Speech by Minister of State for Health, Mr Chee Hong Tat, at Tan Tock Seng Hospital’s Inaugural Public Cancer Symposium, 19 Mar 2016

Dr Jamie Mervyn Lim, Chief Operating Officer, Tan Tock Seng Hospital,

Adjunct Assistant Professor Chong Yew Lam, Divisional Chairman (Surgery), Tan Tock Seng Hospital,

Distinguished guests,

Ladies and gentlemen,

1.    Good afternoon and I am very pleased to be here at the inaugural Tan Tock Seng Hospital Public Cancer Symposium.

Cancers are becoming more common

2.    Cancers remain the number one cause of death^[1] in Singapore. Among males, colorectal, lung and prostate were the 3 most frequently diagnosed cancers. Among women, breast, colorectal, and lung were the 3 most commonly diagnosed cancers^[2]. These cancers constitute about half of the cancer deaths in males and females respectively. Some cancers are also becoming more common as the population ages. In the last few decades, colorectal cancer incidence has been increasing significantly in men, whereas for women, the incidence of breast cancer has almost tripled since the early 1970s.

Fighting back

3.    We can fight back, and we have. Our overall cancer survival rates have shown tremendous progress in the last 40 years. For example, in male cancer patients, the 10-year survival has improved to one in two in 2010 compared to only one in ten in 1975. Similarly, for female cancer patients, the improvement in 10-year survival was also one in two in 2010 from one in four in 1975. These improvements in survival can be attributed largely to advances in medical treatment.

4.    Another important factor is that people are becoming more aware of the importance of health screening for early detection. In 2011, just over a quarter of Singaporeans aged 50 to 69 years came forward for colorectal cancer screening. This has gone up to over one third of Singaporeans in 2014^[3]. We hope more Singaporeans will come forward to screen for colorectal, breast, and cervical cancers. It is not enough to just screen just once, regular screening with follow up is required. For those 50 years and above, annual colorectal cancer screening using the FIT^[4] test is recommended. For women who are 50 years and above, it is advisable to go for a mammogram once every two years. Screening for cervical cancer needs to start from the age of 25, and continue once every three years.

5.    To encourage and assist more Singaporeans to go for regular health screenings, the Health Promotion Board (HPB) subsidises recommended screening tests via Screen for Life, which is available at participating CHAS GP clinics. There are also subsidised breast and cervical cancer screening programmes at our polyclinics under Screen for Life.

6.    Besides screening, we should also be aware of what symptoms to look out for, especially for the more common cancers. This is one of the areas which our doctors would share with you at this Symposium. Treatment for early stage cancers results in much better outcomes compared with late stage cancers. For example, over 90% of those with early stage cancer (or Stage I) breast cancer would survive for at least 5 years, usually much longer. However, only 20% of breast cancers picked up late (or Stage IV) would survive 5 years or more^[5]. Another example is colorectal cancer, where the 5-year survival rate for Stage I cases is 85% compared to only 10% for Stage IV cases.

Prevention

7.    Prevention is the best medicine. We too have a role in improving our odds and fighting back against cancer through our own lifestyle choices. Local research indicates that about a third of our disease burden from cancers could be prevented by adopting healthier lifestyles, for example eat healthily, exercise regularly and not smoking^[6].

8.    Smoking has a direct link to cancer. Smokers increase their risk of developing lung cancer by 20 times compared to non-smokers. We are seeing a decreasing trend in lung cancer rates partly because smoking rates in Singapore have gone down significantly over the past decades. In addition, through a combination of legislation and public education, we have been able to better protect the public from the harms of tobacco use and second hand smoke. This is an on-going effort to reduce the number of smokers in Singapore, especially our young.

9.    We also want to help smokers to quit and improve their health. HPB launched the “I Quit movement” in June 2011, to build a network of support to help smokers to quit. HPB also introduced the 28 Day Countdown in 2013, to get smokers to quit by breaking down the journey into small actionable steps. Findings have shown that smokers who stay smoke-free for at least 28 days are five times more likely to quit smoking for good.

10.    These are important initiatives because we can look forward to further lowering our lung cancer incidence if more people decide to quit smoking, or not take it up in the first place. These are steps we can take to protect ourselves and our loved ones against cancer.

11.    Lastly, we have to fight cancer together. In the diagnosis of cancer, support from family, friends and the society is an essential element of holistic cancer care. Cancer survivors would have gone through a lot of pain, anxiety, and uncertainty. The disease does not only affect the patient, but also their loved ones. This is why I would also like to acknowledge our dedicated volunteers and support groups, many of whom are cancer survivors themselves, who contribute their time and effort to help new cancer patients. Your support has made a difference to their lives and their recovery journey.

12.    Thank you very much and I wish you all a very enjoyable symposium.

^[1] MOH, Singapore Health Facts 2014 

^[2] NRDO Singapore cancer registry interim annual report, Trends in cancer incidence in Singapore 2010 – 2014 

^[3] Health Behavioural Surveillance Survey 2014, HPB 

^[4] Faecal Immunochemical Test

^[5] Singapore Cance Registry, Cancer survival in Singapore 1973 – 2012. Survival rates quoted here are age-standardised observed survival. 

^[6] Wu S, Powers S, Zhu W, Yusuf AH. Substantial contribution of extrinsic risk factors to cancer development, Nature, 2016, 529: 43 – 47.