Japanese Journal of Clinical Oncology 32:S62-S65 (2002)
© 2002 Foundation for Promotion of Cancer Research
An Overview of the Cancer Control Programme in Singapore
Low Cheng Hock+
Tan Tock Seng Hospital and Faculty of Medicine, National University of Singapore, Singapore
 |
ABSTRACT
|
|---|
Singapore is a multiracial, multireligious and multicultural
society. Today, cancer is the leading cause of death in Singapore
and about one in four deaths is from cancer. The Singapore Cancer
Registry has been in existence for more than 25 years and its
accuracy of data for incidence, distribution, changing patterns,
etc., is close to 100%. These statistics revealed that the incidence
of cancer is related to the racial distribution of the population.
A national concerted cancer control programme is targeted at
prevention, early detection and integrated management. Strong
laws against smoking and a national vaccination programme against
hepatitis are in place.
|
INTRODUCTION
|
|---|
Singapore is a multiracial, multireligious and multicultural
society with a population of just over 3 million (about 77.7%
Chinese, 14.1% Malay, 7.1% Indian, 1.1% others). Singapore is
divided into 28 districts, each having a community centre where
the residents can congregate. Racial, cultural and religious
practices have influenced cancer care.
Today, cancer is the leading cause of death (Table 1). About one in four deaths is from cancer. Collection of statistics is of immense importance. We believe that ‘the statistics of today are the strategy of tomorrow’. The Singapore Cancer Registry has been in existence for more than 25 years and its accuracy of data for incidence, distribution, changing patterns, etc., is close to 100% (1). These statistics help us to plan our Cancer Control Programmes.
|
CANCER INCIDENCE IN DIFFERENT RACES
|
|---|
There are differences in the racial distribution and also a
changing pattern in cancer incidence. Colorectal cancer is now
the second commonest cancer and lung, colorectal, breast, cervical,
stomach and liver cancer are present in all three major races
(Fig.
1). It is noted that Chinese are more prone to nasopharyngeal
and oesophageal cancers (Fig.
2). Malays have a slightly higher
incidence of lymphoma (Fig.
3). Unlike the West, Singapore has
a higher incidence of NPC, oesophagus, stomach and liver cancers
and lower rates for cancers of the pancreas, skin and prostate.
Indians are more prone to laryngeal and oral cancers (Fig.
4).
These differences are seen even in second- and third-generation
immigrants. Figures
2–4 reflect the incidence of cancer
in different races in Singapore.
View larger version (14K):
[in this window]
[in a new window]
|
Figure 1. Ten most frequent cancers in males and females in the period 1993–97. The numerals indicate the percentage incidence of all cancers.
|
|
View larger version (14K):
[in this window]
[in a new window]
|
Figure 2. Ten most frequent cancers in Chinese males and females in the period 1993–97. The numerals indicate the percentage incidence of all cancers.
|
|
View larger version (14K):
[in this window]
[in a new window]
|
Figure 3. Ten most frequent cancers in Malay males and females in the period 1993–97. The numerals indicate the percentage incidence of all cancers.
|
|
View larger version (13K):
[in this window]
[in a new window]
|
Figure 4. Ten most frequent cancers in Indian males and females in the period 1993–97. The numerals indicate the percentage incidence of all cancers.
|
|
|
CANCER CONTROL ACTIVITIES
|
|---|
In Singapore, cancer control activities are carried out by the
government and voluntary organizations with activities described
in Table
2.
|
PREVENTION
|
|---|
In the field of cancer prevention, the main activities that
are being promoted are listed in Table
3.
Hepatitis B vaccination was started in 1983. Today, close to
100% of newborns are vaccinated. The incidence of hepatitis
has been shown to be declining. How this will reflect the prevalence
rate of liver cancer is yet to be seen.
Singapore has a very strong anti-smoking programme (Table 4). This programme resulted in a decrease of the smoking prevalence among adults from 19% (1980) to 13.6% (1990).
|
CANCER SCREENING FOR EARLY DETECTION
|
|---|
One of the main approaches to cancer control is targeted at
early detection. Screening programmes are carried out by the
government, clinics, hospitals and voluntary organizations.
Nation-wide screening was focused on breast and cervical cancers,
for several reasons: these cancers are common in Singapore;
screening tests are simple and fairly accurate; early detection
is possible; and effective treatment is available. Programmes
for early detection include a wide distribution of educational
materials, talks at schools, clubs and community centres, public
education through the media, TV, radio and newspapers and making
screening affordable for relevant instances. Awareness clinics
for gastric, lung and colorectal cancers also play an important
role for early detection of cancers.
|
FACILITIES FOR CANCER PATIENTS
|
|---|
The third component of our cancer control programmes is the
establishment of comprehensive cancer centres. A National Cancer
Centre (NCC) has recently been established. There is also a
total comprehensive cancer centre at the National University
of Singapore and a cancer centre in the private sector. With
these specialized centres, our cancer care doctors work together
towards the improvement of treatment modalities. At the NCC,
we have established a National Work Group for all common cancers
(including gastric, liver, lung, breast, cervical, colorectal,
haematological, bone and other cancers). We are working towards
a national concerted effort at cancer control with an integrated
management protocol for common cancers.
A good cancer control programme must also provide an active rehabilitation service. We hope not only to add years to life, but also to add life to the years added. Cancer rehabilitation is a team effort that needs doctors, nurses, paramedics, psychiatrists, social workers, the family and the spiritual director. Rehabilitation is an area in which we have started intensively in the last 10 years. However, there is still occasional inadequate religious and cultural understanding that needs to be resolved. Someone has said, ‘no man is an island’; I think ‘we are all islands’. Each of us is an island, an island of ignorance, separated by seas of misunderstanding. As health care workers in cancer control, we must try to build bridges of understanding across these seas of misunderstanding, so that we can help our patients to live as normal a life as possible. In Singapore, the rehabilitation programmes include the support groups described in Table 5.
The final component of the Cancer Control Programmes is to
provide care for the cancer patients in the terminal stage.
When we take care of cancer patients, it should be kept in mind
that it is important to consider not only the longevity of existence
but also the quality of life. In Singapore, we currently have
three hospices where terminal cancer patients can be taken care
of. We must remember that although not all cancers can be treated,
all patients can be given care.
|
SINGAPORE CANCER SOCIETY
|
|---|
The final point is the role of the Singapore Cancer Society
in influencing the country’s national cancer control programmes.
The Singapore Cancer Society has played a very important role
in the last 25 years, especially in education, screening, public
health awareness, rehabilitation and other support services.
It can act as a catalyst for governmental action.
In 1985, a WHO Seminar on Cancer was held in Singapore. The recommendations of the delegates attending are described in Table 6. All these objectives have been achieved and we are moving forward. A National Cancer Control Coordinating Committee has been formed to oversee cancer control management. The way ahead for us is described in Table 7.
Hopefully our patients will benefit so that he or she can say,
‘I may have cancer but cancer does not have me’.
|
FOOTNOTES
|
|---|
+ For reprints and all correspondence: Low Cheng Hock, Department
of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock
Seng, Singapore 308433. E-mail: cheng_hock_low@ttsh.com.sg
|
REFERENCES
|
|---|
1
Chia KS, Seow A, Lee HP, Shanmugaratnam K. Cancer Incidence in Singapore 1993–1997. Singapore Cancer Registry Report No. 5. Singapore: National Cancer Registry, National University of Singapore 1998.
Received February 22, 2001; accepted September 11, 2001.
CiteULike 
Connotea 
Del.icio.us What's this?
TOP
ABSTRACT
INTRODUCTION