Guide to health screening

Identifying people at risk

After finding out from a health screening last year that she was at risk of diabetes, Ms Lim Swee Ling overhauled her lifestyle and lost 6kg within three months.
After finding out from a health screening last year that she was at risk of diabetes, Ms Lim Swee Ling overhauled her lifestyle and lost 6kg within three months.ST PHOTO: CHEW SENG KIM

Screening leads to early diagnosis and treatment, but there's no need to go through a battery of tests

Today, health-screening packages abound. You can take your pick from basic, deluxe and elite to premium, and each package can easily comprise 10 to 30 tests or more.

These packages, priced from under $100 to a few thousand dollars, are often categorised by gender or age. There are also packages for certain groups, such as smokers or those planning to marry.

Many people have gone through screening tests. Dr Ng Lee Beng, a consultant in the department of family medicine and continuing care at Singapore General Hospital (SGH), said that each year, it sees an average of 1,000 patients who go for basic health screening.

Private operators which offer health screening, like Parkway Shenton, Thomson Wellth Clinic and Raffles Hospital, also report a healthy demand, thanks in part to company medical benefits.

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Health screening not only helps detect diseases but also identifies common risk factors for chronic diseases, thus enabling people to take steps to protect themselves.

However, the irony is that most people are just relieved to get a clean bill of health and do not act on information that predicts future illnesses. This defeats the purpose of screening as a preventive rather than a diagnostic tool, said Dr Ng.

 

STORM AHEAD

What patients and health screeners need to take note of are results that may not ring an alarm bell now, but may be signs of a gathering storm.

DR NG LEE BENG, a consultant in the department of family medicine and continuing care at SGH.

NOT ALL TESTS WILL BENEFIT YOU

There is no such thing as an ideal number of tests to be included in a health-screening package and no one needs a comprehensive battery of tests.

For screening to be useful, the tests should address common conditions such as high blood pressure, high cholesterol, diabetes and the major organ functions of the liver, thyroid and kidney, said Dr Winston Ho, medical director of Parkway Shenton, a general practice operator.

These tests have proven to be valuable as they allow intervention through early diagnosis, he said.

Dr Emily Pwee, a senior physician at Raffles Health Screeners, said screening is advised according to a person's medical history, including his family history, age and health concerns.

It should be done periodically, as recommended. If a breast scan last year turned out normal, it does not mean the results would be the same this year, said Dr Derek Koh, head of the Thomson Wellth Clinic @ Novena.

And as degenerative and metabolic diseases such as diabetes tend to occur after 40, regular screening after this age is recommended, said Dr Ho.

Doctors said there are some tests that are good but not entirely necessary. For instance, certain cancer- marker tests can result in false positive readings or false alarms. This would cause undue anxiety and stress, and unnecessary spending on more tests and investigations.

However, a disease can go undetected due to false negative test results.

When screening test results are clearly abnormal, there are guidelines on their significance and the actions to take, said Dr Ng.

Dr Ho said readings that are out of the normal range should be reviewed by the doctor and discussed with the patient.

He added: "For some readings, the 'abnormal' test may be repeated at a later date for re-assessment.

"For some others, a more detailed assessment is necessary." For example, a breast lump that is reported as having a benign appearance on an ultrasound can be reassessed in six to 12 months' time, while another with an irregular shape may require further assessment with a biopsy.

A diagnosis can be missed if information is lacking or a specific test is not part of the health-screening package, he said.

TAKING IT SERIOUSLY

Health screening should involve medical consultation. Dr Ng said doctors should let patients know that silent damage is already occurring, and empower them with tips for a sustainable lifestyle change.

For instance, the doctor cannot simply tell a pre-diabetic patient "don't eat this and don't eat that" but should, instead, explain why he has to modify his diet and also teach him how to do so, she said.

Dr Ng said: "What patients and health screeners need to take note of are results that may not ring an alarm bell now, but may be signs of a gathering storm."

A high normal or sporadically high sugar levels would already indicate a pre-diabetic state, for instance. Yet, many patients who are diagnosed with pre-diabetes have the mistaken idea that they are "still safe" and do not need to make lifestyle changes, said Dr Ng.

They need to know that their pancreas has already been damaged, and that they need to act.

There is a high chance of the organ returning to normal functional condition if the patient modifies his diet and starts doing some exercise to lose the fat that is damaging his organ, she said.

Doctors said many people tend to ignore test results which they deem unimportant or feel will not have an immediate impact on their health. "High cholesterol, mildly elevated blood glucose and mildly elevated blood pressure are some examples, as they usually do not cause any symptoms till late," said Dr Ho.

If ignored, these conditions can give rise to serious events like heart attack and stroke.

The major benefit of health screening is to identify people at risk. By taking small steps such as losing 5 per cent of their weight, these people can prevent themselves from becoming sick, he said.

A version of this article appeared in the print edition of The Straits Times on July 18, 2017, with the headline 'Identifying people at risk'. Print Edition | Subscribe