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Cancer is the number one cause of death in Singapore, accounting for almost 1 in 3 deaths in the total population¹. However, advances in screening and treatment have greatly improved outcomes for patients with the disease.

Speaking at a webinar in partnership with China Life Insurance Singapore, Dr Wong Siew Wei explained the latest cancer screening and treatments available.

The incidence of many cancers in Singapore have risen greatly over the course of the last 50 years. This is largely attributed to changes in lifestyle such as increased stress levels and higher rate of obesity commonly associated with developed countries.

However, not all cancers—including more common cancers such as prostate and breast cancers—are as deadly as they were just a decade ago. In fact, there have been lower mortality rates for these cancers over the years despite increasing incidence of cancer around the world, which is testament to the advances in cancer screening, imaging and treatment.

Protecting yourself from cancer

An estimated 40% of cancers are preventable. Some steps individuals can take to reduce risk of cancer include adopting a healthy lifestyle (maintaining a healthy BMI, engaging in regular physical activity, alcohol and smoking cessation, safe sun exposure), vaccination to reduce the risk of virus-mediated cancer such as Human Papillomavirus (HPV) and Hepatitis B, and cancer screening.

Cancer screening in particular is helpful in detecting abnormalities in individuals without symptoms, allowing for early intervention. Cancer treatment is most effective when the cancer is discovered in its early stages. In general, the disease screened should have a long window period for detection in the precancerous or early stage, with effective treatments available. The screening test itself should be affordable, safe, sensitive, specific and simple to carry out.

Healthy individuals can discuss additional individualised screening tests for prostate cancer, liver cancer, gastric cancer and lung cancer with their doctors.

Delivering personalised treatment to patients

In this day and age, cancer treatment options have extended to a wide arsenal of treatment modalities and techniques, from surgery to chemotherapy, radiation therapy, targeted therapy, immunotherapy and hormonal therapy. Each patient should have a personalised treatment plan based on their general health and accurate assessment of their cancer, as opposed to a ‘one size fits all’ approach.

Various refinements can be done to tailor treatment to each patient. Improved imaging and staging allow accurate staging of cancer, based on which the most appropriate, effective and least invasive treatment can be prescribed to maximise patient outcomes.

Better understanding of the molecular subclass of cancers through improved cancer mutation profiling also helps refine treatment for each patient. Mutation testing has developed over the years from traditional single gene tests in the past, to comprehensive mutation testing with broad hybrid-capture next-generation sequencing (NGS) today. NGS has the advantage of being able to analyse hundreds of mutations with just one test on one small specimen. For patients who do not have adequate cancer specimens for conventional tissue-based NGS tests, analysis of cell-free DNA (cfDNA) fragments shed by metastatic cancer cells into blood circulation is an alternative method of detecting mutations in cancer cells. The identification of driver mutations from NGS tests allows patients to be matched to the most effective targeted therapies, often with minimal side effects compared to traditional chemotherapy.

Apart from more effective targeted therapies, other newer classes of cancer drugs have also been developed. One such example is immunotherapy that targets checkpoint proteins. Cancer cells have the ability to evade the body’s immune system by ‘switching off’ the immune response. Checkpoint inhibitors can restore the immune system to detect and destroy these cancer cells. Immunotherapy has rapidly become the cornerstone of treatment for many cancer types over the years, not just in the metastatic setting, but also in the adjuvant setting.

Advances have also been made with improved cancer recurrence risk stratification. One such example is recurrence score calculation based on testing for multiple genes in breast cancer cells. Patients with estrogen-positive early breast cancer can safely omit chemotherapy after surgery if their recurrence score is low to intermediate.

Take-home message

Cancer is the main cause of death in many developed countries, but fortunately, about 40% of cancers are preventable by adopting a healthy lifestyle and taking vaccinations against certain viruses. Cancer screening can also help detect cancer at an early stage, allowing for early intervention when treatment is more effective.

Major advances in the diagnosis and treatment of cancer in recent years have resulted in better outcomes for patients. To achieve the best possible outcome, the treatment plan has to be personalised to each patient, using information from precise cancer diagnostics, imaging, and molecular testing to match the patient to the most effective treatment with least side effects.