COLORECTAL cancer is the number one cancer for men and women here, and a panel of specialists is now calling for it to be screened on a national level. The specialists, who are members of the Academy of Medicine Singapore, say that the method of screening should be colonoscopy, which costs about $1,500 without medical subsidy. Patients should be allowed to pay for this procedure using Medisave, they add. They are also calling for the procedure to be subsidised by the Government.
But they acknowledge that, given constraints like cost and the number of specialists trained in the procedure, a nationwide colonoscopy programme is some years away. Their suggestion is contained in a handbook on guidelines on different health screening tests. The guidelines were drawn up by the academy’s Screening Test Review Committee, which includes representatives from the Health Promotion Board. Their recommendations on screenings have been submitted to the Health Ministry. A spokesman said the ministry “will study the report and see how we can encourage more Singaporeans to undergo regular and appropriate screening”.
Latest five-year figures from the Singapore Cancer Registry show that between 2003 and 2007, colorectal cancer accounted for 17.8 per cent of cancers in males and 14.5 per cent in females. There were 7,277 cases in that period. There are two ways to screen for colorectal cancer. One is via a faecal occult blood test. A simple kit is used to collect a stool sample and this is sent to a laboratory to be tested for blood, which can indicate the cancer.
The other is colonoscopy, whereby a narrow tube with a camera is inserted into the anus to inspect for abnormalities in the intestines. A colonoscopy costs between $500 and $700 for subsidised patients, while private patients at restructured hospitals pay $1,500 to $1,600. At private hospitals and clinics, patients may pay more. Almost 17,000 people underwent the procedure last year.
In late 2009, the Health Promotion Board (HPB) introduced a pilot programme for colorectal cancer screening, ahead of plans to implement nationwide screening by 2010. It involved a faecal test for Singaporeans between the ages of 50 and 69. It is understood that HPB will be rolling out the programme this year. An HPB spokesman said yesterday that details are still being worked out.
There are currently two national screening programmes for cancer – breast and cervical – and one for chronic conditions like diabetes, high blood pressure and cholesterol. Under such a programme, Singaporeans and permanent residents can sign up for tests carried out at subsidized rates if they fulfil criteria such as age. The specialists’ recommendation of colonoscopy as a screening test has raised questions on whether this is preferable to a faecal test.
Associate Professor Charles Tsang, head of the division of colorectal surgery at the National University Hospital, said population studies using the faecal test have shown benefits and this is the recommended tool for screening worldwide. “If the patient is found to have occult blood positive, a colonoscopy will be performed for a more thorough assessment,” he said. The specialists acknowledged that a national programme for colonoscopy may be some years away.
Professor Lee Hin Peng of the Yong Loo Lin School of Medicine at the National University of Singapore said the Government must consider the logistics – whether there are enough doctors to conduct the tests, for example – and cost. “We must first make sure that hospitals and clinics have adequate facilities to conduct the screening,” said Prof Lee, who chaired the Screening Test Review Committee. Professor Eu Kong Weng, a senior consultant colorectal surgeon at Singapore General Hospital, said more specialists would need to be trained. How much patients should pay under such a national programme must also be determined, added Prof Lee, who raised the issue at a press conference on Thursday to release the handbook.
Guidelines on screening tests
HEALTH-CARE professionals can now refer to a booklet to help them decide which screening tests to give patients. Drawn up by the Academy of Medicine Singapore’s Screening Test Review Committee, the booklet – the first ever – has guidelines on tests for more than 50 diseases. It is also available on the academy’s website, and a simplified version for the public will be released later. Doctors currently follow protocol set by the clinic or hospital that they work in to decide on the screening tests, but this can differ from clinic to clinic.