Cancer Screening Not Enough, Oncologist Tells Putrajaya

By CodeBlue | 01 April 2019

Beacon Hospital medical director Dr Mohamed Ibrahim Abdul Wahid points out that in Western countries, each person has one GP for life, who will remind them to do screenings like mammograms and pap smears.

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PETALING JAYA, April 1 — An oncologist questioned how the government could ensure Malaysians screened for cancer, instead of expecting them to voluntarily get check ups without doctors pushing them.

Beacon Hospital medical director Dr Mohamed Ibrahim Abdul Wahid pointed out that in countries like the United States, United Kingdom, and Australia, each person would have a single general practitioner (GP) attached to them for life, telling them when to do screenings like mammograms or pap smears to detect breast cancer and cervical cancer early respectively.

“Here, when you talk about early screening, it’s still on a voluntary basis,” Dr Ibrahim told CodeBlue in an interview at Beacon Hospital here.

“Whether you want to go or don’t want to go, no one encourages you to go or tells you when to go or what to do.”

The former Malaysian Oncological Society president said screening rates in Western countries were very high because doctors pushed their patients to get check ups.

“It’s different when you come and see the doctor. Doctor says ‘How old are you?’ ‘I’m 50’. ‘Do you have a family history of breast cancer? Oh you better go for screening’. That’s different from voluntary basis.”

According to data over a decade old from the Malaysian National Cancer Registry Report 2007 to 2011, breast cancer is the most common cancer in the country. Almost half, or 43 per cent, was diagnosed at the late stages of three and four.

Breast cancer five-year survival in Malaysia was only 66.8 per cent for those diagnosed between 2007 and 2011, according to the Malaysian Study on Cancer Survival (MySCan) 2018 report. Survival rates in Australia and the US, in comparison, were 89.5 per cent and 90.2 per cent respectively for women diagnosed in the 2010-2014 period, according to a January 2018 study published in The Lancet.

Cervical cancer, which is the third most common cancer in women in Malaysia, was also mostly diagnosed in the late stages of two to four at 76 percent, according to the outdated Malaysian cancer registry report.

Only about half, or 51.6 percent, of women diagnosed with cervical cancer in Malaysia in the 2007-2011 period survived for more than five years, according to the MySCan report.

The Health Ministry, however, has simply urged the public to get diagnosed early, with Deputy Health Minister Dr Lee Boon Chye reportedly saying last month that mammograms and pap smears were available at most health clinics in the country.

When asked about the Health Ministry’s Peka B40 scheme that provides free health screenings for the poor, Dr Ibrahim said the programme was still unclear.

“You can talk about all these things, but how do you practically implement something that is workable?” he asked.

The Peka B40 scheme is only applicable for the bottom 40 percent (B40) of income earners aged 50 and above, even though pap smears and mammograms are generally recommended for women starting from age 21 and 45 respectively.

Dr Ibrahim instead proposed social health insurance, suggesting that the government work with a consortium of insurance companies to provide universal health coverage with different tiers of care, depending on one’s contribution rate.

“You can tell the patients, okay, you can choose your doctor whom you feel comfortable with and register with a particular group of doctors,” he said.

He said the consortium of insurance companies could negotiate with hospitals the price of various procedures.

“Then they can work out a competitive thing because there is workload. And that will drive private health care costs down.”

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