Breast Cancer, the TOP cancer for women in Singapore

(This article was edited and first published in the 'Hammer', issue: 0902)

Mortality rate is a measure of the number of deaths, women has a lower mortality rates because of their longer life span as compared to men. However, morbidity rates which refers to the prevalence rate of poor health, is higher for women. Statistics have shown that the reason behind higher morbidity rates for women is the complex body that we have.

Over the decade, the word ‘cancer’ never fails to strike fear in people. Breast cancer is the most common cancer in Singapore among women. Women of all the 3 major ethnic groups (Chinese, Malay, and Indian) are equally affected.

A report from ‘Channel News Asia’ (http://www.channelnewsasia.com/stories/singaporelocalnews/view/380260/1/.html) reported that, some 1,300 women are diagnosed with the disease every year, and 313 women die from breast cancer every year. Early detection saves lives, but only 41 per cent of women go for screening.

This incidence has more than doubled over the last twenty-five years. What are some of the possible reasons that had caused this particular type of cancer to be the number 1 cancer in Singapore?

1) Ageing population

Singapore's population is ageing rapidly. The initial cohort of post-war baby boomers will reach 65 years of age by 2012. Today, one out of every 12 Singaporeans is aged 65 or above. This ratio will become one out of five by 2030. Due to lower mortality rates, women are likely to live longer than men and with higher morbidity rates, the longer live span comes with unhealthy body conditions such as Breast Cancer.

2) Dietary factors

Singaporeans’ diet includes a wide variety. Due to the better standard of living that we now have, many are able to afford good food. However, ‘good’ food may not necessarily mean healthy food. Excessive red meat and animal fat and too little fibre increases the risk. Unfortunately, both red meat and animal fat form a huge chuck of our diet now.

3) Higher reproductive ages of women

Singaporean women are getting married at a later age hence giving birth at a later age too. Research had shown that women with no children or having the first child after age 35 are at a higher risk of Breast Cancer. Genealogists always have this as an advice for all mothers-to-be, which is to breast-feed. Besides benefiting the baby, it also reduces the risk of Breast Cancer.

4) Not educated about the illness

A nation-wide government-subsidized breast screening programme was initiated in January 2002. It is targeted at women aged 50 to 69 years of
age. Women who are eligible are invited by letter to present for the
first screen, and recalled at two-yearly intervals for mammogram. This programme which is administered by the Health Promotion Board will be responsible for tracking and recalling. However, there is still a group of women who are not aware of it, the illiterate. They have little or no knowledge of Breast Cancer.

The only proven and effective method of detecting Breast Cancer is the Mammogram. The subsidize cost of a Mammogram in the Polyclinic is $50 (http://www.hpb.gov.sg/hpb/default.asp?pg_id=1274#mammocost). This amount may seem to be affordable by many but at the same time; it could mean a lot to some as well. What else can the Government do to help decrease the number of deaths caused by this dreaded illness?

It would be ideal to provide ‘free’ Mammogram screening for women age 50 – 69, with the Government funding these institutions. Why this particular age group because Mammogram had proven to be most effective for women in this age group.

This ‘free’ screening can be made available to women who belong to a certain group. That is to say probably capita per household is less than $1000. This is because there is a high chance of women in this age group, earning this income is illiterate. Hence, she is firstly not able to afford and secondly not aware of it at all. This group of people will receive letters from MOH informing them about free mammograms and where they can have the screening done. Have brochures with pictures to illustrate the point so that they can understand, otherwise have contact numbers big enough for them to notice so that they can call to enquire. Have people who are able to speak dialects as well as mother tongue be it mandarin, Tamil or Malay to handle the calls.

Another alternative is to allow the usage of Medisave to finance 50% of the cost of screenings. A survey (http://smj.sma.org.sg/4801/4801a5.pdf) done in 2007 revealed that women who found the cost of mammographic screening at a subsidized rate of $50 to be expensive, most gave a range of $20–$30 to be a reasonable price for the service.

Hence if women are required to pay a range of $20 - $30 for a mammogram, it could increase the chances of them going for the screening.

Why Medisave? Medisave contribution varies according to age. The table below illustrates the contribution for employee age 50 – 65 and above.

(Table taken from CPF website)

Let’s cite an example of a woman age 55 with a monthly salary of $1000. That is to say her monthly CPF contribution is 28.5% which is $285. $84.987 out of the $285 goes into her Medisave Account. One year later, she would have accumulated $1019.844 in her Medisave.

With a 4% returns on her Medisave annually, $1019.844 can bring $40.79 which is 80% of the cost of a mammogram. Hence, with this interest paid to the account, the 50% of a screening which is $25 can be paid from it instead of exhausting her Medisave. This will then means that the woman pays only $25 in cash instead of $50.

Among the other reasons cited, I personally believe that cost is the main factor. The other factors can be easily overcome through outreach and education, but money is a strong practical hindrance. Hence, it is vital for the government to provide free mammogram screening for specific groups of women, and allow Medisave to be used to pay for it.