More screenings, vaccinations to push down cancer rates

Associate Professor William Hwang says that between an ageing population and better treatment, the number of cancer patients in Singapore has been soaring.
Associate Professor William Hwang says that between an ageing population and better treatment, the number of cancer patients in Singapore has been soaring.PHOTO: AZIZ HUSSIN FOR STRAITS TIMES

With numbers on the rise, National Cancer Centre chief wants to focus on prevention

More needs to be done to prevent people from getting cancer, says Associate Professor William Hwang, who took over as head of the National Cancer Centre Singapore (NCCS) in November last year.

"If we leave things as they are, cancer incidence would definitely get much higher, and the healthcare burden to the country would double or triple in the next 30 to 50 years," he told The Straits Times.

This is why he plans for the NCCS to go beyond just treatment and to help with prevention, working with organisations such as the Health Promotion Board and cancer societies.

Prof Hwang wants to push for greater screening to identify pre-cancerous cells and early-stage cancers; higher rates of vaccination to prevent the disease; and to reduce smoking, which not only pushes up cancer risks but also makes patients more difficult to treat.

He said cancer doctors here have their work cut out for them because between an ageing population and better treatment, the number of patients has been soaring.

"Cancer incidence is going to get a lot higher as cancer is a disease of older people," said Prof Hwang, who is NCCS' medical director.

The number of cancer patients in Singapore has gone up, with the latest figures for 2015 showing 14,148 newly diagnosed patients, a 7 per cent increase over the previous year.

More cancer patients are living longer with better treatment and some are as good as cured of the disease. But many still need either long-term treatment or constant monitoring.

Prof Hwang is glad that, increasingly, people are living with cancer rather than dying of it. But the need for continuous care does add to NCCS' workload.

"Some cancers may be treatable but not curable, so the number accumulates and the burden increases."

Prof Hwang said it makes sense to put more money and effort into prevention. Looking back, he noted that the national hepatitis B childhood immunisation programme, launched in 1987, reduced the incidence of the disease, and hence of liver cancer in Singapore .

Breast cancer rates have also gone down slightly, with more careful use of contraceptives, while Pap smears have reduced the number of cervical cancer patients. Prof Hwang noted that there are vaccines against the more common types of cervical cancer. Unfortunately, he said, the take-up rate is low.

Reducing the number of smokers would also have a major impact on the incidence of several types of cancers. More than half of the patients with lung cancer, which remains the top killer here, are smokers who also succumb to cancers of the larynx, oesophagus and bladder.

Based on NCCS patients between 2013 and 2017, current and former smokers make up three in four patients with laryngeal cancer; two in three esophageal cancer patients, and more than half of the number of bladder cancer patients.

If Singapore succeeds in getting people born in this millennium to be a smoke-free generation, Prof Hwang foresees a big drop in such cancers here. He said: "Many cancers are related to smoking. It's about time we do a stronger push for a tobacco-free generation."

He added that smoking also reduces the effectiveness of cancer drugs as tobacco smoke produces cytokines that give cancer cells added protection.

He also wants to see more people getting screened for cancers such as that of the colorectum, which could be prevented if any polyps in the large intestine are removed early.

Prof Hwang also wants to change palliative care - from something that signals the patient is in the final lap to support throughout his ordeal in fighting the disease. Such care will help patients cope, including being able to enjoy food. In the past, oncologists were mainly concerned with patient survival. But Prof Hwang said quality of life is perhaps even more important to patients.

Having the palliative team involved early also makes the transition easier for the patient should he lose the fight.

Prof Hwang outlined his philosophy by borrowing a quote from 19th-century American physician Edward Livingston Trudeau, who said: "To cure sometimes, to relieve often, to comfort always."

Prof Hwang, who tweaked the quote, wants the NCCS to "cure often, relieve always, and comfort at every opportunity".

Correction note: The story has been updated to reflect Associate Professor William Hwang's correct title.

A version of this article appeared in the print edition of The Straits Times on January 10, 2018, with the headline 'More screenings, vaccinations to push down cancer rates'. Print Edition | Subscribe