Whether you’ve got symptoms or not, it never hurts to chat with your doctor about things you can do to stay up to date and in the know about your health. Here, we shine the light on five different ways you can get checked for critical health issues – with advice from the experts.
1. Breast inspections
While a breast examination itself can’t prevent breast cancer, early detection can mean earlier treatment, which also means a better chance of survival. Breast and general surgeon Dr Georgette Tan fills us in on the importance of regular breast examinations, and the different types.
Self-checks
“A monthly self-check is very important because it allows us to detect even subtle
changes – things like lumps, or nipple discharge,” says Dr Chan.
“Young women should ideally start doing this in their twenties to become familiar with how their own breasts feel. Seven to ten days after the start of your menses is the best time to do it, because that’s when the breasts are least sensitive.”
What to do if you find a lump
“Firstly, don’t panic, because about 90 percent of lumps detected are benign,” says Dr Chan. “If you find one while you’re close to your menstrual period, it could be due to temporary hormonal changes. So, I suggest waiting until after your period to see if it’s still there. If it is, go to see your GP.”
Medical examinations
Dr Chan recommends that women should start going for medical breast examinations from the age of 40; however, she adds that if someone in your family has had breast cancer it’s wise to come five to 10 years earlier than your relative was when her cancer was diagnosed. “Depending on the age of a patient and the density of the breast, I may recommend both a mammogram and an ultrasound,” she says.
Mammography
According to Dr Chan, mammography has an accuracy rate as high as 90 to 95 percent, and has proven effective in detecting cancers early. Early detection is associated with a 20 percent drop in breast cancer mortality.
As for patients’ concerns over radiation from the mammography machine, Dr Chan says there’s nothing to be worried about. “Though mammography can be uncomfortable, it’s limited to 15 seconds and is not harmful. As for the amount of radiation, it’s a very low dose, akin to that of a couple of chest x-rays and much lower than a PET scan or a CT scan. So, the risk of harm is low, especially if done only yearly (from 40 to 50), and then every two years (from 50 onwards), as we recommend.”
Ultrasound
Dr Chan says that, although ultrasound is not effective on its own as a screening tool, it’s a good supplementary tool because it’s better at detecting little, delineating nodules.
Georgette Chan Consultancy
#11-09 Mount Elizabeth Medical Centre
6386 5167 | georgettechan.com.sg
2. Melanoma Screening
General surgeon Dr Dennis Lim, whose sub-specialities include head and back surgery, and surgical oncology, chats with us about melanoma, one of the most feared cancers, and the importance of screening for it.
What exactly is melanoma?
Melanomas are cancers that develop from pigment cells in our skin called melanocytes. There are quite a few different types of melanomas, but the most common type is called superficial spreading melanoma.
What causes it?
Excessive sun exposure is the biggest risk factor.
Who should be screened for melanoma, and how often?
Clearly, someone with a family history or their own history of melanoma should be screened, but any light-skinned individuals living in the tropics for the long term, and anyone who works outdoors, should also consider consulting a dermatologist.
What types of screening procedures are available?
A dermatologist usually does a visual inspection, or an inspection with the aid of a lighted magnifier called a dermatoscope.
Say a melanoma lesion is found; at what stage is it potentially fatal?
All cancers progress through stages. Unless it’s treated, a Stage I melanoma will almost always progress to Stage II and so on.
What are the main treatment options, and how effective are they?
The treatment of melanoma is based on the stage it’s at. Early stage melanomas are very effectively treated by surgery, while late stage melanomas are treated with increasingly effective immunotherapy. Stage III melanomas are treated with a combination of surgery and systemic therapy, and Stage IV with chemotherapy or immunotherapy, or both. The earlier melanoma is detected, the better the outcome of treatment. That’s survival greatly depends on the stage at which melanoma is identified. There’s a 95 percent five-year survival rate for someone whose melanoma is picked up at Stage I; if identified at Stage II this drops to about 75 percent; the figure at Stage III is about 50 percent; and by Stage IV it’s about 20 percent.
Are there any recent advances that have helped increase the accuracy of screenings and the effectiveness of treatments?
A diagnosis of melanoma is not as pessimistic as it was 10 years ago. That’s because of the rapid progress we’ve made in accurately identifying the stage of the cancer. What’s more, recent advances in the fields of sentinel lymph node localisation and immunotherapy for advanced disease have improved the outcome for patients.
Dennis Lim Surgery
#11-09 Mount Elizabeth Medical Centre
6386 5167 | dennislim.com.sg
3. Prostate exams
Apart from skin cancers, prostate cancer is the most common cancer among males. In fact, according to the American Cancer Society, about one in seven men will be diagnosed with prostate cancer during his lifetime; the older a man is, the higher his risk, as prostate cancer is much more common after the age of 50, and is found in about six out of 10 men aged 65 or older. Luckily, this type of cancer can grow slowly, and most men diagnosed with prostate cancer do not die from it.
When it comes to screening for prostate cancer, Dr Colin Koh of Complete Healthcare International (CHI) says it’s a very personal choice based on individual risks and concerns, especially for those who know a cancer sufferer or have a family history of the disease. “There is much controversy regarding prostate cancer screening. The main issue is that prostate cancer is generally slow-growing and is often without symptoms. Hence it’s possible for a man to die from other illnesses like a heart attack, a stroke or another cancer before he even develops symptoms of prostate cancer,” says Dr Koh. Many feel that screening for signs of cancer at an early stage, before any symptoms appear, prevents any possible risks or discomfort – the “better safe than sorry” attitude.
“Advocates of screening for prostate cancer would do a digital rectal examination (DRE) and a prostate-specific antigen (PSA) blood test. They believe that early detection is crucial to finding cancer confined within the gland, and reducing complications and mortality. When symptoms develop, or when DRE results become positive, such cases might have already advanced beyond the prostate,” says Dr Koh. Others, however, feel that screening for prostate cancer does more harm than good, since this type of cancer is usually not life-threatening. For example, men may go through unnecessary followup tests, biopsies and other treatments, and experience anxiety over a false-positive PSA test. After all, raised PSA levels do not confirm prostate cancer. A prostate infection can raise PSA, for instance, and, in that case, your doctor would prescribe a course of antibiotics before rechecking the prostate.
Dr Koh notes that further testing may include a prostate ultrasound to detect any prostate enlargement or suspicious growths within the gland. He says specialised blood tests like the Prostate Health Index (PHI) may also be ordered to determine the likelihood of cancer before doing a biopsy, which can confirm whether or not cancer exists. According to Dr Koh, if cancer is confirmed, treatment options are divided into early stage and advanced stage.
If the cancer is small and contained within the prostate gland, it’s usually managed either by “watchful waiting” (regular monitoring of PSA blood levels), radiation therapy (implanting radioactive seeds into the prostate, or radiotherapy involving radiation beams aimed close to the cancer) or surgery in which the prostate is removed. If the cancer is more aggressive or advanced, Dr Koh says the patient may require a combination of radiotherapy and hormone therapy. Every case is unique and needs to be discussed with a doctor, notes Dr Koh. “All these treatment options have their advantages and disadvantages, and must be customised.”
Complete Healthcare International
45 Rochester Park
6776 2288 | chi-health.com.sg
4. Cardiopulmonary Exercise Test
A Cardiopulmonary Exercise Test (CPET) is an advanced, noninvasive clinical test that allows a doctor to see how a patient’s lungs, heart and muscles react together during exercise. The test, which is done while walking on a treadmill, measures the amount of air being breathed in during exercise, how much oxygen is needed, and how fast and efficiently the heart beats during exercise.
“Measuring the gases in breath during exercise allows us to estimate very accurately the health and fitness of an individual’s entire heart, lung and circulatory system,” says DR Peter Ting, fromThe Harley Street Heart & Cancer Centre. “The VO2 (cardiorespiratory fitness) measurement gives us the oxygen consumption of the body, and is a very accurate measure of the intensity of the physical exercise being done; it’s a very strong predictor of the longevity of a person, as well as the prognosticator of any underlying disease condition that he or she might have.”
The CPET, which Dr Ting believes is the most precise gauge of cardiorespiratory fitness, is used for a variety of purposes, such as helping to determine the cause of unexplained exercise limitations or breathlessness. For instance, he says, breathlessness can result from being overweight, or from physical deconditioning through being sedentary, but it may also be a sign of serious underlying heart, lung or circulatory problems. “Any deficiency in one of more of these systems may result in a sensation of shortness of breath on exertion.
The CPET test helps us identify if there is a serious underlying medical problem, as well as pinpoint which systemmay be responsible,” he explains. Dr Ting also says the CPET can help assess a patient’s maximum exercise capacity, and the degree to which he or she is limited by the disease. It can help in following disease progression over time, and in monitoring the effects of therapy in order to make decisions about treatment plans. Another key way the CPET is used is measuring a patient’s fitness to undergo surgery.
“Gauging the performance of the person during the CPET is an extremely good way to evaluate their overall health and cardiorespiratory function. Hence a normal or better VO2 performance is indicative of a very low risk of heart or lung complications, both during and after surgery,” says Dr Ting. “In certain countries, if the surgery isn’t urgent, some patients are even sent for ‘pre-habilitation’ to improve their VO2 before going for surgery.”
In addition, Dr Ting says the test can be done to monitor the effects of training in highly conditioned athletes, and to guide decisions regarding training programmes. As for any potential risks and complications, he says that the CPET is “generally safe and well tolerated”. He explains: “Most complications are minor and include injuries sustained from falling from the treadmill machine. Some patients may develop chest discomfort or an abnormal heart rhythm as a result of their underlying condition, and may require urgent treatment as a result.”
However, he says, patients are closely supervised by trained medical professionals throughout the testing process, which can be stopped at any time a patient feels unwell or experiences any chest pain or discomfort.
What to expect when you go for a CPET:
You’ll be asked about any symptoms you’ve had while exercising in the past. It’s important to describe any chest discomfort, breathing problems, light-headedness, dizziness, fluttering in the chest, weakness, tiredness, or anything else you think may be relevant. An ECG (electrocardiogram) will monitor the rhythm and rate of your heart, using sticky patches called electrodes that are placed on your chest. An inflatable cuff on your upper arm will measure your blood pressure throughout the test, and a small peg on your finger will measure howmuch oxygen is in your blood. A soft facemask over your mouth and nose will help monitor your lungs. Once the treadmill begins, it will increase at a predetermined speed and incline. You’ll need to keep walking until you’re told to stop, or until you’re unable to carry on. Your breathing, heart rate, blood pressure and oxygen level will continue to be monitored during the recovery period.
The Harley Street Heart & Cancer Centre
#02-38/41 Annexe Block, Gleneagles Hospital, 6A Napier Road
6472 3703 | harleystreet.sg
5. Endoscopy
The gastrointestinal system is, of course, crucial to how our bodies function; and, if this system fails, there can be all sorts of unfavourable reactions. We asked Dr Ganesh Ramalingam, a gastroenterologist and general surgeon specialising in gastrointestinal, trauma, bariatric and laparoscopic surgery, about common gastrointestinal problems to be aware of, and how endoscopies can help diagnose these issues. First, it’s important to understand what exactly makes up the gastrointestinal (GI) system. The hollow organs that make up the GI tract are the mouth, the oesophagus, the stomach, the small intestine, the large intestine – which includes the rectum – and the anus.
Food enters the mouth and passes to the anus through the hollow organs of the GI tract. The liver, the pancreas and the gallbladder are the solid organs of the digestive system. So, what are some of the common symptoms or signs that the GI tract is malfunctioning? Dr Ganesh says to look out for a change in stool (loose stools, for example), abdominal pain and bloating, regurgitation and vomiting, or loss of appetite and weight. Abdominal pain and bloating, he says, are two of the most common gastrointestinal problems faced, along with rectal bleeding. Other gastrointestinal conditions include irritable bowel syndrome, constipation, chronic diarrhoea, gallstone pancreatitis, acid reflux, gastroesophageal reflux disease (GERD) and haemorrhoids, to name a few.
In order to diagnose GI conditions, Dr Ganesh performs either a biopsy, depending on symptoms, or a nonsurgical procedure called an endoscopy, used to get direct visualisation of the digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view photos of your digestive tract on a monitor.
Gastroscopy and colonoscopy are two different types of endoscopy. During a gastroscopy, an endoscope is passed through the mouth and i n t o t he oesophagus, allowing the doctor to view the oesophagus, stomach and upper portion of the large intestine. For a colonoscopy, an endoscope is passed into the large intestine through the rectum to examine the lower part of the GI tract. Once the problem is found, treatment options can be decided upon. According to Dr Ganesh, these options include diet and lifestyle modification, medication and surgical intervention.
In a case of irritable bowel syndrome, for instance, he would help the patient identify any food and lifestyle triggers (like stress or irregular meals, for example) causing the bowel irritation, so that the patient can work to avoid those triggers on a daily basis. Dr Ganesh would also prescribe supplementation such as probiotics that can help ease digestion.
At the same time, he would suggest investigating the bowel with an endoscopy to check for organic causes like inflammation or a growth. “It’s my belief that almost all GI issues are directly related to current diet and lifestyle. It’s important that patients understand and identify these causes, and modify as many of them as possible,” he says. “It’s also very important to ensure that the GI tract is free of any disease before embarking on dietary and lifestyle modification.”
Dr Ganesh Ramalingham
#10-43/44 Mount Elizabeth Novena Specialist Centre, 38 Irrawaddy Road
9088 8313 | glsurgical.com.sg
This article first appeared in the August 2016 edition of Expat Living Singapore. Subscribe so you never miss an issue!
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