Early screening for cancer makes the difference between life and death

MR ROBERT Hoo is a man on a mission which centres on a rather delicate matter for most of us – but that does not faze the semiretired businessman.

You see, this month is colorectal awareness month, and nothing gets this cancer survivor fired up quite like an occasion such as this.

His mission is practical prevention, and involves the handing out of stool sample kits to his friends, family, and even strangers he meets.

He tells them urgently: “Just send two samples of your stool to the Singapore Cancer Society and they will be tested for blood – even tiny amounts.”

The test can detect colorectal cancer as long as there are slight traces of blood in the stool. Studies have shown that such annual tests can reduce colorectal cancer death rates by 33 per cent.

These faecal occult blood test kits provided by the Singapore Cancer Society are also available free of charge at Guardian pharmacies islandwide and at 18 polyclinics.

Mr Hoo, a 67-year-old father of two who helps his son with his nutrition product business, started the quirky habit of dispensing test kits after a colonoscopy in 2007 found two benign polyps in his colon.

Polyps can be precursors to colorectal cancer, so he was advised to have another colonoscopy in two years, in late 2009.

But in March last year, he used one of the free test kits and blood was detected in a sample of his stool. A Singapore Cancer Society member advised him to have a colonoscopy immediately.

Mr Hoo was found to have early-stage colon cancer. He immediately underwent surgery to remove 20cm of his colon and, as a precaution, some of the surrounding lymph nodes.

There was no need for further treatment as the cancer had not spread beyond the colon.

Mr Hoo, whose father had lung cancer, regrets the drinking sessions with his business contacts in his 40s and 50s. He has read many books on colon cancer and knows all about the link between alcohol and colorectal cancer.

But he also knows how lucky he is to have caught the cancer early and side-stepped death.

“I was initially very upset and disappointed at my failing health.

But after reading five books, I realised how lucky I was to have caught it early. At Stage I there is a good chance of a complete cure.”

His near-miss galvanised him to encourage others to seek early screening: “People are a bit taken aback when I hand them these kits but after I tell them my story, they appreciate it and use them.”

National Kidney Foundation chairman Gerard Ee has also become an advocate for early screening for colorectal cancer.

But unlike Mr Hoo, Mr Ee’s colon cancer was not caught early.

The former accountant, affectionately known as Mr Charity, did not think of going for a colonoscopy until he developed bowel problems three years ago at age 57.

“I noticed that my stools were pudding-like and that lasted for two weeks. It was only then that I went for a check-up,” he said.

“And I did know that the general advice is for everyone over 50 to go for colonoscopies because that’s when you run the risk of developing polyps.

“On top of that I have a family history of cancer: My father died of liver cancer.”

He was diagnosed with Stage III colorectal cancer with a tumour the size of a tennis ball, resulting in the removal of part of his small intestine and over half a metre of his large intestine. That was followed by 12 sessions of chemotherapy.

He has been free of cancer since.

“If the cancer was Stage IV, I’d be a goner. If only I had gone for regular screenings and detected the cancer early, I would have been spared the agony of going through the chemotherapy treatment,” says Mr Ee.

“Colorectal cancer is a silent killer. It is preventable and curable when detected early. The stool test is a simple test that can save heartache and costly treatments.”

Colorectal surgeon Adrian Leong, deputy director of the National University Cancer Institute, Singapore (NCIS), agrees that early screening and detection for most cancers, especially colorectal, can mean the difference between life and death.

Colorectal cancer, like most cancers, is measured in four stages.

Stage I and II are contained in the colon. By Stage III, it has migrated into the lymph nodes and by Stage IV, the malignancy has spread, or metastasised, into the other major organs such as the liver and lungs.

For colorectal tumours discovered in Stage I or II, the survival rate (five years after diagnosis) is reassuringly high at almost 90 per cent. The treatment is also straightforward: surgery, perhaps followed by low doses of radiation.

But survival rates drop precipitously as the diagnosis shifts to Stage III or IV, when the cancer is well established and spreading. The five-year survival rate at this point falls to 60 per cent and then 10 per cent.

Unfortunately, Prof Leong notes, more than two-thirds of colon cancers here are not found until the later stages because screening is far less prevalent here than in the United States.

For example, nearly half of all Americans would have undergone some form of screening for colon cancer in recent years. Here, the figure is less than 10 per cent – far below the 70 per cent screening level needed to arrest the number of deaths.

Prof Leong notes most of his patients get a colonoscopy only after they spot a fair amount of blood in their stool: “If it is cancer, by then it may have already advanced and treatment will be difficult.”

This explains the poor survival rates for colon cancer patients here.

Only about half of these patients survive five years after tumours are found.

Prof Leong stresses that a colonoscopy or a cheap and simple faecal occult blood test done annually can give an advance alert on cancer polyps growing in the intestines. “In the majority of cases, this is a slow -growing cancer and once the polyps are snipped off, the cancer is prevented,” he says.

Singapore Cancer Society chairman Koo Wen Hsin makes the point that the survival rate for many other cancers is similar to the cliff-like curve that defines colon cancer: Find the disease early and the odds of survival approach 90 per cent.

But find it late, after the tumour has metastasised, and treatment requires infusions of toxic drugs and blasts of radiation. And the prognosis for the patient is bleak.

He stresses that there are now reliable ways to detect several cancers early enough to prevent the disease from catching hold. But many people here are either ignorant of, or simply ignore, these life-saving actions.

Cervical cancer, for example, can be detected through a Pap smear and stopped in its tracks, says Prof Koo, who is also deputy director of the National Cancer Centre Singapore. Yet a third of women here have never had one. Breast cancer can be diagnosed early with regular mammograms. But only 40 per cent of Singapore women go for breast cancer screening.

Prof Koo notes that it could be due to the costs involved, even though women aged 40 and above can enjoy a subsidised rate of $50 at polyclinics.

He urges the Government to look into making cancer screening convenient, cheap and affordable by allowing the use of Medisave for cancer screening. He notes that the response has been good for the stool testing kits the Singapore Cancer Society is offering for free through pharmacies.

Last year, close to 30,000 people picked up the kits and 609 individuals were found to have blood and referred for colonoscopies.

About 184 were found with pre-cancerous polyps, which were removed. Of the 41 found to have cancer, 34 have had surgery so far and of them, only one patient had metastatic cancer. The other 33 had either Stage 0, I, II or III, and they are all potentially curable with surgery.

He urges Singaporeans to go for regular medical screening.

“Even if it costs a little bit more like colonoscopies, it is better to spend more upfront in prevention and early diagnosis, than to spend it on treating a severe disease.”