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The illusion of invulnerability

Health screening comes up a lot during conversations with my friends and family, mainly because of the nature of my job as a public health officer overseeing Singapore’s national health screening programmes.

A senior citizen participating in a free health screening session at a National Kidney Foundation  open house. Some people surveyed by the HPB feel that a normal result following screening would cause undue emotional distress beforehand besides being a waste of time and money, while abnormal test results would burst their blissful bubble. So they perceive screening as a lose-lose situation. 
TODAY FILE PHOTO

A senior citizen participating in a free health screening session at a National Kidney Foundation open house. Some people surveyed by the HPB feel that a normal result following screening would cause undue emotional distress beforehand besides being a waste of time and money, while abnormal test results would burst their blissful bubble. So they perceive screening as a lose-lose situation.
TODAY FILE PHOTO

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Health screening comes up a lot during conversations with my friends and family, mainly because of the nature of my job as a public health officer overseeing Singapore’s national health screening programmes.

Many of my friends have multiple responsibilities and conflicting priorities: Children to take care of, elderly parents to worry about as well as a full-time job to manage. Health screening often gets relegated to the bottom of their priority list, as it is perceived to be inconvenient and time-consuming. They tend to think that there is no need to visit a doctor for screening if they feel perfectly healthy.

The Health Promotion Board (HPB) recently carried out a consumer insights study with interviews and focus group discussions to understand Singaporeans’ attitudes and perceptions as well as motivations and barriers towards health and screening. We found that men and women aged 40 and above generally do not see the value and necessity of going for health screening.

Some operate under an illusion of invulnerability, believing that it is not necessary to go for screening as long as they look and feel healthy. Others feel that a normal result following screening would cause undue emotional distress beforehand besides being a waste of time and money, while abnormal test results would burst their blissful bubble. So they perceive screening as a lose-lose situation.

These qualitative findings indicate a misconception about screening, which is to detect conditions well before they become obvious and while people still feel healthy. For example, a mammogram can detect breast cancer while the cancer growth is still very small and cannot yet be felt as a lump.

Going for regular screening at the recommended frequency also ensures that conditions that may have developed in the time since the last screening can be detected and treated early, both of which lower the risk of complications and result in better health outcomes.

It is also not that time-consuming. Visiting a doctor for a Pap smear or going for a mammogram takes an hour or two at the most and this needs to be done only once every two to three years.

If you do not have a family history of certain medical conditions, you will require only a basic health screening to check for obesity, high blood pressure, diabetes, high blood cholesterol and three cancers — colorectal, cervical and breast cancer.

At most, it would take half a morning once every two to three years for screening tests — a small investment of time to enjoy peace of mind for you and your loved ones.

SINGAPOREANS NOT INTO SCREENING

It is worrying that Singaporeans are not going for screening as regularly as they should, even though national health screening programmes are heavily subsidised and easily accessible at both public and private healthcare providers, via the polyclinics and Community Health Assist Scheme general practitioner clinics, respectively.

The Health Behavioural Surveillance of Singapore 2013, which is conducted annually, showed that only four in 10 women, or about 180,000 women, aged 50 to 69 had a mammogram done within the past two years, lower than the average of six in 10 women in most developed countries. The screening rate for colorectal cancer has shown some improvement in recent years, possibly due to a greater awareness of such screening. The proportion of Singapore residents aged 50 to 69 who were screened within the recommended frequency increased from about one in four, or roughly 235,000 persons, in 2011, to about one in three, or 325,000 persons, last year.

But the numbers going for screening are still considered low. It is troubling because cancers — particularly those related to lifestyle factors such as smoking and obesity — are on the rise in Singapore. Colorectal cancer remains the most common cancer here. Among Singaporean women, the number of breast cancer cases has risen by 30 per cent from 2003 to 2012.

Social influence may well be the key to convincing more Singaporeans to go for regular screening. It has been shown to be even more powerful than mass media in persuading people to adopt healthy behaviours.

People are more likely to go for screening if they are encouraged to do so by those around them. Studies have found that for those who believe in regular mammography, their loved ones will be twice as likely to get regular mammograms. In fact, the more people talk to others about screening, the more likely they will make a change and go for screening.

Doctors also have a role to play. Research has found that patients are more likely to attend screening when encouraged to do so by their doctors.

Ultimately, if everyone makes it a point to talk to friends and family about screening, it will eventually reach a point where going for screening becomes a habit — and an instinctive choice. With regular screening also comes peace of mind.

ABOUT THE AUTHOR:

Dr Shyamala Thilagaratnam is director of the preventive health programmes division at the Health Promotion Board.

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