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ANNUAL HEALTH CHECK-UPS HAVE BECOME A COMMON LINE OF DEFENCE WHEN IT COMES TO SCREENING FOR DISEASE. HOWEVER SOME EXPERTS
ARGUE THAT THEY ARE ONLY PART OF THE SOLUTION
Throughout most of human history, people have consulted doctors and other healthcare providers when they were sick. Some time back, most of us wouldn’t think of seeing a doctor until the symptoms became serious. “If it ain’t broke, don’t fix it”, right? But that doesn’t hold true anymore. Annual check-ups have now become customary, if not the norm. Basic ones usually include things like a blood count, urine sample analysis, chest x-ray or EKG. In some cases, they have become increasingly sophisticated with the introduction of executive health screening. Private hospitals and clinics offer a variety of state-of-the art screening methods that provide a more accurate and detailed picture of a person’s health.
As Dr. Crystal Ng Chyi Wen, Medical Director of Executive Health Screeners (under Parkway Shenton), explains, “Increasing life expectancy is creating an ageing population. We need to focus on prevention, delaying the onset and slowing down the progression of chronic diseases. That will enable people to enjoy a better quality of life in their twilight years. The single and most important factor in this is disease detection – discovering, treating, curing and preventing medical conditions from worsening.”
Basic health assessments can begin at the age of 20. They include blood pressure, cholesterol, glucose, BMI, waist circumference and pap smears for ladies. As we age, however, different and more thorough health assessment packages are recommended.
“Many of us might be predisposed to certain medical conditions as we age, and additional health checks may be added. Our experienced resident physicians conduct detailed consultations that explore areas such as medical, surgical and family history, health concerns and habits (like exercise, nutrition, alcohol consumption and smoking) before they help people to choose an age-related package that suits their needs,” says Dr. Ng.
Tests are another aspect of medical check-ups that has evolved over the past decade. According to Hong Kongbased Nutritionist Miles Price of Life Clinic, physicians can go further by using data from such tests to support patients in their journey back to optimal health, rather than just helping them to manage their conditions.
“There have been some key innovations in investigative analyses of particular markers in blood, urine or stools during the past 10 years,” he notes. “Certain laboratories, especially in the US, have capitalised on the use of the latest techniques and applications to determine specific markers that can guide a physician. This has in turn created a new paradigm of medical practice known as functional medicine.”
Price says the remit of functional medicine is to determine the root cause of a disease through various medical tests, and then apply a protocol to help the patient return to full health. Results from health check-ups also assist physicians in their decision-making processes.
“Health check-ups at hospitals are a valuable way to diagnose a condition, and they will remain a good source of analytical data to support the decisions of physicians. However, when it comes to general health check-ups, most hospitals follow a standard formula of tests that does not provide enough feedback in one consultation to determine any dysfunction.
“The body is a complex array of many biological systems. Determining all the relevant markers of good health is difficult, so a ‘snapshot’ is given instead. Thus, patients come away with a range of test results and drug prescriptions, but no answer as to the origin of their condition.”
A lot of what functional medicine has to offer comes under the category of age management. Dr. Julinda Lee, a specialist in Age Management and a gynecologist with the Pacific Healthcare Specialist Centre in Singapore, says this practice evolved from “patients who fell into the ‘it’s in your head’ category. They did not have a disease, but that did not mean they were healthy. Just that they had a disease drugs couldn’t treat. They had an altered state of wellness that needed optimising in terms of their hormones, nutrition and supplementation.”
Dr. Lee says age management treatment can begin at any age, but her largest category of patients consists of men and women in their 40s who see her for hormone replacement therapy, which she says is important for maintaining optimal health as we age.
Levels of hormones such as oestrogen and progesterone decline in women as they age, and levels of testosterone diminish as men age. There is also a decline in growth hormone and thyroid hormone levels as both sexes age. Meanwhile, other hormones, such as insulin and cortisol, may increase with age. That may sound normal, but Dr. Lee says some patients cannot manage the symptoms associated with these hormonal changes.
“Certain patients are debilitated by them. Fatigue, insomnia and shifts in the areas where weight accumulates are all very real hormone deficiency issues. So are loss of concentration, memory, motivation and confidence. Quality of life is important when you consider whether or not to use hormones as you age. Hormone optimisation helps to reduce the risk of chronic diseases, such as heart disease, diabetes mellitus, osteoporosis and dementia.”
Asked about the risks involved in injecting bioidentical hormones into the body, Dr. Lee explains that they must be administered in the correct fashion and dosage. It is important to find a physician who is comfortable with using bioidentical hormones. Many of them, such as thyroid and insulin, have been used for a long time. However, the only area of medical practice where bioidentical hormone replacement is uncommon is the use of synthetic non-bioidentical hormones for treating menopause.
Dr. Ng from Parkway at Shenton says it offers its patients a test called Pathway Fit. This is a nutrigenomic profile that helps them to understand how their genetics and lifestyle may be affecting their diet, nutrition and exercise.
Hippocrates said that all diseases begin in the gut. He was not far off. Nutrition, as Dr. Lee and Mr. Price explain, is an area that requires a lot more attention than it gets. “It is important that patients realise nutrition is how we should nourish the cells in our bodies and that many chronic diseases or states of dis-ease are due to malnutrition. Without proper nutrition, one cannot hope to regain health.”
Expert Comments on Screening and Testing
Pap Smear + HPV
Dr. Kelly Loi
Medical Director, Obstetrician and Singapore Gynaecologist at the Health & Fertility Centre for Women in Singapore.
Pap smear and HPV screening are recommended for women, starting from their 20s. It is important to protect against vaginal and pelvic infections, and cervical cancer, which is now known to be predominantly caused by certain strains of the Human Papilloma Virus (HPV).
Pap smear tests involve using a plastic device called a speculum to visualize the cervix. A sample of cells is then obtained using a special brush. This sample is sent to the laboratory for assessment of cellular changes, including pre-cancerous changes.
Guidelines now recommend HPV screening to be included as well. Regular and frequent Pap smears are recommended if high-risk HPV strains are found. Conversely, if they are not detected, the frequency of Pap smear screening may be reduced.
Our centre strongly advocates regular preventative health screening. This is important, as it allows women to detect problems early and prevent them from becoming serious illnesses. The recommended screening tests for women in their 30s are Pap smear and an ultrasound scan. A mammogram is added to this range of tests when women reach their 40s. At 50, tests should include a Pap smear, ultrasound scan, mammogram and bone mineral density scan.
Dr. Ashok Seth
Chairman and Chief Cardiologist at the Fortis Escorts Heart Institute and Chairman of the Cardiology Council of the Fortis Group of Hospitals in New Delhi, India.
The CT angiogram is the most accurate test for coronary artery disease, with an accuracy rate of between 80 and 90 percent. It is a very precise test in terms of its negative predictive value. That means if a CT angiogram result is negative, if it shows no signs of blockage in the arteries, the chance of that person having serious coronary artery disease is one percent. On the other hand, if it is positive, meaning that the results show significant blockage in the arteries, there is a 90-percent likelihood of that person having coronary artery disease. Since a CT angiogram has fallacies in predicting the percentage of blockage, it is better for patients with a high suspicion or previous history of coronary artery disease to undergo a conventional angiogram. Patients with a fast heart rate, ventricular ectopic activity, kidney dysfunction, raised creatinine, a known allergy to contrast agents or severe LV dysfunction are not fit for a CT angiogram.
The procedure is conducted by injecting a radioactive contrast dye into the vein. This can be detected by the CT scan, and thus give an accurate image of the arteries. Because the CT Scan requires contrast agent which can be harmful to the kidneys, we prefer not to do this test on patients with weak kidneys; so a kidney test is a precondition for a CT angiogram. The procedure should also be avoided if the patient’s heartbeat is abnormally fast or irregular, or if the patient is proven to be allergic to the contrast dye.
It is a non-invasive test, and it is an outpatient investigation, meaning that the patient can come in, take the test and leave the same day. It takes two minutes to perform. Over the years, the CT angiogram has evolved through better imaging machines to give excellent images of the heart arteries almost close to the gold standard of the invasive coronary angiogram.
Dr. Michael Lim
Medical Director of the Heart, Stroke & Cancer Centre in Singapore.
Middle age is the appropriate time for both men and women to go for a heart screening. However, generally speaking, men are more predisposed to heart disease than women, and thus they should go for screening at a younger age.
Evaluation of an individual’s risk factors should also provide an indication of whether to have a screening or not. Men with multiple risk factors – for example, hypertension, diabetes mellitus, high cholesterol levels, smoking, or a family history of sudden death and heart disease – should be screened for heart disease from the age of 35 onwards.
Most women contract heart disease after entering menopause. Hence, screening at the age of 50 is recommended if there are no symptoms or risk factors. Both men and women should undergo heart screening regardless of age if there are symptoms – such as shortness of breath and chest pain – along with risk factors.
Certified Clinical Nutritionist at the LIFE Clinic in Hong Kong.
People can be made more aware of the difference between monitoring their health (to prevent sickness and disease) and what it means to strive for optimum levels of health, such as hormone, gut and allergy testing.
It really depends on how people perceive responsibility for their health and welfare. If they still believe the government has a significant role to play in managing chronic health conditions, they will trust in conventional medical models of health management and feel complacent about its delivery. However, a small but growing group of savvy and motivated individuals are directly looking after their own health needs.
As we move towards a global transition towards less government intervention, the general trend is towards increasing one’s own health knowledge by interacting with nutritionists, osteopaths, personal trainers, etc.
So much information is available about functional medicine and healthy lifestyle practices, as well as expert advice, in an age of almost-universal access to the Internet. It gives the public almost too much choice, and it is essential for reliable, trustworthy knowledge to be disseminated via social media and websites.
Improvements in medical technology are making functional testing procedures to provide information to patients faster and easier. Within the next five years, finger-prick tests will become the normal way to access a vast range of biomarkers. This will surely shift power into the hands of the individual. Moreover, the cost of testing will come down, its accessibility will increase, and doctors will assume the role of “health advisors”.
Communities of health-aware individuals like those you currently see on Facebook are the key motivators and disseminators of such information. Discussions about which allergy test or hormonal profile to use can lead to many threads of ideas and suggestions, arming individuals with a powerhouse of knowledge they can discuss with their doctor.
Dr. Koh Poh Koon
Director and Senior Consultant at the Colorectal Surgical Oncology & Cancer Genetics Service at Fortis Colorectal Hospital in Singapore.
Colorectal cancer is the third most-common cancer worldwide. Almost a million new cases are diagnosed each year. Over the past three decades, the age-standardised incidence rate for colorectal cancer has increased by between two and fourfold in Asian countries such as China, Japan, South Korea and Singapore.
Colonoscopy remains the goldstandard screening tool for colorectal cancer. It not only detects but also allows for the immediate removal of polyps, which are its precursors. The process is painless and takes less than 30 minutes to perform. It is done as a day procedure and patients can resume their normal activities thereafter.
While colorectal cancer arises from a complex interplay of environmental and genetic factors, studies have shown that up to 30 percent of all cases exhibit some degree of familiar inheritance. In fact, at least 5 to 8 percent of these cases are inherited in an autosomal dominant fashion. That means the children of affected individuals carrying mutated genes have a 50-percent chance of inheriting the defective ones. Genetic testing has been advocated by international bodies for high-risk patients with a strong family history of colorectal cancer, as it enables the identification of an entire family at risk of cancer in the future, and it allows individuals to manage their lifestyle better.
Dr. Simon, Ho Man Wong
Specialist in Radiology at the Central Medical Diagnostic Centre (CDMC) in Hong Kong.
The top three screening tests for women are mammogram screening for breast cancer, Pap smear for cervical cancer, and a low-dose CT scan of the thorax for chronic female smokers aged 50 or above.
Mammogram screening for breast cancer is important because it is the top cancer killer of women in many parts of the world, including Hong Kong. Early detection through mammogram screening has been proven effective in reducing cancer deaths because it makes it possible for effective treatment to be started earlier in the course of the disease, possibly before the cancer has spread.
The National Cancer Institute advises women aged 40 and older to have a screening mammogram every one or two years. Women who are at higher than average risk of breast cancer (for example, those with a family history of the disease or who carry a known mutation in either the BRCA1 or the BRCA2 gene) should discuss with their health care providers whether to have screening mammograms before the age 40, and how often.
The overall sensitivity of a mammogram in breast cancer detection is about 80 percent. Several factors affect mammographic sensitivity. Breast density is a well-known one. Women with dense breasts are advised to undergo a breast tomosynthesis or supplementary ultrasound scan to increase the sensitivity of the mammogram.