Health Screening

Health Screening In Singapore: Everything You Need To Know

by Dr Wenus Ho
Monday, April 20, 2020

Comprehensive health screening allows you to find out if you have a certain disease or condition in the absence of any signs or symptoms. More often than not, early detection and management of diseases and conditions will result in better outcomes.

What Is Health Screening?

Simply put, health screening is the process of using tests, physical examinations, and other procedures to detect diseases or conditions in generally healthy people, who show no symptoms.

Why Should One Consider Health Screening In Singapore?

Apart from being able to assess your overall well being, a comprehensive health screening in Singapore can detect diseases, health risks, or conditions, either while they’re still in the early stages, or in some cases, even before they happen or present symptoms.

Health screenings are most effective when they are customised and tailored according to your needs, where tests are recommended by your doctor after assessing the following factors:

  • Your age
  • Your gender
  • Lifestyle habits
  • Family history
  • Pre-existing conditions and/or current symptoms

Sometimes, you may not show any symptoms or signs of disease. Certain chronic conditions like diabetes take time to develop, and when detected early, can be managed better with fewer complications and improved long term outcomes.

As cancers start small, by the time the patient develops symptoms such as pain, inflammation, or when lumps start to appear, the cancer may already be at an advanced stage.

These are some of the reasons why it’s important to get screened even when you feel perfectly healthy. Singapore has been very proactive in this area and supports in many ways e.g. Shield for Life, Medisave reimbursable items (eg > 50 years old, claim up to S$500 for mammogram).

What should I be screening for

Every individual will have different health screening needs, which are based on the factors mentioned above, such as your family medical history (i.e. presence of cancer, diabetes, heart disease in your family), your age, lifestyle, and if you have any symptoms present.

Here are some of the conditions you can be screened for in Singapore:

Cancers

Cancer is one major area of concern for many individuals. Let’s review the main ones.

Breast Cancer

Mammogram

According to the American Cancer Society, these are the general screening recommendations for women at average risk of breast cancer. Their definition of average risk:

“For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene), and has not had chest radiation therapy before the age of 30. (See below for guidelines for women at high risk.)”

Screening Recommendations (Average Risk):

  • Women between 40 and 44 have the option to start screening with a mammogram every year.
  • Women 45 to 54 should get mammograms every year.
  • Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live 10 years more or longer.
MRI and Mammogram

Screening Recommendations (Average Risk):

  • Lifetime risk of breast cancer above 20% to 25%, according to various breast cancer risk assessment tools
  • Have a known BRCA1 or BRCA2 gene mutation
  • Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
  • Had radiation therapy in the chest area

Women above 30 who are at high risk are recommended, under the guidance of their health care provider, to have MRI and Mammogram once a year, preferably at a female health screening clinic.

Note: MRI does not replace a Mammogram, it should be done in addition to a screening mammogram. Although an MRI (Breast) is more effective at detecting breast cancer than a mammogram, it may still miss some cancers that a mammogram might detect.

www.Link to 3d Tomosynthesis.com

Cervical Cancer

Almost all cases of cervical cancer are caused by infection with various types of human papillomavirus, also known as HPV. HPV types 16 and 18, are responsible for approximately 70% of all cervical cancer cases.

These infections are controlled by the immune system over the course of 12-24 months and may cause temporary changes in cervical cells.

However, when cervical infections with high risk types of HPV persist, the infections can cause the cellular changes to develop into precancerous lesions.

When these precancerous lesions are not detected and left untreated, they may progress to cervical cancer over a period of time.

Cervical Cancer Screening Guidelines In Singapore

Under the National Cervical Cancer Screening Programme (NCCS):

  • All women who have ever had sex are advised to have their first cervical cytology test (PAP Smear) from the age of 25
  • Age 25 – 29 years: Cervical cytology (PAP Smear) taken once every 3 years
  • Age 30 – 69 years : HPV test alone every 5 years for a negative HPV test

Options for Women Above 30 Years of age (Non NCCS):

  • Cervical cytology (PAP Smear) alone every 3 years
  • HPV test alone every 5 years
  • Co testing with cervical cytology and HPV test every 5 years
What Is A PAP Smear?

A Pap Smear is a procedure that involves collecting cells from your cervix.

In a Pap test, the doctor uses a (vaginal) speculum to hold your vaginal walls apart. Next, a sample of cells from your cervix is collected using a small cone-shaped brush and a tiny wooden spatula (1,2). Your doctor then rinses the brush and spatula in a liquid-filled vial (3) and sends the vial to a laboratory for testing.

When in doubt, consult a doctor. Female doctors may be more popular where pap smears are concerned.

Ovarian Cancer Screening In Singapore (High Risk Groups)

At early stages, cancers of the ovaries are often symptom free. Some types of ovarian cancer can rapidly spread to organs nearby. A very small percentage of ovarian cancers (20%) are found at an early stage, and when detected early, an estimated 94% of patients live longer than 5 years after diagnosis.

Ultrasound Of Ovaries

Ultrasound scans use high frequency sound waves to produce images of a part of the body. It can show the ovaries, womb and surrounding structures… While an ultrasound is able to detect masses in the ovaries, it is unable to tell if a mass is malignant, and data has shown that most masses detected are not cancer.

Therefore, ovarian cancer screening is only recommended for women who are considered High Risk (Inherited BCRA Mutations)

CA 125 (Cancer Antigen 125)

A blood test that measures amounts of CA-125, a protein in the blood. Data has shown that women with ovarian cancer have elevated levels of CA-125.

Note: In approximately 20% of advanced stage ovarian cancers, and 50% of early stage ovarian cancers, the CA-125 is NOT elevated. Other conditions such as endometriosis, uterine fibroids, and even pregnancy have been known to elevate CA-125.

As the above tests are not definitive, in the event a physician suspects ovarian cancer (usually after a CA-125 test or TVUS), a laparotomy may be required for definitive diagnosis of ovarian cancer.

During the laparotomy, cysts or other suspicious areas are biopsied.

Colorectal Cancer

The number 1 Cancer in Singapore, screening tests such as the Faecal Immunochemical Test (FIT) and Colonoscopy can help prevent colorectal cancer and improve treatment outcomes if detected early.

Overview Of Colorectal Cancer

Colorectal cancer (cancer of the large intestine) often begins as small, non cancerous growths known as polyps. Polyps are attached to the wall of the colon, and turn cancerous over time.

Faecal Immunochemical Test (FIT)

In Singapore, people over the age of 50 with no symptoms are recommended to take the FIT once a year. Also known as the Faecal Occult Blood test, this detects small amounts of blood in stools that can’t be seen with the naked eye.

Colonoscopy

A colonoscopy is recommended for individuals with increased risk, as defined below:

  • Personal history of polyps or IBD (Irritable Bowel Disease)
  • Family history
    (a) 1 First degree relative with CRC aged <60 years or 2 first-degree relatives with CRC of any age
    (b) First degree relative with confirmed advanced adenoma(s)
  • Presence of high risk syndromes such as hereditary nonpolyposis CRC and polyposis syndrome

A tube called a colonoscope is used to examine the lining of the colon and rectum. The procedure takes about 30 minutes, and is typically done by a specialist gastroenterologist who is trained in doing colonoscopies.

Colonoscopies are generally safe procedures, but with all procedures, there are risks of complications, such as:

  • Vomiting, headache, or dizziness
  • Adverse reactions to sedatives
  • Bleeding in cases where polyps were removed
  • Perforation in the colon wall (1 in 1428 cases or 0.07% of cases)

In the market, there are some blood tests available to indicate if one is at high risk of colorectal cancer, such as CRC Protect.

Prostate Cancer Screening In Singapore

Overview Of Prostate Cancer Screening

Prostate cancer screening is a controversial topic, mainly because cancers in the prostate tend todevelop slowly and are often without symptoms. As most prostate cancers are slow growing, studies have shown that many men above 80 have died from other ailments without ever realizing they had prostate cancer. It is worth noting that the 5-year relative survival among men with cancer confined to the prostate (localised) or with just regional spread is 100%.

According to Singapore’s Ministry of Health cancer screening guidelines:

“given the lack of data on whether screening improves disease free survival, there is a lack of evidence to support population based screening for the early detection of prostate cancer in Singapore”

“Health professionals should adopt a shared approach to decision making for men who express an interest in prostate cancer testing and discuss both the potential benefits and harms associated with prostate cancer screening.”

Who Should Be Offered Screening For Prostate Cancer In Singapore?

Men who are between 50 and 75 years of age, at higher risk, such as those with strong family history of prostate cancer.

Prostate Specific Antigen (PSA)

The PSA test is a blood test that measures levels of prostate-specific antigens (PSA) and is used for the screening of prostate cancer. Men with prostate cancer usually have a higher PSA level.

A high PSA test result is not definitive, and does not mean you have prostate cancer. When PSA is high, a biopsy may be ordered to definitely diagnose prostate cancer.

Cardiovascular Risk Screening

Overview

Coronary heart disease (CHD), also known as coronary artery disease, is a condition that refers to the narrowing of the coronary arteries.

Coronary heart disease happens when cholesterol accumulates on the walls of the coronary arteries, creating plague.

The plague makes the artery walls rigid and narrow, it restricts blood flow to your heart, leading to the heart becoming starved of oxygen.

As the arteries narrow, the risk of blood clots and heart attacks increases.

Cardiac Ischemia

When plague and fatty matter narrow the insides of the coronary artery, the supply of oxygen rich blood to your heart is depleted. There are cases where people who have Cardiac Ischemia do not experience any signs or symptoms.

Coronary Heart Disease Symptoms

Angina

The following are symptoms of angina:

Chest pain: Often described as a squeezing, pressure, heaviness, tightening, burning, or aching across the chest that usually starts behind the breastbone, and spreads to the neck, jaw, arms, shoulders, throat, back, or even the teeth.

Other symptoms include: Shortness of breath, general weakness, sweating, nausea, heartburn, and cramping

Shortness Of Breath

When your heart and other organs are getting too little oxygen, any exertion may cause you to start panting and have shortness of breath.

Heart Attack

Symptoms of a heart attack include:

  • Extreme chest discomfort, or a crushing chest pain
  • Perspiration and clammy skin
  • Shortness of breath
  • Dizziness
  • An overall feeling of being very unwell
  • Nausea and vomiting
  • Coughing

Coronary Heart Disease Screening In Singapore

12-Lead Electrocardiogram (ECG)

A quick, pain-free, and safe test that detects your heart’s electrical activity. The test assesses your heart’s rhythm, detects signs of heart disease and can also determine if any part of the heart is enlarged.

Treadmill Exercise Stress Test

Data has shown that some people with coronary heart disease present little to no symptoms during rest, but may present symptoms when the heart is under stress, such as exercise. When exercising, healthy coronary arteries enlarge to facilitate the increase in blood flow, but narrowed arteries are unable to compensate for the increased blood flow needed for exercise.

Treadmill stress tests are performed by comparing ECG results during rest with those during exercise. If there is reduced heart activity during exercise, indicating blockages, further tests may be ordered to allow a more definitive diagnosis, such as an angiogram.

Coronary Calcium Score

Cardiac Scoring is a non-invasive CT scan of the heart. It will evaluate your risk of developing coronary heart disease (CAD) by measuring the amount of calcified plaque in the coronary arteries.

High-Sensitivity C-Reactive Protein (hs CRP)

When there is inflammation in the body, the level of C-reactive protein (CRP) increases, and this protein can be measured in your blood. High levels of hs-CRP has been associated with an increased risk of heart attacks. However, the CRP test is not able to identify the cause of inflammation, which could be caused by something other than your heart.

The hs-CRP test is more useful for people with higher risk, as determined by performing a Global Risk Assessment based on family history, lifestyle choices, and existing symptoms of conditions.

Why Is Screening Important?

Coronary heart disease is a leading cause of death worldwide, and affects other major parts of your body besides the heart. Detecting it early can prevent complications.

Lifestyle factors are one of the major causes of cardiovascular disease, which often progresses to other high risk diseases such as hypertension, diabetes, and even obesity.

By screening and identifying those at risk of cardiovascular disease, patients will then be able to apply lifestyle modifications which may reverse certain conditions that are caused by cardiovascular disease.

Hyperlipidaemia (High Cholesterol)

Overview

Lipids are fatty substances such as cholesterol and triglycerides, which play an important role in living cells.

When there is too much cholesterol and/or triglycerides (high levels of lipids in the blood), your risk level for certain diseases such as Coronary Heart Disease increases.

In order to prevent complications that arise from hyperlipidaemia, it is important to detect it early, and learn how to control it.

Screening For High Cholesterol In Singapore

Fasting Lipid Profile Test

Recommendations from Academy Of Medicine Singapore:

Screening should be carried out in all individuals aged 40 years and above. If the results are within optimal range, screening should be repeated at 3 yearly intervals. Screening should be considered at an earlier age if risk factors for hyperlipidaemia are present. For at-risk individuals, screening should be repeated more frequently.

In summary, the following groups are to be screened:

  • All individuals aged 40 years and above
  • All adults with pre-existing coronary heart disease, cerebrovascular or peripheral artery disease irrespective of age
  • All adults with diabetes mellitus irrespective of age
  • All adults with impaired fasting glycaemia or impaired glucose tolerance irrespective of age
  • All adults with a family history and/or clinical evidence of familial Hyperlipidaemia
What Do The Tests Measure?
  • Total cholesterol
  • Low-density lipoprotein (LDL) cholesterol
  • High-density lipoprotein (HDL) cholesterol
  • Triglycerides
Test Preparation

When you’re getting your complete lipid profile done, eating or drinking anything with the exception of water should be avoided for 9-12 hours before your test.

Conclusion

When detected early, high cholesterol is a very manageable condition. In most cases, your doctor or dietician can help you create a treatment plan that you can maintain, such as dietary changes, exercising regularly and other lifestyle modifications.

Hypertension (High Blood Pressure)

Overview

Commonly known as high blood pressure, hypertension refers to the condition in which your blood is pumped around the body at a pressure that’s too high, thus applying too much force against the blood vessel walls.

Current guidelines define hypertension as a blood pressure higher than 130 over 80 millimeters of mercury (mmHg).

Risk Factors

Age: High blood pressure is commonly found in people over 60 years old. As we grow older, our arteries become narrower and stiffer due to plaque build up, resulting in an increase in pressure.

Size and weight: Obesity increases the chances of developing high blood pressure.

Alcohol and tobacco use: Alcohol consumption, in large amounts, has been associated with increasing blood pressure, along with tobacco use.

Existing health conditions: High cholesterol, heart disease, chronic kidney disease and diabetes are some conditions that can lead to hypertension.

Symptoms And Screening For High Blood Pressure

A person with high blood pressure may not experience any symptoms. When undetected, it can cause damage to the cardiovascular system and is associated with internal organ damage such as kidney damage.

Due to the lack of symptoms most of the time, Regularly checking your blood pressure is crucial.

In cases where symptoms are present, there can be sleeping problems, unnecessary sweating, anxiety, and blushing.

Hypertension can be diagnosed by a blood pressure monitor.

Systolic (mmHg) Diastolic (mmHg)
Nomal blood Pressure Less than 120 Less than 80
Elevated Between 120 & 129 Less than 80
Stage 1 Hypertension Between 130 & 139 Between 80 and 89
Stage 2 Hypertension Atleast 140 Atleast 90
Hypertensive crisis Over 180 Over 120

Generally, when you’re diagnosed with high blood pressure, your doctor will do further testing to check for complications, such as:

  • Relevant Blood & Urine Tests
  • Check for cardiovascular disease
  • A Chest X-Ray may be performed
  • Investigate further into your medical history to determine further risk factors

Managing High Blood Pressure

Lifestyle Modifications

Certain types of high blood pressure can be managed by making lifestyle modifications, such as exercise, avoiding alcohol and tobacco, reducing stress, and avoiding a high sodium diet

Managing Body Weight

As obesity and excess body weight is closely related to high blood pressure, when a person loses weight, the blood pressure normally drops, with exceptions.

Renal Screening In Singapore

Screening Recommendations

People who are at increased risk of developing chronic renal disease should undergo testing. The following are considered high risk groups:

  • People with Diabetes
  • People with High Blood Pressure
  • People suffering from Cardiovascular Disease
  • Smokers aged 50 and above
  • People with a family history of kidney failure

Serum Creatinine Blood Test

Creatinine testing will reveal important information about your kidneys. When kidneys are healthy, they filter creatinine and other waste products from your blood.

Increased levels of creatinine in your blood generally suggests that your kidneys are not functioning properly, resulting in a low Glomerular Filtration Rate (GFR).

Urinalysis

This test is done by taking a urine sample from you, and inserting a chemically treated dipstick into the sample. The dipstick can detect abnormalities such as excess protein, blood in the urine, increased levels of sugar in the urine, and also pus. This test can help detect the following:

  • Urinary tract infections (through white blood cells and bacteria)
  • Early kidney disease – ACR (Albumin to Creatinine Ratio)

Diabetes Screening In Singapore

You can be tested for diabetes with a simple blood glucose test. Prior to the test, you’re required to fast for a minimum of 8 hours.

Screening is recommended for patients with a number of risk factors. To diagnose diabetes, your doctor can perform the following tests:

  • A glycated haemoglobin (A1C) test,
  • An oral glucose tolerance test,
  • A random blood sugar test. They may also test your urine.

Conclusion

Here are a few takeaways:

  • Early detection and management of diseases and conditions will result in better outcomes.
  • Health screening requirements are different for every individual, consult with your healthcare provider before making a decision on which screenings you require.
  • Regular Health Screening may lead to lower healthcare costs, check on your benefits under Screen for Life.
  • By going for regular Health Screening, you tend to be generally more aware and conscious of your health, and how your daily lifestyle decisions affect your health in general.

 

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