Even if you don’t have symptoms, going for health screenings helps you stay ahead of diseases – and early detection can mean the difference between life and death. We chat to six healthcare professionals about some common and important screenings that can help keep you safe and healthy.
1. Sexual Health Screenings
“If you are sexually active, getting tested for sexually transmitted diseases (STDs) is one of the most important things you can do to protect your health. Make sure you have an open and honest conversation with your doctor about your sexual history, and ask whether you should be tested for STDs,” says Dr Christopher Eldridge, a GP at International Medical Clinic (Jelita Clinic).
Who should go for a sexual health screening and how regularly?
Recommendations vary depending on what you’re screening for, your sexual orientation and the number of partners you have had. According to Dr Eldridge, anyone who has unprotected sex or shares injection drug equipment should get tested for HIV at least once a year.
Even in the absence of symptoms, chlamydia and gonorrhoea should be screened for annually in all sexually active women under 25 years – because women often don’t show symptoms – as well as in older women with risk factors like new or multiple partners, or a partner who has an STD. Pregnant women should also be screened early during their pregnancy, for their baby’s safety.
All sexually active men who have sex with men (MSM) should be screened annually for syphilis, chlamydia and gonorrhoea and, if anonymous or multiple partners are involved, screenings should be more frequent, at three- to six-month intervals.
What treatment options are available?
Chlamydia, gonorrhoea and syphilis can be treated quite simply with oral antibiotics and injections. The body can sometimes clear certain STDs over time on its own; these include HPV (human papillomavirus), hepatitis A, acute hepatitis B and acute hepatitis C. STDs for which there is currently no cure include HIV and AIDS, oral and genital herpes, chronic hepatitis B and C, and some strains of HPV.
Why is screening important?
Regardless of the type of STD, it’s important to be screened and then, if necessary, treated. Where an STD cannot be cured, there are treatments that can stop the disease from worsening, or slow its progress. Regular screening will also catch treatable STDs that have no symptoms, such as chlamydia, which, if left untreated, could lead to serious damage to the reproductive organs, and even cause infertility.
Are there any sexual health vaccines we should know about?
Yes. The pre-exposure HPV vaccination is one of the most effective methods for preventing transmission of human papillomavirus (HPV), HAV hepatitis A and HBV hepatitis B. Boys and girls aged 11 to 12 should get their HPV vaccinations routinely; it can be administered from nine years old. Vaccination is also recommended up to the age of 26 for females and age 21 for males who have not yet received any of the doses. For those with HIV infection and for men who have sex with men, vaccinations are recommended up to the age of 26.
The hepatitis B vaccination is also recommended to all unvaccinated, uninfected persons being evaluated or treated for an STD. In addition, the hepatitis A and B vaccines are recommended for men who have sex with men, injection-drug users (IDUs), persons with chronic liver disease, and those with HIV infection.
2. Diabetes Screening
According to the Diabetes Research Institute Foundation, diabetes takes more lives today than AIDS and breast cancer combined, and is a leading cause of blindness, kidney failure, amputation, heart failure and stroke.
What is diabetes?
Diabetes occurs when the body no longer produces insulin properly. Most of the carbohydrate that you eat is turned into a sugar called glucose. In a healthy person, the pancreas releases insulin, which serves as a “key” to open your cells, allowing glucose to enter and be used for energy. In people with diabetes, this system does not work.
Screening for Diabetes
Dr Daniel Wai Chun Hang, Medical Director at the Daniel Wai Diabetes, Thyroid and Hormone Clinic says that the usual screening test in Singapore is the blood sugar test while fasting. Blood glucose levels are measured to see if the patient falls within the diabetic range. They will also be asked if they have symptoms of diabetes, such as thirst, frequent urination, tiredness and loss of weight.
He would suggest diabetes screening to anyone who is overweight or obese, those who have a first degree relative with diabetes, those with hypertension, high cholesterol or a history of cardiovascular disease. Also at risk are women with polycystic ovarian syndrome, and women who have delivered a baby weighing four kilograms or more, or who have been previously diagnosed with gestational diabetes mellitus. Asian races are at higher risk of diabetes than other ethnicities.
Dr Wai explains why screening is so important: “In Singapore, 30 to 50 percent of those suffering from diabetes are not aware of their condition. If left untreated, diabetes can start to cause complications such as damage to the kidneys, eyes, nerves, heart and blood vessels. Early detection can be followed by treatment that lowers the blood sugar and therefore prevents complications.”
The type of treatment your doctor prescribes is highly dependent on the type of diabetes you have. Diabetes is usually classified as Type 1 or Type 2.
“Type 1 diabetes is an autoimmune disease, where the body’s white blood cells mistake one’s own pancreas as the enemy and attack it. As a result, the patient loses the ability to make insulin, causing the blood glucose to be very high; but glucose does not succeed in entering our cells to create energy,” says Dr Wai. This type of diabetes is genetic and not preventable, and most people present with the disease when they are children or teenagers. This type of diabetes requires insulin treatment for life. Type 2 diabetes, on the other hand, is “a disease of many causes”, says Dr Wai. “Both genes and lifestyle affect the risk. Having a family history of diabetes, being overweight, leading a sedentary lifestyle without exercise, and eating too much sugar all contribute to the risk of getting it.”
The main problem, he says, is resistance to insulin. The pancreas is forced to make too much insulin and ultimately can’t keep up, so insulin doesn’t function properly in the body. This is highly preventable with a sensible diet and lifestyle. “When the condition is mild, treatment involves lifestyle changes; for severe cases, oral medication is prescribed. For more serious cases, insulin injections may be required,” he adds.
Symptoms of Type 1 diabetes include fever, vomiting, severe dehydration, and acetone breath. In cases of Type 2 diabetes, symptoms may be less obvious; they include thirst, frequent urination and, in severe cases, tiredness and weight loss.
3. Colon Cancer Screening
The Singapore Cancer Society (SCS) ranks colorectal cancer as the most common cancer in males, and the second most common cancer – after breast cancer – in females. According to the SCS official website, among the races in Singapore, the Chinese have a higher risk of colorectal cancer. You also have a higher risk from the age of 50 onwards.
Who should go for a colon cancer screening?
According to Dr Ganesh Ramalingam, Consultant General Surgeon at G & L Surgical, healthy individuals with no family history of the cancer should start screening regularly from the age of 45, as the chances of developing colon cancer increase as we get older.
“Ninety percent of cases are in people over 50, and about 20 percent of people with colon cancer have a first-degree relative (parents, siblings or children) or second-degree relative (aunts, uncles, grandparents, grandchildren, nieces, nephews, or half siblings) who also had colon cancer,” says Dr Ramalingam.
Having certain symptoms also warrants a screening. “Whatever age you are, if you have bleeding, a change in bowel habits or something vague like abdominal pain and bloating, we will consider screening,” adds the doctor.
Screening is important even when you feel fine, because small polyps or early cancer usually cause no symptoms. Once symptoms start to show, it may be too late, as the tumour would already have grown to a dangerously advanced stage.
Dr Ramalingam lists three options, and their pros and cons:
- A high-sensitivity faecal occult blood test (FOBT), which involves providing stool samples to your doctor; this should be done once every year.
- A colonoscopy, which requires anaesthesia and a scope, during which the doctor can remove on the spot any polyps that may be found. A colonoscopy is only needed every three to five years, unless a close relative has developed colon cancer.
- A flexible sigmoidoscopy, which can be used to find polyps but not to remove them; removal would require a separate procedure. This screening should be repeated every five years.
Dr Ramalingam recommends a colonoscopy over the other two screening options, because any polyps found can be removed during the procedure. While the FOBT is easier and less expensive, he adds, “the FOBT and the CT scan only detect potential problems or polyps – you would still need a colonoscopy to have them removed.”
Besides tests that your doctor can perform, you can also do your ownFaecal Immunochemical Test (FIT). This simple test is available in a takehome kit and can be carried out in the comfort of your own home. How it works, according to the SCS website, is that colorectal polyps and cancers can bleed into the colon in small amounts that are invisible to the naked eye but can can be detected by the FIT test. The SCS distributes FIT kits, without charge, to Singaporeans and Permanent Residents aged 50 and above, and it is recommended that you do this test once a year.
4. Gastric Cancer Screening
“Although the incidence of gastric cancer is decreasing slowly worldwide, it remains the second-highest cause of cancer death, accounting for approximately 700,000 deaths annually,” says Dr Andrea Rajnakova of Andrea’s Digestive, Colon, Liver and Gallbladder Clinic.
Gastric cancer is particularly common in East Asian countries such as Japan, Korea and China, Dr Rajnakova tells us. In Singapore, 78 percent of the population is ethnic Chinese, and gastric cancer is the sixth most common cancer among Singaporean males, who have a one in 50 risk of developing the cancer.
If you’re a Chinese male above 50, regular screening is a good idea. Other risk factors include having a family history of gastric cancer, smoking, having a Helicobacter pylori infection, atrophic gastritis and intestinal metaplasia (as detected in gastric biopsies).
Gastric cancer is curable if detected early, says Dr Rajnakova, and it can be diagnosed in the early stages only by an endoscopy screening. “More targeted screening and surveillance is required in countries with higher rates of gastric cancer, like Singapore. Pre-cancerous lesions associated with early gastric cancer may appear very subtle on a standard endoscopy, so they are very difficult to detect. Currently, in most countries, only a minority of gastric cancers are detected at an early stage. In recent years, several new endoscopic imaging modalities, which may improve the detection of early gastrointestinal cancer, have been developed.”
Traditionally, gastric cancer has a poor prognosis because of its late presentation. That’s why screening and early detection are so important.
“Treatment of stomach cancer depends on the cancer’s stage, its site in the stomach, and whether it has spread to the lymph nodes or other organs,” says Dr Rajnakova. “Early gastric cancer that is limited to the inner layer of the stomach (the mucosa) can be treated by endoscopic resection. In this procedure, the cancer is removed through an endoscope and does not require open surgery”.
This technique was developed in Japan, she says, where stomach cancer is often detected at an early stage during screening. If the tumour has already penetrated deeper than the innermost lining, surgery becomes necessary, often combined with chemotherapy, or chemo plus radiotherapy. “In cases of advanced cancer which has spread to other organs, a cure is not possible – treatment at this stage is aimed at relieving symptoms.”
5. Thyroid Screening
Experiencing sudden weight gain or weight loss? Suddenly feeling lethargic, or experiencing unusual hair-loss? You might have thyroid issues.
The thyroid is a butterfly-shaped gland that is part of the endocrine system – the body’s regulating system that stores and releases hormones into the bloodstream. The thyroid gland produces hormones that control your metabolism and regulate other vital body functions like breathing, heart rate, weight, muscle strength, body temperature, menstruation, cholesterol levels, the nervous system and more.
Who should go for a thyroid screening?
“Thyroid screening is offered as a part of most health checks,” says Dr Charu Narayanan of Complete Healthcare International. “While there is no age barrier to disease affecting this gland, being a woman and getting older can increase one’s chances of developing the disease.”
There are, however, those who are at increased risk of developing thyroid problems. If you have a personal or family history of immune system diseases or are taking medication for a mental health disease or heart disease, you’re at higher risk than most. If you’re pregnant, you should know that pregnancy outcomes have been linked to thyroid function, so it’s advisable to have it checked early. In addition, some women may develop an inflammation of the thyroid gland (thyroiditis) soon after delivery.
What are the symptoms that signal thyroid issues?
According to Dr Narayanan, thyroid-related complaints may be subtle, come on gradually and be easily overlooked. Typical symptoms include fatigue, unexplained weight loss or weight gain, fast heartbeat, anxiety, tremors, lethargy, mental slowness, depression, dry hair or hair loss, dry skin, puffiness around the face, constipation and feeling very cold. “Swelling of the neck (goitre), together with difficulty in swallowing or obvious lumps on the neck may also be symptoms of a thyroid disorder,” she adds.
Are thyroid problems related to one’s lifestyle?
“Chronic stress can affect the thyroid, as can diet and other lifestyle factors. Stress has been known to trigger abnormal immune responses. Other causes could include certain viral infections, medications taken for other reasons, and deficiencies in nutrients such as iodine and selenium. People who have had radiation therapy can also be predisposed,” says Dr Narayanan.
What treatments are available to fix thyroid problems?
Thyroid hormone supplements should ease symptoms within a few weeks, and specific medication is required for overfunctioning thyroid glands, explains Dr Narayanan.
“Reducing stress and maintaining a healthy lifestyle and nutrition, as well as testing and treating for nutrient deficiencies, are a holistic approach to the condition. Appropriate treatment can lead to dramatic improvements, including greater energy, quicker thinking, weight loss and better mood,” says the doctor.
6. Depression Screening
Depression is easy to miss, particularly since the symptoms can vary widely. According to Maria Luedeke, counsellor and psychotherapist at Aspire Counselling, depression can look different depending on the individual, their age and gender.
“Men may identify feelings of persistent anger, short-temperedness or frustration, whereas women feel sadness, emptiness and loneliness. Children and teens experiencing depression may feel anxiety, fatigue, anger and withdrawal,” she says.
There are a number of general signs counsellors and therapists look out for to make a diagnosis, says Ms Luedeke. These include:
- Insomnia, early-morning wakefulness or excessive sleeping
- Irritability and restlessness
- Loss of interest in activities or hobbies that were once pleasurable, including sex
- Overeating or loss of appetite Persistent aches, pains, headaches, cramps or digestive problems that do not ease with treatment
- Persistent sadness, anxiousness or feelings of emptiness
- Thoughts of suicide and suicide attempts
- Difficulty concentrating, remembering details or making decisions
- Fatigue and decreased energy
- Feelings of guilt, worthlessness or helplessness
- Feelings of hopelessness or pessimism
Getting help is important, because depression tends to worsen over time, and research has shown that the sooner people seek help, the better the long-term outcome. If you’ve experienced any of the above symptoms continually for two to four weeks, or if they’re impacting your daily routines or relationships, it’s time to check in with a qualified medical practitioner or mental health professional, says our expert.
What to expect
The first step to managing mental health is a trip to your GP. A full medical history will first be taken, in order to rule out and treat any physical disease or disorder that can cause symptoms of depression.
A full personal and mental health history of yourself and your family will also be done, including alcohol and drug usage habits. Your doctor will then ask about your symptoms, their duration and severity. “If you’ve experienced these symptoms in the past, the practitioner will want to know how they were treated,” Ms Luedeke says.
There are three main ways that depression is treated: by antidepressant medication, psychotherapy or by a combination of both. In Singapore, medication can only be prescribed by a qualified medical doctor or psychiatrist. Psychotherapy is carried out by qualified counsellors, psychologists or social workers, and by some psychiatrists.
When it comes to depression, your doctor or mental health professional will make a treatment recommendation; ultimately, though, you may choose the treatment plan that best fits your needs. There are exceptions to this, however.
“If the patient is a child, his or her parents would decide the treatment plan. Another exception is where the individual is a danger to themselves and shown by the attending psychiatrist to be mentally unable to make decisions. In Singapore, under the Mental Disorders & Treatment Act (MDTA), police are empowered to bring mentally ill persons to the Institute of Mental Health for assessment if they are found or believed to be acting in a manner that is dangerous to themselves or to others,” says Ms Luedeke.
“Seeking help should never be seen as a sign of weakness or incompetence; it is a sign of intelligence, strength and honesty,” she adds.
For more stories like this, check out our Medical section.