Do not smoke, drink less alcohol, maintain a healthy weight and stay physically active to lower your risk of cancer.
These are some of the key recommendations made by the World Health Organisation (WHO).
This is a timely reminder. Today is World Cancer Day and the theme this year is Cancer Can Be Prevented Too.
Cancer is the leading cause of death in Singapore. In 2008, almost 30 per cent of all deaths nationwide were from this disease.
While colorectal cancer was the most common here, the cancer that took the most lives were lung and breast cancer, the Singapore Cancer Registry said in its interim report for 2002 to 2006.
But why does cancer strike people who "play the game right" in adopting a healthy lifestyle? And how does sex come into play with cancer?
Mind Your Body puts 10 such questions about cancer to three specialists: Dr Ang Peng Tiam, Dr Wong Seng Weng and Dr Lim Soon Thye.
1. Although Singapore has a high standard of medical care and sound medical facilities, why are there so many cancer cases?
Dr Ang: The number of cancer cases in a country is not necessarily a reflection of the standards of medical care. In less developed countries, the cancer incidence may be under reported.
In most developed countries, cancer is on the rise. We blame this partly on the ageing population. Lifestyle and environmental factors also up the risk of getting cancer.
Dr Wong: The high standards of medical facilities here may have, counter-intuitively, contributed to the increase in cancer cases. High standards of medical care have led to higher life expectancies.
As cancer typically affects older people, the longer one lives, the greater the chances of developing cancer. Conversely, in developing countries with a lower life expectancy, many people will die before they have a chance of developing cancer.
Part of the increase in cancer incidence may be due to improved data collection.
2. Is the rate of cancer increasing among the young globally?
Dr Ang: Increase in cancer rates among the young is largely due to environmental and social factors. For example, smokers are more likely to develop lung cancer. A high fat and low fibre diet is linked to colorectal cancer. Early menarche (the age at which girls begin to menstruate), late marriages and having fewer children increase one's breast cancer risk.
Dr Wong: Cancer is still a disease that usually affects older people.
3. Is cancer a result of our own abuses? Compared to previous generations, or "kampung" days, we are seeing more gas emissions and eating more processed foods.
Dr Ang: To me, smoking is the biggest culprit. People smoke out of choice. We need to do more to educate and discourage them from picking up the habit.
Dr Lim: Except for smoking and alcohol, cancer is not the result of our own abuses. Its etiology is complex and many factors are involved. Previously, not much was known about it. Many people could have died of cancer without knowing they had it.
4. What impact does diet- genetically-modified and highly-processed foods and the use of insecticides by farmers - as well as environmental change have on the high occurrence of cancer in modern times?
Dr Wong: Changes in our environment probably account for 1 to 2 per cent of the rise in cancer. In terms of diet, excessive caloric intake and obesity, increased alcohol consumption, increased intake of refined
carbohydrates and animal protein and a lack of dietary fibre may play a bigger role in causing cancer than insecticides and genetically-modified food.
5. Can I lower my risk of getting cancer by eating organic food or non-processed food?
Dr Wong: Fresh food is better than processed food. The latter tends to be more calorie-dense, leading to obesity, which is associated with increased cancer risk. The preservatives in processed food may contain nitrates and high salt concentrations, which are associated with stomach cancer.
Dr Ang: There is no data to suggest that eating only these foods will lower the risk of getting cancer.
6. I know of people who eat healthily, exercise regularly and do not smoke or drink. But they have cancer. Why?
Dr Ang: The truth is we often don't have a good answer. There are preventable and non-preventable risk factors. Genetics is a non-preventable risk factor. Some people are simply genetically more predisposed to cancer than others.
I have seen many in this category who get cancer. Their initial disbelief is followed by the frustration of "Why me? I live so healthily".
Dr Wong: We should not adopt a fatalistic attitude. We should do what is within our control to reduce our risk of cancer and accept that there is also an element of fate.
7. I had cancer and am now declared cancer-free. Is it possible for my cancer to recur?
Dr Ang: Remission is defined as complete disappearance of all cancer. Uninterrupted remission, without further treatment, for five years is deemed as a cure. However, patients might remain well for five years and cancer can recur after that. This is especially so for breast cancer.
Dr Wong: The recurrence risk is related to the type of cancer and the stage of disease. Typically, early stage cancer is associated with a lower probability of relapse as opposed to late stage. Survival rates vary in different cancers, depending on the stages. Stage 1, or early stage, breast cancer may have a survival rate that is as high as 90 per cent. However, stage 1 lung cancer has a relapse and death rate of 40 per cent.
Certain cancers tend to recur at, or close to, the original site. Examples are cancer of the mouth and throat. Other types of cancer, like breast and lung, tend to disseminate through the blood stream to affect distant
8. What should one do when considering alternative and complementary therapies for cancer treatment?
Dr Lim: Always discuss it with your doctors. If you have a potentially curable cancer like lymphoma or leukaemia, or early stage cancer curable by surgery or radiotherapy, alternative therapy must never be tried. Otherwise, it will definitely compromise your chances of survival. Complementary treatment should complement and not replace standard treatment. Certain supplements and herbs may interact with cancer drugs and increase their side effects or reduce their efficacy.
9. My father has been diagnosed with cancer but he refuses treatment. What should I do?
Dr Ang: There are many reasons why your father chooses not to have treatment. Take him for a chat with an oncologist. A good doctor makes all the difference in convincing patients to accept treatment. He often does this by understanding the patient's concerns and then allaying the unfounded ones.
Speaking to patients who have had a similar cancer and been successfully treated makes a huge difference.
Dr Wong: Many patients who refuse treatment do not fully understand the nature of the disease, the usefulness of available treatments and the consequences of refusing treatment. To overcome the preconceived prejudices, providing information and persuasion are often not enough. A strong relationship is necessary. You may need to find a doctor who is able to establish a strong rapport with your father.
10. Is sexual intercourse harmful for a cancer patient?
Dr Ang: Of course not. It may be difficult for a cancer patient to engage in sexual activity when there are physical limitations, including sores around the genitals, but otherwise, just do it.
Dr Wong: In most instances, sexual intercourse is not harmful to the patient. However, be aware that many forms of cancer treatment, such as chemotherapy and radiation, are detrimental to foetal development. The choice of contraception is also important. Breast cancer patients should not use oral contraceptive pills as the female hormones in them may aggravate the condition of breast cancer.
10 FACTS YOU SHOULD KNOW
- Cancer begins with a change in a single cell in the body. This change may be triggered by carcinogens like ultraviolet radiation and components of tobacco smoke, and inherited genetic factors, says the World Health Organisation (WHO).
- Early signs of cancer might include lumps, sores, persistent indigestion, persistent coughing and bleeding from the body's orifices.
- Cancer is the No. 1 cause of death in Singapore. Colorectal cancer - which affects the large intestine and the rectum - is the most common here.
- It is the top cancer among men and second most common among women here, behind breast cancer.
Worldwide, it is the third most common cancer.
Although colorectal cancer is the most common cancer in singapore, lung and breast cancer had the highest mortality rates in males and females here respectively between 2002 and 2006.
- Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year worldwide.
- According to WHO, in 2004, 7.4 million people worldwide died of cancer. This accounts for 13 per cent of deaths worldwide. More than 70 per cent of these deaths occurred in low and middle-income countries.
- Cancer deaths globally are projected to increase, with an estimated 12 million deaths in 2030.
- More than 30 per cent of cancer deaths can be prevented.
- Prevention strategies mainly include not using tobacco products, keeping to a healthy diet, staying physically active and lowering alcohol intake.
- Some of the most common cancer types - such as breast, cervical and colorectal - have high survival rates if detected early and treated accordingly. Someone diagnosed with stage 1 colorectal cancer - the earliest stage - has a five-year survival rate of over 95 per cent. This means that more than 95 out of 100 patients are still alive five years after diagnosis.
Sources: Ministry of Health, Singapore Cancer Registry Interim Report, Singapore Cancer Society and World Health Organisation