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    Feb 17, 2014

    Cancer hike also linked to lifestyles

    IF YOU thought Singapore's rising cancer rates are just due to its ageing and expanding population, think again.

    Latest figures from the Singapore Cancer Registry show that annual diagnosis figures rose from 10,576 in 2008 to 12,123 in 2012.

    However, experts who have studied rising age-standardised figures - which take into account how many young and old people are in the population - say it's not just growing old that is to blame. It is also our lifestyles.

    Dr Christopher Wild, director of the World Health Organisation's International Agency for Research of Cancer and co-editor of The World Cancer Report 2014, said nearly half of all cancers that occur can be prevented.

    He told the British Medical Journal that "tobacco use, infections, obesity and physical inactivity, excessive alcohol consumption, high exposure to sunlight and workplace hazards" are all major factors.

    Tobacco alone is responsible for one in five cancers, he said.

    To add to the problem, more people here are finding out at a late stage - sometimes too late - that they have cancer. This is despite frequent reminders that early detection and treatment often mean a better chance of survival, while subsidies here make screening for some cancers affordable.

    Colorectal cancer is the most common form of the disease in Singapore. From 2008 to 2012, 22 per cent of sufferers were diagnosed when it was in its final stage and had spread to the rest of the body. This was up from 19 per cent in the preceding five-year period.

    At that fourth and final stage, the chances of living another five years are less than 5 per cent. Yet if it is diagnosed in the early stages, there is a 95 to 100 per cent chance of survival.

    Nine per cent of patients with breast cancer - the most common form of the disease among women here - were also diagnosed when it was in its final stage.

    There are established screening tests in Singapore for both types of cancer.

    Professor Chia Kee Seng, head of the School of Public Health, said a large part of the problem is that cancer awareness "is just head knowledge".

    "It has to be translated into change in behaviour," he added.

    Doctors know what to tell patients who are at risk, he said, but "we don't know how to motivate them to adopt the right behaviour".

    However, Dr Ang Peng Tiam, medical director of Parkway Cancer Centre, suggested that figures showing an increasing number of people discovered with end-stage cancers may be down to improved methods of diagnosing what stage the disease is at.

    He said "advances in medical technology and higher standards of medical practice" have allowed doctors to see the spread of cancer more accurately.

    Associate Professor Lim Soon Thye, head of medical oncology at the National Cancer Centre Singapore, said some cancers - such as those of the lung - can be difficult to detect early.

    He believes the higher numbers could also be due to more widespread screening picking up cases that might otherwise have remained undiagnosed.

    But he added that the increase in the absolute number of cases will continue to rise, as ageing remains a major factor.

    Dr Robert Lim, a senior oncologist at the National University Cancer Institute, said that when people age, their cells make more genetic mistakes as they replicate.

    When the number of mistakes crosses a certain threshold it can cause cancer. He concluded: "The principal risk of developing cancer is the ageing process."