Early Screening Is Still Best

18 Nov 2009

By MR KHAW BOON WAN

Venue: PAN PACIFIC HOTEL

SPEECH BY MINISTER KHAW BOON WAN, MINISTER FOR HEALTH,

AT THE OPENING CEREMONY OF

SGH’S INTERNATIONAL COLORECTAL CONGRESS,

ON 18 NOVEMBER 2009 AT 8.45 AM

AT PAN PACIFIC HOTEL

“Early Screening Is Still Best”

Chairman, Organising Committee

Distinguished guests

Ladies and Gentlemen

1.  Two months ago, I went for my regular endoscopy at the Singapore General Hospital.  Prof Eu Kong Weng attended to me.  He asked if I would officiate at this Congress.  I forgot now whether he popped the question before the procedure or after it. How could I say no?

2. I was not going to give him a free lunch; so I asked him for a paper on the development of colorectal surgery in Singapore: how do we now fare in the world, and what else should we do, going forward.  I have an interest in this subject, having witnessed its formation and tracked its development over the years.

3.  When the Department of Colorectal Surgery was set up in SGH in 1989, I had already been working in the Ministry of Health for 11 years.  I knew the significance of that decision and the strategic intent of that move.  Subsequent developments confirmed the wisdom of that policy decision. 

4. Your achievements in the past 20 years are well known to this audience.  There is no need for me to elaborate.  But we must pay tribute to the people who have toiled to make these achievements possible, starting with Dr Goh Hak Su, who led the pioneer batch of colorectal surgeons. He was succeeded by Dr Francis Seow Choen in 1997 and then in 2003, by Prof Eu Kong Weng.  Together, they have trained many of our best colorectal surgeons.  With each passing decade, they have moved colorectal surgery to higher levels, adding research and academic excellence to clinical services, while forging important ties and research collaborations internationally.  They have done Singapore proud.

COLORECTAL CANCER IS STILL RISING

5.  Meanwhile, modern unhealthy lifestyle continues to challenge our health.  The incidence of colorectal cancer has risen steadily, in tandem with our GDP. It is now the commonest cancer in Singapore.  Every year, about 1,500 new cases are diagnosed.  As the risk of colorectal cancer goes up significantly after the age of 50, we can expect many more new cases of colorectal cancer as our population ages further.   And for some reason, the incidence of colorectal cancer among Chinese Singaporeans is much higher than the Chinese in Hong Kong, Shanghai and Hawaii.  We must find out why and try to arrest the trend.

6.  Improvement in treatment helps.  In 1973, only 1 in 3 patients with early stage colorectal cancer survived after 5 years. Today, with improvements in surgery, adjuvant radiotherapy and chemotherapy, the survival rate has more than doubled.

7.       This is good but not good enough.  Our present overall 5-year survival rate is below OECD average, and we are behind Canada, Japan, New Zealand and the U.S.  One major reason is that 60% of our colorectal cancers are picked up too late, at more advanced stages, leading to poor survival.

REGULAR SCREENING SAVES LIVES

8. We must work harder to get more Singaporeans screened regularly and to pick up colorectal cancer early, in order to save lives. Today, our screening rates for colorectal cancer are too low.  Among those aged 50 and 70, only 1 in 9 men and 1 in 13 women have undergone a colonoscopy at least once.  Even for the less invasive stool test, only 1 in 4 has been screened. 

9. Let’s get more Singaporeans to come forward to be screened for colorectal cancer.  Over the next few months, we will pilot a colorectal cancer screening programme for Singaporeans over 50. 

WISH LIST 

10.      I asked Prof Eu for his wish list for colorectal surgery.  He gave me quite a long list.  Let me just mention some of them:

• Accreditation by the Specialist Accreditation Board as a subspecialty and recognition by the Academy of Medicine;

• Greater collaboration among the local colorectal surgeons to share their clinical data in order to support research and guide clinical practice improvements;

• Exploring the potential of diagnostic gene testing and preventive treatment for hereditary colorectal cancer;    and

• Greater recognition of the importance of genomics-based research so as to raise the quality of patient care.

11.    I am not a doctor and leave it to the profession to argue out their case with their peers.

CONCLUSION

12.     In conclusion, let me acknowledge the pioneering efforts of the SGH in colorectal surgery.  Because of your excellent work, there are now trained colorectal surgeons in nearby every hospital, both public and private.  But modern lifestyle is relentless in pushing up the incidence of colorectal cancer.  We must work even harder to prevent and fight this killer.  I am pleased to launch the International Colorectal Congress. 

Thank you.