DESPITE 15 years of campaigns pushing for early detection of breast cancer, fewer women are going for subsidised mammograms available to those over 40.
Take-up numbers for the national breast cancer screening programme fell by about 8,000 last year from the previous 12 months.
Doctors say fear of pain during the mammogram - in which the breasts are compressed for an X-ray to be taken - and time constraints are common reasons cited by patients.
Many also feel that they are "healthy" and will not succumb to the disease. Yet, breast cancer is the top cancer among women here, accounting for nearly 30 per cent of all cancer cases.
The disease is in the spotlight as October is Breast Cancer Awareness Month.
The decline in subsidised mammogram take-ups comes even though the BreastScreen Singapore programme run by the Health Promotion Board (HPB) covers about half the test's cost of $100 or so.
Some 44,384 women took up the subsidy last year - down from 52,078 in 2011.
Last year's figure was also lower than the 46,319 women who took part in the programme in 2010.
However, it is slightly higher than the 43,114 in 2008.
Women above 40 are advised to undergo screening for breast cancer every year, and those 50 and above, once every two years.
BreastScreen Singapore allows women above 40 to get subsidies at 16 centres, mainly polyclinics.
In addition, since 2011, women aged 50 and above can use their own or their family members' Medisave to pay for mammograms. This can be done at 29 centres islandwide, up to $400 per account a year.
At the end of last year, more than 15,000 women tapped Medisave to get screened, said a Health Ministry spokesman.
Medisave can be used on top of the BreastScreen Singapore subsidy, so some of the 15,000 women could have come under the national programme's totals as well.
In addition, a new scheme started in March this year by the HPB and the Breast Cancer Foundation has helped to screen 6,190 low-income women.
To encourage even more to be screened, the Singapore Cancer Society is offering a $25 subsidy for women who book mammograms next month at 40 clinics.
The discount is part of the annual drive to raise breast cancer awareness and is for women 50 and above. It can be claimed on top of the $50 subsidy at BreastScreen Singapore centres.
Mammograms are also done by private health-care groups. The largest, listed Parkway Pantai, says that demand for the test has been about the same for the past few years.
Dr Lim Siew Eng of the National University Cancer Institute notes that most women know that a mammogram is useful and can save lives.
However, findings from the National Health Survey 2010 - the most recent survey for which figures are available - showed that three in five women aged 50 to 69 are not up to date with breast cancer screening.
Dr Lim, who heads this year's Breast Cancer Awareness Month, said that underlying reasons may be a fear of the test, and of knowing the results.
Indeed, the 2010 survey found that women avoided the procedure as they felt that it was painful, while others said they did not have the time to go for it.
But Dr Lim pointed out: "A mammogram can even detect breast cancer two or three years before a lump is noticed."
Dr See Hui Ti of Parkway Cancer Centre said breast cancer patients who never had a mammogram also tend to say, "I didn't think it would happen to me".
Such early detection can prolong lives, as cancer survivor Sharon Lee, 51, found out.
She was diagnosed with Stage 2 breast cancer - which is a relatively early stage - in 2002. After an operation to remove part of her left breast, the cancer went into remission. Although the disease showed up again in 2005, drugs have helped to control its spread so far. "The doctor is always surprised to see me alive," she said.
Five main 'excuses' that women make for not getting a mammogram done:
- "I feel healthy"
- "No time"
- "Not at risk"
- "Never thought about it"
- "Too busy with work"
- "Won't be so unlucky"
- "Too troublesome"
- "Test takes too long"
- "Scared of pain"
- "Busy with family commitments"
Pain 'not even 10% that of childbirth'
A COMMON reason for not going for a mammogram is the lack of time - an excuse 59-year-old Speaker of Parliament Halimah Yacob knows only too well.
She put off going for a mammogram for five years.
The reason? No time, she told yesterday's launch of Breast Cancer Awareness Month, which is in October.
This year's campaign highlights reasons women give to avoid screening.
The Jurong GRC MP said: "I started asking myself whether 'no time' is a valid reason, or whether I'm just deliberately putting it off." Madam Halimah, who went for the test last month and got the all-clear, also expressed concern about low screening rates among Malay women.
Referring to another excuse women give for not having a mammogram, she said the pain during the test is "not even one-tenth" that of giving birth.
Minister in the Prime Minister's Office Grace Fu, 49, told the launch that she has been going for yearly checks. Her insurance company sends her yearly discount coupons for health screening for her birthday.
She urged women to similarly "take charge of their health".
"Women, very often, are the caregiver in the family but we need good health to do that," said the MP for Yuhua. "There is nothing to be afraid of," she added.
POON CHIAN HUI