249 274
SCREENING
249
January15
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“Screening for diabetes should start
at age 40,” he recommends, “or earlier if
one of your parents or siblings is diabetic.”
Cholesterol
levels should be checked
regularly from age 35, or earlier if you
are a smoker or have a family history of
heart disease.
Blood tests can also be used to
screen for common health problems
such as a
thyroid dysfunction
,
vitamin
D deficiency
and
anaemia
(due either
to iron or vitamin deficiencies).
Colon cancer is the commonest
cancer in Singapore, notes Dr Lin. “An
annual stool test for occult blood is a
good idea; so is a first colonoscopy
at the age of 50, or earlier if you have
a family history of the disease.” And if
you notice symptoms of changed bowel
habits lasting for more than six weeks,
or if you see blood in your stools, get
yourself to a specialist immediately.
So much for the Big Five. Depending
on your gender and your particular
risk factors, he explains, you can also
opt to be screened for a host of other
potentially debilitating conditions, from
sight-threateningglaucoma to skin cancer.
Men
should be aware of tests
for prostate cancer, and that low
testosterone can be treated with
hormone replacement therapy.
Regular Pap smears are essential for
the cervical health of
women
aged 25 to
64; breast cancer screening by means of
physical examination, mammogram or
ultrasound, depending on your age and
other factors, is likewise vital, he says.
Finally, youmight want to have your BMD
(bone mineral density) checked for signs
of osteoporosis or its less advanced
form, osteopaenia; this test, happily, is
subsidised here by the MOH.
As Dr Lin points out: “A multitude of
illnesses or conditions can exist without
signs or symptoms for many years, but
their eventual consequences can be
shattering.”
Oncologically speaking
Many of us harbour some degree of fear that we may unwittingly be playing
host to a tumour, and especially so if a close family member has had cancer.
So I asked oncologist DR LAVINA BHARWANI, the Medical Director at Johns
Hopkins Singapore, to identify the worst of the “silent killers”: tumours that
cause no pain, weight loss or other symptoms as they grow within the body.
“The real silent killers are cancers of the pancreas, the ovaries and the
stomach – unlike, for example, a tumour in the colon that’s going to grow and
press on something, or a palpable lump in the breast. Cervical cancer is another,
too, but to a lesser extent; there are generally symptoms such as bleeding.”
Stomach cancer is a particular worry for Dr Bharwani, who says she has been
seeing many advanced cases in the past few years. Mostly, these are people
who mistake its symptoms for indigestion or reflux.
Johns Hopkins Singapore
11 Jalan Tan Tock Seng
6880 2222
hopkinsmedicine.org/singapore
To screen or not to screen?
The crux of screening lies in the
question: Are we able to pick up cancers
early enough tomake a difference in the
outcome? Unfortunately, that’s often
not the case.
To some degree, she says, screening
has changed the outlook for
breast
cancer
: identified early enough,
it can be cured. “And despite the
controversy about mammograms,”
says Dr Bharwani, “I still think they’re
important.”
The same goes for the Pap smears
that pick up
cervical cancer
, and also
for
colon cancer
, if the tumours or
pre-cancerous polyps are found during
the course of a timely colonoscopy
and removed. Potentially deadly skin
melanomas
, too, are completely
curable if identified and excised in the
early stage.
What about other cancers?
For many other cancers, there is often
no reliable test available; for instance,
there’s no test for lung cancer in a non-
smoker. Pancreatic cancer is another
example; it’s generally only found after
a patient seeks medical attention for
pain and weight loss, a mass on the
pancreas is picked up on a scan and a
biopsy is performed. “Even when caught
early,” she explains, “pancreatic cancer
cure rates are low, both because of the
nature of the cancer and the fact that
effective treatment drugs have not yet
been identified.”
For risk-averse souls like me, it’s
alarming to be told that there is no
standard screening protocol for the
majority of cancers. Each country
has its own guidelines, explains
the oncologist, “and it’s often a
physician-patient thing”.
Her advice? The main thing is to
listen to your body; and, of course,
to limit the risk factors in your own
life. We can’t choose our parents or
our DNA, but we can avoid tobacco,
limit alcohol intake and maintain a
healthy weight. “Physical activity is
hugely important,” she stresses.
Last word
For someone who’s feeling good,
what would Dr Bharwani suggest in
the way of screening?
“From your early twenties,
periodically check your general
wellbeing – blood pressure, blood
sugar, cholesterol and so on: for
women, breast self-examination from
the age of 20, and Pap smears from
21” And then?
“Disease incidence increases with
age; that’s why screening for breast
cancer is recommended from 40,
and for colon cancer from the age
of 50, or earlier with a family history
of either of these diseases.”