KUALA LUMPUR – Finding and treating cancer at an early stage can save lives. Not only that but detecting cancer early can also greatly reduce its financial impact. Not only is the cost of treatment much less when the cancer is in its early stages, but people can also continue to work and support their families if they can access effective treatment on time.
According to the World Health Organisation, the total annual economic cost of cancer through healthcare expenditure and loss of productivity was estimated at US$1.16 trillion in 2010.
However, the figure could be higher now along with a significant rise in cancer detection due to constant education to promote early diagnosis and screening.
In Malaysia alone, the number of cases over a period of five years from 2012 to 2016 has increased to 115,238 from 103,507 cases recorded in the corresponding period of 2007 to 2011.
Based on the Malaysia National Cancer Registry report 2012-2016, the Age Standardised Incidence Rate for cancer stood at 86 cases for every 100,000-male population, and 102 cases for every 100,000-female population.
Rising incidence of cancer in patients below 50
Sunway Medical Centre clinical oncologist Dr Aqilah Othman said the incidence of cancer diagnosed in patients aged below 50 is rising.
She noted that these cases are usually diagnosed in late stages as they would usually already have symptoms for a period of time but tend to dismiss them.
“Screening programmes aim to detect early changes when it is an early cancer or even at the pre-cancerous stage whereby the individual is well with no symptoms.
“This can facilitate a much less complicated treatment and a full recovery thereafter,” she told Bernama in an interview here recently.
For the average risk individuals who are well with no symptoms, Dr Aqilah recommended that they begin with breast and colorectal cancer screening from the age of 45.
Cervical cancer screening, meanwhile, can start from the age of 25 if sexually active and lung cancer screening from the age of 55 for smokers or those who have been heavy smokers in the past, she said.
“If cervical cancer is caught at its earliest stage, the chance of survival is more than 85 percent,” she added.
How cancer screening is conducted
Dr Aqilah explained that awareness and uptake of validated screening programmes are important especially amongst those who may be at higher risks of developing a history of cancer, such as those who have a strong family history of cancer and immediate family members diagnosed with cancer before the age of 40.
She said those who have a genetic predisposition should discuss their case with their doctor as a tailored screening approach or preventative measures can be offered including screening at a younger age or increased frequency of medical check-ups.
Aqilah said screening is targeted at the population who are well and with no symptoms and is done at regular intervals.
“When symptoms are present, for example, persistent tiredness longer than four weeks, presence of lumps, unintentional weight loss and abnormal discharge/blood, they need to be promptly investigated,” she added.
Dr Aqilah also said that the screening methods used differ and can be invasive or non-invasive depending on the types of cancer being screened.
For example, the presence of stool in blood can easily be checked and if positive, it will be followed on with colonoscopy in colorectal cancer screening that is done annually.
Breast cancer screening generally involves a yearly clinical examination, mammogram and ultrasound scan while cervical cancer screening involves a pap smear speculum test that is done every three years, and/or the HPV swab test.
Lung cancer employs low dose computerised tomography (CT) yearly.
Dr Aqilah said most large tertiary hospitals would have screening packages in place.
“However, it is also important to ensure the results of these are interpreted accurately in combination with the individual’s pre-existing medical conditions and risk stratification,” she added.
Cancer can happen in any part of the body. If it is in a visible area, for example, the skin, it will be obvious. However, if cancer is to develop within the body, it has to grow to a certain size before it becomes palpable or visible, such as a lump in the breast or underarms or neck.
“In cancer that is deep within the organs, it has to grow to a significant size before it causes pressure symptoms such as pain, discomfort, bleeding and nausea and constitutional symptoms such as fatigue, weight loss and early satiety.
“Blood tests may not necessarily detect abnormality in these organs until its function is decompensated enough to be reflected on paper results,” said Dr Aqilah.
She added that there is also a tendency for people to ignore these symptoms and even when suspicious be in denial in the hope that the symptoms will self-resolve.
“Attending screening programmes at regular intervals can detect early curable cancers or pre-cancerous changes well before the symptoms become apparent.
“Therefore, awareness and uptake of screening is an important proactive measure that an individual can do for their own health, in addition to maintaining a healthy lifestyle,” she added.
Are cancer markers a reliable indicator?
Dr Aqilah said tumour markers are not specific and can also be raised in other conditions not due to cancer and also stressed that not all cancers are associated with raised tumour markers.
In cancers associated with these raised parameters, it can be useful in monitoring response to cancer treatments, she added.
“In the absence of a known diagnosis of cancer or symptoms suggestive of cancer, raised tumour markers can pose a diagnostic dilemma and may well be a false positive which indicates raised values in the absence of cancer.
“Similarly, a false negative result whereby the tumour markers are normal in the presence of cancer can give a false sense of security and therefore tumour marker tests should only be performed by expert medical professionals who are able to interpret the results,” she explained.
Currently, she pointed out, people are delaying their screening, treatment and follow-up appointments due to the COVID-19 pandemic.
She said it is safe to delay screenings for those who are well and without any symptoms of cancer until the pandemic is more settled but those who have symptoms should be investigated as a delay in diagnosis and treatment can affect outcomes.
“Similarly, those who are on treatment and follow up should discuss their specific cases with their doctors to assess the risk and benefit of treatment or follow-up schedule,” she added.
Dr Aqilah also said that not all cancer patients are equal as some may have higher risks of having lower immunity due to either their treatment or pre-existing medical conditions, while some have the same average risks as the normal population.
“If those in the higher risks category were to contract COVID-19, then a multidisciplinary approach to tailor treatment specific to the patients’ current cancer treatment requirements and complications from COVID-19 will be undertaken,” she said.
Dr Aqilah also said there are many myths surrounding cancer and that there will be some who are swayed into believing many baseless claims, delaying their diagnosis and treatment, and as a result adversely affecting their disease course and outcome.
“We as individuals should take charge of our own health. When diagnosed with cancer, learn about the disease, have a thorough open discussion with the oncologist, clarify any doubts and make an informed decision,” she said.
Dr Aqilah said those who are propagating incorrect information must also realise that their irresponsible acts are burdening the patients in these difficult times and that they may be the contributing factor in the patients’ suboptimal course of disease, at times unnecessarily leading to an early demise.