When you catch a common cold or flu, you are likely to recover in a week with treatment or rest. However, with certain other diseases, once you get them, you may have to live with and manage them for the rest of your life. These are termed chronic diseases, ie. long-lasting illnesses which need to be managed and which, without proper control, may turn deadly.
In 2016, cancer topped the list of top 10 causes of death in Singapore compiled by the Ministry of Health. This was followed by ischaemic/coronary heart disease in 3rd place, cerebrovascular disease in 4th, hypertensive disease in 6th and diabetes mellitus in 10th place. All of these are chronic diseases.
What is surprising is that, although these conditions rank as top causes of death, they are potentially preventable diseases.
These conditions, as well as several other chronic diseases common among Singaporeans, can be nipped in the bud when detected early by health screening.
Let's look at some common chronic conditions that are preventable with health screening:
Diabetes is a disorder that disrupts the way your body uses sugar. Insulin converts sugar into glycogen, a storage form. However, in people with diabetes, the body does not produce enough insulin or the body's cells do not respond to insulin, which causes sugar to build up in the blood. Over many years, this can lead to serious problems such as a heart attack, stroke, kidney disease, vision problems (or even blindness), and pain or loss of feeling in the hands and feet.
Most patients with diabetes do not show any symptoms. As such, the only way to screen for diabetes is to do a fasting blood test to measure the amount of sugar in your blood. If the blood test shows mildly high levels of sugar, a condition termed pre-diabetes, you can reduce your chances of diabetes by losing weight (if you are overweight), controlling your diet and being active. If the blood test shows high sugar levels and you are diagnosed with diabetes, you can also seek treatment early and make lifestyle modifications. With early intervention, diabetes can be controlled well and some people even go into remission. As such, complications as listed above can be averted.
Hypertension (High blood pressure)
Blood pressure is the force exerted by blood against the wall of blood vessels. Hypertension occurs when this pressure is consistently high above 140/90 mmHg.
Hypertension is associated with risk factors such as physical inactivity, a salt-rich diet, alcohol and tobacco use, and certain diseases and medications. Unmanaged hypertension can lead to problems such as a heart attack, stroke and kidney disease.
Most people with hypertension do not experience any symptoms, hence the disease is often called the ‘silent killer’. Screening for hypertension is done by measuring blood pressure using an upper-arm cuff device called a sphygmomanometer.
If you are diagnosed with hypertension, lifestyle modifications can help treat and prevent high blood pressure. These include salt restriction, moderating alcohol consumption, minimising intake of saturated fat and total fat, reducing and maintaining weight, regular physical exercise and stress reduction. Some patients may also need medical treatment to control their blood pressure.
Hyperlipidaemia (High lipid levels in blood)
Cholesterol is a waxy fat-like substance that is found in all cells of the body. It is both produced by your body and derived from the food that you eat. It is used by the body to make hormones, vitamin D and enzymes, which are substances that digest food.
Hyperlipidemia occurs when your cholesterol level is high. People with hyperlipidemia have a higher risk of a heart attack, stroke and other health problems. The higher your cholesterol level, the greater your risk of these problems.
Most people with hyperlipidemia do not display any symptoms. The only way to screen for it is by doing a fasting blood test. You can lower your cholesterol by losing weight, being more active and avoiding red meat, butter, fried food, cheese and other foods that contain large amounts of saturated fat.
Fatty liver is the build-up of abnormal amounts of fat in the liver. It occurs more commonly in people who are overweight, suffer from diabetes mellitus or hyperlipidemia, or those with excessive alcohol use. If not treated, it can lead to scarring of the liver, a condition known as cirrhosis. Once the fatty liver has progressed to cirrhosis, the risk of liver failure and death rises significantly. Hence it is important to diagnose and treat fatty liver early.
As most people with fatty liver have no symptoms, your doctor may suspect that you have fatty liver if blood tests show that liver enzymes are higher than normal. An ultrasound can then be done to detect fat in the liver.
There is no medication or surgery to treat fatty liver. Instead, you will need to avoid or limit alcohol consumption, manage your cholesterol, reduce your sugar intake, lose weight and increase physical activity.
Breast cancer is the most commonly diagnosed cancer worldwide. More than 25% of all cancers in women are breast cancers. The risk of breast cancer increases with age, with most patients being older than 40 years old, but younger women may also be affected.
Early breast cancers may be asymptomatic (ie. has no symptoms) and can only be picked up via a mammogram. Early diagnosis is important because more than 90% of women diagnosed with breast cancer at an early stage survive their disease for at least 5 years, as compared to around 15% for women diagnosed at an advanced stage of the disease.
Cervical cancer is the 10th most common female cancer in Singapore. It is potentially curable if detected in its early stage. The 5-year survival for early stage cervical cancer is between 80 – 95%, as compared to less than 40% in advanced stage cervical cancer.
As such, cervical cancer screening with a Pap smear should start as soon as a woman becomes sexually active. The screening should also be regularly done in 1 – 3-year intervals, depending on the woman’s age and frequency of normal Pap smear results.
Colorectal (colon) cancer
Colon cancer, which affects the large intestine, is the most common cancer in Singapore that affects both males and females. Male Chinese Singaporeans are particularly at risk and most persons diagnosed with colon cancer are older than 45 years of age, but younger persons can also develop a hereditary form of colon cancer.
The majority of colon cancers arise from polyps, which are benign, abnormal tissue growths that are relatively asymptomatic. Malignant change in these polyps takes 5 – 10 years. Hence, if these polyps are detected early, they can be removed before they turn cancerous. As such, screening should begin at the age of 50 for people without any risk factors. In high-risk individuals, such as those with a family history, screening should begin at an earlier age.
The most effective screening test is a colonoscopy, which is the use of a thin, flexible tube to examine inflammation and bleeding in the large intestine. However, faecal occult blood testing, which detects small amounts of blood in faeces, is also commonly used.
Prevent these conditions with health screening
If you think that going for health screening isn’t necessary because you do not experience any health problems, think again. A host of chronic conditions and diseases do not have outward signs or symptoms, especially in their early stages, and can often go undetected until a screening is done.
For particular conditions, health screening can make all the difference by preventing them from even happening in the first place. This is done through discovering and treating any abnormalities that could later develop into a disease, such as colorectal cancer.
Going for regular screening is thus a vital part of a healthy life, no matter how fit you think you are!
Article contributed by Dr Edwin Chng, medical director at Parkway Shenton, One Raffles Quay