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EXPERT ADVICE: Don’t Delay Health Screening During COVID-19!

Regular health check-ups are essential to identify a medical issue before it becomes a serious problem.


Everybody agrees that our lives have all hit the pause button, thanks to the COVID-19 pandemic.

Certainly, because of Circuit-Breaker (CB) restrictions and social distancing rules, everything from birthday celebrations to weddings have been put on hold. Annual medical check-ups were also suspended temporarily as health screening did not fit the Government’s “essential services” criteria.

Indeed, it’s easy to put routine health check-ups on the back burner when working from home and supervising home-based learning are top on every parent’s mind.

However, Dr Derek Koh, head of Thomson Wellth Cliniccautions that when it comes to your health, there’s no difference between our current COVID-19 situation and non-COVID-19 times. So, do reschedule your health screening appointment if it was postponed as a result of CB.

He points out, “The development of disease processes, including chronic diseases and cancer occurrences, will still happen ― and they will eventually kill. So, routine screening should still be part of one’s preventive measures.”

Screening tests like mammograms and colonoscopies detect cancers early, when they’re easiest to treat. When tests are put off, this could give an aggressive cancer time to spread, even though most tumours grow over time.

To put things in perspective, in 2018, some 52 per cent of deaths in Singapore were caused by cancer (28 per cent), coronary heart disease (18 per cent) and strokes (6 per cent).

In contrast, while COVID-19 has struck some 42,000+ people in Singapore, there have been 26 deaths to date (at press time) in a population of about 5.7 million people. This works out to a mortality rate of about 0.06 per cent.

And since COVID-19 doesn’t show signs of going away soon, Dr Koh states that we need to adopt a new normal with regard to the routine management of our health. So as to ensure that your body ― your precious asset ― remains in good shape, his succinct advice is, “Make screening your new norm ― screening saves lives.”

Dr Koh tackles readers’ questions on the importance of getting regular health check-ups.

You feel well, so is health screening still necessary?

Very necessary. Chronic diseases like diabetes, elevated cholesterol and blood pressure, the three cornerstones of the development of heart attacks and strokes develop silently. Significantly, heart attacks and strokes combine kill 25 per cent of the population, while cancer, which also affects one in four people in Singapore, is also present silently in the beginning when early discovery can make a difference between survival and death.

What is your advice to people who put off health screening because they fear the worst?

Whatever has happened or is developing will continue to progress and eventually lead to illness and maybe even death. However, early discovery can lead to interventions that will halt or slow down the progress of the disease.

Is a general screening test sufficient for people in general?

A useful general or “starter” screening test should include the checking of BP, sugar, cholesterol, as well as for the common cancers that can occur in the patient’s particular profile, taking into account his/her age and gender.

How often should you go for health screening?

My advice is that that those above 40 years should be screened every year, and if you’re below 40, once every two years. Unless you have a special risk in the family or lifestyle, or if your previous tests suggest possible early development of certain illnesses. This doesn’t guarantee that you won’t develop in the interim, but even if it does, it will be detected at an earlier stage when intervention can make all the difference.

What about those with a family history of certain diseases, such as diabetes or cancer?

The three major chronic diseases namely diabetes, hypertension (elevated BP) and dyslipidemia (elevated cholesterols) have a certain genetic bias. The actual risk can however be modified by healthy lifestyle choices, which we’ll always discuss during the screening sessions. Cancers, especially colon and breast, are also known to have a genetic propensity. It is however less influenced by lifestyle choices.

For diseases like heart attacks and strokes, the risk is usually in proportion to existing diabetes, hypertension, dyslipidemia, obesity and smoking.

EXPERT ADVICE: Don’t Delay Health Screening During COVID-19! 1
Any additional health screening tests men and women should take after age 40?

All screening tests should be evidence based. However, for patients above 40, there will be increase in the likelihood of cancers, diabetes, hypertension, dyslipidemia, as well as heart diseases. So, these will have to be tested more in depth. The older folks should also be screened for osteoporosis and hormonal decline.

Let’s talk about stress, which is a huge contributing factor in lifestyle diseases.

Stress is a big part of life in Singapore. In the 2019 Cigna 360 Well-Being Survey, a whopping 92 per cent of working Singaporeans report feeling stressed, higher than the global average of 84 per cent.

Stress harms the body not just emotionally but also physically as it can contribute to increasing one’s chances of getting or worsen certain diseases like heart disease, hypertension, asthma and gastric ulcers. It is a common cause of headaches, and also accelerates ageing and premature death.

Stress will influence lifestyle choices like over eating, drinking alcohol and smoking ― these choices will increase the likelihood of diseases and sicknesses. 

What post-screening advice can doctors provide?

Screening by itself serves no function unless there’s a proper follow-up. The review where advice is given is probably the most important aspect of the screening. The advice we give addresses not just the follow-up actions of all abnormal results, but also the actions needed to maintain good results.

Besides advice, there will also be a follow-up of specific abnormal tests that will be arranged after a period of lifestyle changes or supplements/medication. For abnormal tests that are associated with other possible illnesses, further tests may be done to ensure that there are no further issues. Examples would be blood in the urine or stool that can be due to multiple reasons, so, further tests will have to be arranged to find out the causes.

Another example are abnormal liver parameters ― it can be caused by a fatty liver (because the patient is overweight or drinks a lot of alcohol). Or it could be due to their status as a hepatitis B carrier or even gallstones.

Or perhaps an elevated prostate cancer marker could indicate prostate cancer, but other common reasons could include prostate enlargement or even transient prostatitis (a serious bacterial infection of the prostate gland).

Some abnormal test results such as elevated cholesterols can, in the long run, lead to heart disease. So, further tests may include heart-related tests like a treadmill ECG or perhaps a heart scan for patients with long-standing elevated cholesterols.

We may offer lifestyle advice on diet, exercise and supplements to take to maintain current good health or improve poor results. Examples of such advice may include:

  • Exercising more to increase a low level of HDL (good cholesterol).
  • Losing weight to reduce a borderline sugar test, which can lead to pre-diabetes or even diabetes
  • Going on a low purine^ diet to reduce high uric acid levels, so as to reduce gout occurrences.
  • Taking a course of fish oil to reduce triglyceride levels.
  • Taking a course of milk thistle to improve fatty liver.
  • It can be as simple as exposing oneself to more sunlight for the patient with a low vitamin D level, as well taking vitamin D supplements.
  • Taking zinc supplements if male patients have dwindling testosterone levels.
What’s your advice if someone spots red flags like bloody stools or a lump on their breast?

I would always suggest to my regulars that they highlight all acute changes to me, not just during their health screening but also during the interim, between screenings. The two symptoms mentioned are especially important as they may indicate the presence of colon and breast cancer and these are the number 1 cancers for men and women.

^ Found in some seafood like tuna, sardines and cod, red meat, organ meat and alcoholic beverages, especially beer.

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