With work, family and friends, we are all leading busy lives. It’s all too easy to neglect your health. There are some basic screening tests you should make a point of having done. Here’s our guide to some of the key ones.
One of the best things about breasts, says breast surgeon Dr Georgette Chan, is how accessible they are to regular self-screening.
For self-screening, it’s very important women check their breasts at the correct time of the month, she explains. That’s because our breasts change in texture throughout the menstrual cycle, in accordance with hormonal changes.
The first half of the menstrual cycle runs from when your period starts to the point of ovulation, which is usually the midpoint of the cycle. The second half of the cycle begins after ovulation and ends when your next period begins.
From the seventh to the tenth day from the start of your period is the best time to check your breasts, says Dr Chan: “That’s when they’re at their least lumpy, least dense and also least sensitive. You will you feel any lumps more easily.”
During the second half of the menstrual cycle, our breasts get lumpier, making it hard to tell whether what you’re feeling is in fact a lump, or just a prominent gland. “Breasts tend to be a bit sore and tender at this time, so poking them can be uncomfortable.”
A little TLC
A Canadian website called Rethink Breast Cancer recommends that instead of merely checking for lumps, we should be more “breast aware” in general – and, especially, aware of any changes. It proposes an approach that it calls “TLC”: Touch your breasts; Look at your breasts; and Check with your doctor if you notice any untoward changes in shape or texture.
Dr Chan likes this approach. “Someone who checks herself every month has a good chance of picking up a lump early,” she says. “Benign or harmless lumps usually take a longer time to grow – months or even years. Tumours tend to grow faster, however, taking only weeks or a few months to become palpable.”
“No other organ is as accessible to being screened so often and so easily – not only annually by your doctor and his or her screening machines, but also monthly by you and your own two hands. That’s 13 times a year!”
What to look for
Look carefully for any skin changes, such as persistent rashes. Check the nipples for changes, too – a change of direction, an inversion or a discharge are all abnormal and should be checked out.
Any lumpiness should fade away quickly after the start of menses, says Dr Chan. “Use your sense of touch to look for individual lumps, and for any areas that remain lumpy even after menstruation has started.”
If you’re at all in doubt, check with your GP or your gynae. If they feel you need further attention, that’s where a specialist surgeon like Dr Chan comes in.
Personal risk profile
Nowadays, women are also advised to be aware of their personal breast cancer risk profile, which is largely gene-based. However, only five to 10 percent of breast cancers are of the hereditary type; the great majority are “sporadic mutations”, unrelated to heredity.
So, when would it be appropriate to send a patient for genetic testing?
“Most of our breast cancer patients have no family history at all of the disease,” confirms Dr Chan. “If a patient comes to me with a very strong history of breast or ovarian cancer, however, I will consider sending her for genetic testing.”
In Singapore, genetic testing and counselling always go hand in hand, she says. “We need to know what to do with the results! Being confirmed as having the BRCA1 or BRCA2 gene mutation has lots of implications, not only for the woman herself but also for her daughters, for her sisters, and for their daughters.”
Each of these wants to know her own risks, naturally. “There are many ethical considerations, so counselling is immensely important.”
Until recently, blood samples for genetic testing were always sent overseas, usually to the US. Starting in 2017, however, a Singapore company has been available to do the job. It still takes two to three weeks to get the results, but the costs are lower as there’s no shipping involved.
The media has made much of some “high risk” carriers of the BRCA gene mutations, opting for either preventive mastectomy or chemo prevention. In Dr Chan’s opinion, choosing to undergo preventive mastectomy is “quite drastic”, and something that she would not always advise.
“Instead, I would put them on close surveillance,” she says – meaning a check-up every six months, as opposed to just once a year. “That would include mammogram, ultrasound, and sometimes MRI too.”
The beauty of MRI is that it involves no radiation and is very safe: “It’s especially useful for younger women who tend to have denser breasts, sometimes too dense for effective mammography. It’s also a good option for someone who has a known BRCA gene mutation.”
In the end, the message is clear. Whether you’re examining your own breasts on Day Seven of your cycle, or picking up the phone to book your next mammogram, the health of your breasts is largely in your own hands.
As food intolerances and allergies become increasingly common, consultant gastroenterologist Dr Andrea Rajnakova’s clinic has developed a new speciality with a holistic approach to food-related gastrointestinal problems such as gluten intolerance and coeliac disease.
For many of the millions who suffer from a digestive disorder, it’s merely a source of irritation and discomfort; for those with coeliac disease, however, it can be a lot more serious.
Cutely described as the body’s “food processor”, the long, muscular tube that is our gastrointestinal (GI) tract has the ability to sense and react to whatever passes through it. And to maintain a healthy digestive system, each of us needs to choose the right food to match our individual GI tract’s capacity, says Dr Rajnakova.
Food intolerance or allergy is a primary cause of GI tract problems such as reflux, bloating, dyspepsia, diarrhoea, constipation, diverticulosis, gallstones, fatty liver and even GI cancer. It’s no wonder these problems are on the rise, she says, when you look at the modern diet: centred on concentrated proteins from meat and dairy products, preferring simple to complex carbohydrates, and laced with harmful additives.
How do you screen for gluten intolerance and coeliac disease?
We do a physical examination and take a detailed medical history, plus an evaluation of dietary habits. GI tract problems show symptoms that may include nausea and vomiting, bloating, abdominal pain, constipation and diarrhoea. Coeliac disease can be detected by a blood test, after which we would do a gastroscopy to confirm the diagnosis.
Tell us about coeliac disease.
It’s an immune-based inflammatory reaction in the small intestine to dietary gluten (the storage protein for wheat, barley and rye), and it affects those who are genetically predisposed to it.
It’s a serious condition: the inflammation caused by the body’s reaction to gluten damages the lining of the small intestine, reducing its absorptive surface area, reducing its digestive enzymes and impairing the absorption of important micronutrients. Apart from abdominal pain and bloating, this causes chronic malabsorption, malnutrition and unhealthy weight-loss.
In cases of lactose intolerance or coeliac disease, bloating is linked to a failure of the digestive tract to break down nutrients into small, absorbable molecules. Other GI symptoms of coeliac disease include diarrhoea, oily stools and flatulence; it can also lead to liver disease, anaemia, bone disease and skin disorders. Some coeliac sufferers, surprisingly, may have no symptoms at all!
What is the cure?
Excluding gluten from the diet completely resolves the problem. But this is not always straightforward – it often requires detailed patient education, proper motivation and ongoing follow-up.
Any advice on going gluten-free?
This is interesting! Increasing numbers of people are going gluten-free, mainly because of the huge misconception that gluten-free food is in and of itself “healthier”. In fact, there is no evidence that avoiding gluten is beneficial for people who do not have coeliac disease.
My patients with coeliac disease know that most commercially made gluten-free food is highly processed, low in nutrients and loaded with harmful additives. Instead, I advise them to focus their diet on whole foods that are naturally free from gluten.
I advise anyone who suspects that they or a family member may have a food intolerance or allergy to go for proper medical evaluation and testing.
Gastronomy and colonoscopy
Colorectal cancer is the commonest cancer in Singapore, says Dr Melvin Look of PanAsia Surgery – and though it affects both men and women of all races, the incidence is especially high in Caucasians.
Though overall rates for colon and rectal cancer have been dropping in recent years, that’s mainly for older people. A February 2017 study found that people born in 1990 have double the colon cancer risk and four times the risk for rectal cancer compared with people born in or around 1950 – so there’s no room for complacency!
“Symptoms arising from digestive cancers usually mean advanced disease,” warns Dr Look – “so regular screening is vital, even if you have no symptoms and seem to be healthy.”
Who, why, when and how often?
Most cancers in the colon develop from tiny, fleshy growths called polyps which take a good five to 10 years to grow before they undergo cancer change. The doctor recommends screening colonoscopy to detect colorectal cancers at an early curable stage, and also to prevent cancers by removing the precancerous polyps before they turn malignant.
Start screening from the age 50 and schedule repeat screenings every five to 10 years thereafter, says Dr Look. “But if you have a family history of colorectal or other cancers, you should start screening from the age of 40 or earlier.”
Especially if you have a history of frequent stomach bloating, discomfort or heartburn, it’s a good idea to opt for a gastroscopy to be done at the same time as your colonoscopy – and it only takes another 10 minutes. “These could be symptoms of ulcers, gastritis or reflux,” he explains – or of Helicobacter pylori, a bacterial infection of the stomach that is common in Asia, and is an important risk factor for stomach cancers.
What to expect
Screening gastroscopy and colonoscopy is usually done as a day surgery procedure. A screening colonoscopy uses a flexible telescope to do a complete visual examination of the entire colon and rectum. It is a simple and safe 20-minute procedure done with intravenous sedation. You will be comfortably asleep during the entire process and you can go home once you are fully awake.
A screening gastroscopy can be done at the same time by using a similar flexible scope to examine the oesophagus, stomach and duodenum from the mouth down. You fast for six hours before your gastroscopy so that your stomach is empty, and you undergo a bowel prep the night before to clear your intestines for the colonoscopy.
PanAsia Surgery has a Direct Access Colonoscopy service which eliminates any need for prior consultation or referral – it’s all done and dusted in just one visit. What’s more, most medical insurance plans cover screening colonoscopy because of it cost-effectiveness in preventing colorectal cancer.
Prostate cancer is one of the leading cancers in men – about one man in seven will be diagnosed with it at some time in his life. Consultant urologist Dr Sam Peh of PanAsia Surgery recommends screening at an early stage, when it is easier to treat.
A healthy human prostate is a kiwifruit-sized gland situated below a man’s urinary bladder. Its function, he explains, is to produce the liquid that sperm swim in: “Combined, they’re called semen, and this is what a man ejaculates.”
What to expect
The basic screening test for prostate cancer is a rectal exam by a doctor to detect suspicious lumps in the prostate gland, and a prostate-specific antigen (PSA) blood test.
“Broadly speaking,” says Dr Peh, “the higher the PSA count, the greater the probability of having cancer in the prostate.” However, elevated PSA alone does not mean that a man definitely has cancer of the prostate. That’s because other conditions can cause a high PSA, including benign prostate hyperplasia and prostate infection.
Who, why, when and how often?
PSA testing should be done annually from the age of 50, says Dr Peh – and, if there is a family history of prostate cancer, from the age of 40.
More common than prostate cancer is benign prostate hyperplasia (BPH), especially in older men. The prostate enlarges, causes symptoms like waking up at night to pass urine, a slow urinary stream, frequent urination and an urgency to pass urine. If you think you may have BHP, see a doctor for assessment – and also to rule out cancer.
News! SelectMDx is a urine test that measures two biomarkers for prostate cancer and promises to reduce the need for invasive biopsies in men with raised PSA levels.
Specifically for women
Dr Nandini Shah from the International Medical Clinic (IMC) team believes that regular health screening can provide important information to help maintain and improve our wellbeing throughout our lives.
“We urge all women to have an annual health screening,” says Dr Shah. “From a comprehensive screening to one aimed at a specific area – for example: Women’s Gynae or Sexual Health – we offer a full range of screening services to suit different budgets, time constraints and health concerns.”
Spotlight on: The Pap Smear
A Pap smear test involves the collection of a sample of cells from the cervix (the entrance of the uterus) during a routine pelvic exam; it’s a method of detecting precancerous or cancerous cells so as to prevent cervical cancer.
Cervical cancer is on the rise, explains Dr Shah, so women aged 21 and older are advised to undergo this important screening test every two years. If abnormal cells have been identified, this should be discussed with a doctor.
“Sometimes, a repeat test shows that the cells have gone back to normal on their own. In other cases, the abnormal cells will need to be removed before they become cancerous.”
Spotlight on: Mammogram
A mammogram is simply an x-ray picture of the breast. It uses low-dose x-rays to help identify changes in the breast and detect lumps that may not be palpable, so as to detect early signs of breast cancer. Despite the current controversy surrounding mammography and its benefits, Dr Shah is one of the majority of doctors who recommend that women undergo a mammogram every two years from the age of 40. Breast cancers that are picked up early, before they have spread, have a higher chance of full recovery, she says. “Also, there is also an increased possibility of undergoing breast-conserving surgery, thereby avoiding a mastectomy.” For your mammogram, each breast is positioned and then compressed between two flat x-ray plates.
The discomfort, fortunately, usually lasts only for the few seconds it takes for the x-ray to be done.
Remember that an abnormal mammogram result does not always indicate cancer. “A repeat mammogram may be required, or at times additional testing; or you may be referred to a breast specialist for further evaluation,” explains Dr Shah.
Spotlight on: Bone Mineral Density (BMD)
Scan Though men get osteoporosis too, women are four times more prone to this bone-thinning condition, especially after menopause, and some of us develop it as early as in our forties – especially if we experience early menopause.
Generally, however, a BMD scan – also known as a DEXA scan – is advised for women over 60 years of age. “By measuring the bone mineral density of first your hip and then your spine, it can identify if bones are weak,” explains Dr Shah – weaker bones being more susceptible to fractures.
Happily, the scan takes less than 20 minutes and doesn’t involve being enclosed inside a tunnel. Instead, you lie flat on your back on an open x-ray table. Your test results are usually reviewed with a doctor, who, if the scan shows evidence of bone thinning (osteopenia) or full-blown osteoporosis, may offer lifestyle advice or medication to help stabilise your bone loss or even reverse it.
Vital for Women!
• Blood pressure monitoring
• Cholesterol and glucose monitoring
• Cervical cancer testing (Pap smear)
• Breast cancer screening
• Contraception advice
• Colorectal cancer screening
• Immunisation discussions
• Osteoporosis screening
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