrate how nutritious and tasty food that is suitable for cancer patients and survivors can be cooked easily. I’m sure you are looking forward to him sharing tips.

Closing

12.       I commend the NCIS for organising this symposium to reach out to the community and encourage each and every one of us here to take charge of our lives by living and eating healthily.

13.       So with this, I would like to thank all of you for taking time to participate in the Symposium, and the organisers for organising this Symposium. I hope that you will have a fruitful time at this Symposium. And before I end, for our Chinese friends, I wish you a Happy Lunar New Year, 新年快乐,身体健康,万事如意!

[1] Source: http://www.worldcancerday.org/wcd-2014-resources/press-release-wcd-2014

[2] Source: Singapore Cancer Registry Annual Registry Report, Trends in Cancer Incidence in Singapore 2009 – 2013 https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/cancer-trends-report-2009-2013.pdf?sfvrsn=0

[3] Cancer survival statistics are usually given as a 5-year survival rate, which describes the percentage of people with cancer who are alive 5 years after diagnosis, excluding those who die from other diseases.  The age-standardised observed survival of colorectal cancer by stage (2009 – 2013):

Stage I: 82.48%

Stage II: 70.06%

Stage III: 53.39%

Stage IV: 10.39%

[4] Health Behaviour Surveillance Survey 2013

[5] Anand, P., Kunnumakara, A. B., Sundaram, C., Harikumar, K. B., Tharakan, S. T., Lai, O. S., … Aggarwal, B. B. (2008). Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharmaceutical Research, 25(9), 2097–2116. doi:10.1007/s11095-008-9661-9

[6] Screen for Life refers to HPB’s screening programmes for cardiovascular disease and cancer screening programmes such as BreastScreen Singapore, CervicalScreen Singapore, Community Functional Screening Programme, Integrated Screening Programme and National Colorectal Cancer Screening Programme. For more information, please visit www.screenforlife.sg.