High incidence of cancer in an ageing society

01 June 2020

High incidence of cancer in an ageing society

A report by the Malaysian Statistics Department last year predicted that by 2030, Malaysia will enter a phase where the portion of its population aged over 60 will exceed 15%. This means that the number of cancer cases in Malaysia will gradually increase, hence the need to raise cancer awareness and promote cancer screening is a matter of great urgency.

High number of cancer cases in an ageing society

Cancer is the second most common cause of death worldwide and in Malaysia in 2018 and according to the Malaysian National Cancer Registry Report 2012-2016 released by the Ministry of Health this year, the number of cancer cases in the country has been increasing year on year.

Sunway Medical Centre Consultant Clinical Oncologist, Dr Ivan Shew said the main risk factor for cancer is age. As we get older, our bodies and organs gradually age, causing us to be more susceptible to cancer.

According to current data, the older a society is, the higher the incidence of cancer. For example, the life expectancy in Western countries and Singapore is about 5 to 10 years longer than ours, therefore their incidence of cancer is higher. However, as our society becomes older, the incidences of cancer will slowly catch up with these ageing countries.

Nevertheless, Dr Ivan stressed that not all cancers occur in the elderly. The two most common cancers in Malaysia are colorectal and breast cancer, which also tends to occur in the younger generation. But overall, these cancers are still rather uncommon among young people in Malaysia.

“Based on statistics, the incidence of cancer in women is at a lower age and this is because of breast cancer. The risk of breast cancer increases in women after the age of 40, whereas the risk of men developing cancer may start after the age of 50 or 60, and is mainly colorectal and lung cancer.

“The main factors that trigger colorectal and lung cancer are poor diet, smoking, air pollution and cell exposure to this as people get older. Breast cancer is caused by delayed marriage, late births and infrequent births, causing the breasts to be affected by hormones which leads to breast cancer among younger people,” Dr Ivan said.

Another cause of breast cancer in young people is genetic mutations, with the most common being the Breast Cancer Susceptibility Gene (BRCA). The BRCA mutation causes the cancer suppressor gene to fail to function properly, resulting in cancerous cells.

Around 10% to 15% of breast cancers are caused by BRCA mutations, and these mutations can also lead to ovarian and prostate cancer. Therefore, if there is a family history of breast cancer, it should be traced back to identify if anyone in the family has ovarian, prostate or breast cancer as these cancers are related to genetic mutations.

For women who develop breast cancer before the age of 40, especially those with Triple-Negative Breast Cancer or those with a strong family history of the disease, it is recommended that they consider genetic counselling and genetic testing.

This is because if they carry a genetic mutation, there is still a risk of developing other cancers such as ovarian cancer or cancer in the other healthy breast, even if they have recovered from breast cancer. The follow-up of cancer treatment may also be different for those with gene mutations.

If there is a situation where many family members have cancer, it may be caused by common lifestyle risk factors such as unhealthy eating habits including consuming overnight meals and processed meats with less vegetables, obesity, inactivity and smoking.

“Smoking does not only cause lung cancer, but also oral, vocal cord, stomach and kidney cancer. In fact, before cigarettes were invented, lung cancer cases were rare,” Dr Ivan said.

Regular screening to improve survival rate

Although Malaysia has a lower cancer rate than older countries due to a younger population, our cancer mortality rate is higher than those countries.

“This is mainly because of the low level of awareness among our people as many cancer cases are diagnosed at an advanced stage where treatment may be too late. Furthermore, the awareness of cancer screening is not widespread.

“In the case of breast cancer, although free mammograms are available in government hospitals, the response from the public is poor. The same goes for colorectal cancer where most cases are diagnosed in the third or fourth stage,” Dr Ivan said.

He reckons that this also has to do with the convenience of getting screened. Taiwan, for example, allows faecal occult blood test samples to be submitted through a community pharmacy, whereas in Malaysia, most tests have to be done in hospitals.

Yet, the faecal occult blood test is not the most accurate test. If the result is positive, a colonoscopy has to be done to confirm the result.

“Stool samples do not always contain occult blood, so the results may not be accurate. A colonoscopy can directly observe the presence or absence of polyps and remove it. Those with a family history should undergo a colonoscopy,” Dr Ivan said.

As for the common blood tests that people are more accustomed to, they are even less accurate in screening for cancer.

Dr Ivan pointed that when blood tests show any signs linked to cancer, it is usually an advanced cancer. The main reason for screening is to detect cancer and intervene at the early stages, and even before the cancer has developed (e.g. Stage 0 or Stage 1).

For example, if colorectal polyps are detected through a colonoscopy and removed early, the survival rate of the patient is very high, even more than 90%. If intervention comes at an advanced stage, the efficiency of treatment will be greatly reduced.

“One of the reasons for the high mortality rate of colorectal cancer in Malaysia is that the test is not popular enough and according to data, most diagnosed cases are already at the third or fourth stage,” Dr Ivan said.

As time progresses, cancer treatments have improved tremendously. Besides conventional radiation therapy (radiotherapy) and chemotherapy, targeted therapy and immunotherapy are also becoming familiar to the public.

Furthermore, robot-assisted minimally invasive surgery and laparoscopic surgery have also become the latest in cancer treatment. New radiotherapy technologies and equipment have expanded vastly, and Sunway Medical Centre is equipped with the Intraoperative Radiotherapy (IORT), Brachytherapy, TrueBeam STx, Gamma Knife and Tomotherapy.

“Each equipment has its own strengths and weaknesses. For instance, tomotherapy has a better radiation dose distribution whereas TrueBeam STx is faster,” Dr Ivan explained.  

Multidisciplinary team for customised treatments

Dr Ivan explained that there is no one treatment that is considered the “best treatment” among doctors, but only the “most suitable” one for the patient. Doctors will determine the treatment plan based on the patient’s cancer type, staging, age and health condition, and several treatment options will be provided for the patient to choose according to their personal wishes and condition.

“An example is Treatment A may be able to fully eradicate cancer cells but requires the removal of the entire bladder and catheterisation, while Treatment B does not require the removal of the bladder and only involves chemotherapy and radiotherapy, allowing the patient a less strenuous treatment plan, but the chance of recovery is lower,” he said.

Some patients choose diet or natural remedies because they are afraid of treatment, but Dr Ivan said these alternative treatments are not scientifically proven, and may cause delay in treatment and lead to the spread and progression of the disease.

“We had a kidney cancer patient who refused treatment because of his fear of the side effects of chemotherapy. He delayed treatment until the very last minute when his cancer has spread, worsening his condition. And yet, his disease is not treated through chemotherapy but targeted therapy,” Dr Ivan said.

He added that many people think that the only way to treat cancer is through chemotherapy, not knowing that some cancer treatments do not involve chemotherapy. For this reason, it is always best to consult an oncologist to understand your treatment options.  

He pointed that advances in medicine have also allowed doctors to adjust treatment in a variety of ways, such as prescribing new medication or adjusting the administration of chemotherapy to fit the patient’s need, in order to make the treatment process less stressful for the patient.

A complete, well-planned and dedicated treatment plan requires the collaboration from a multidisciplinary team. Surgery, chemotherapy, radiotherapy and hormone therapy involves surgeons and oncologists, while biopsy and imaging require pathologists and interventional radiologists.

“The advantage of a large hospital like Sunway Medical Centre is that we can provide not only comprehensive treatment from the cancer team, but also other forms of supplementary therapies such as diet and physiotherapy.

“Moreover, we have a dedicated rehabilitation centre and a speech and hearing centre which consist of speech therapists and swallowing therapists. We are a one-stop centre for cancer treatment where we are able to provide everything from screening, diagnosis, treatment, prognosis to rehabilitation.

“Compared to foreign hospitals, Malaysia’s medical expenses are affordable and complete with facilities of high standards, which is a major advantage for our people. Therefore, it is important for our people to be proactive in getting screened and early treatment to prevent cancer before it starts,” Dr Ivan said.

Tips to avoid cancer

  1. Maintain an ideal body weight and exercise more often. Those who are overweight should diet instead of relying on health supplements.
  2. Early detection and treatment is key to improving cancer survival rate. After undergoing health screenings, go for regular check-ups or follow-ups according to doctor’s advice.  
  3. If you have symptoms, see your doctor as soon as possible so you don't miss the window for treatment.
  4. The myth about cancer patients having to avoid sugar intake is misguided. This is because if the body is completely sugar-free, cancer cells will convert protein and fat in the body to sugar, resulting in weight loss and lower immunity.
  5. Don't be misled and delay your treatment by false information on the internet.

Source: Sin Chew Daily Sabah