Doctors warn of hidden cancer risks, but urge caution over excessive or unproven tests
Doctors recommend following evidence-backed methods such as the health ministry's recommended cancer screening programmes for various age groups and genders.
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SINGAPORE: Doctors are urging the public to seek medical advice when unusual or persistent symptoms arise, as some cancers remain difficult to detect early and may not be picked up in routine checks.
Their warning comes amid growing awareness of the “grey areas” in cancer detection – where symptoms can be subtle, screening tools are limited and diagnoses may come only at an advanced stage.
DIFFICULTIES IN DETECTION
That uncertainty is reflected in the case of local marathoner Eugene Lim, who died on Apr 10 at the age of 45 after battling Stage 4 urothelial cancer.
The co-founder of local running group The High Panters first noticed brown urine in 2020 after a run. Initial medical checks did not raise concern.
But over the next two years, that symptom became more frequent. In June 2024, during a trip to Johor for a run, Mr Lim – hailed by many in the running community as an inspiration, mentor and friend – discovered that his urine had turned deep red.
Further tests eventually confirmed Stage 4 urothelial cancer, which had already spread to other parts of his body including his lungs and neck.
Some cancer specialists say his case is uncommon.
Professor Ravindran Kanesvaran, chairman and senior consultant at the National Cancer Centre Singapore’s (NCCS) Division of Medical Oncology, noted that urothelial cancer is less frequently seen in patients in their 40s, as it is more commonly diagnosed in those aged 60 and above.
“Hence, the degree of suspicion, even by family medicine specialists and doctors, may be low for urothelial cancer, and usually we will treat for common things like infection that can also cause urinary issues,” he said.
Compounding the challenge is the lack of screening tests for urothelial cancer globally, making it especially difficult to detect, added Prof Ravindran.
“So it's not a cancer that can be screened on a regular period and be picked up easily. So in these kinds of circumstances, we depend a lot on symptoms.”
Urothelial cancer is among several cancers, including pancreatic, liver, and ovarian cancers, that are harder to detect early.
Studies show that around seven in 10 cancer deaths are linked to cancers without recommended screening tests.
WHEN “HEALTHY” ISN’T A SAFEGUARD
Mr Lim’s case has also raised questions about cancer risk among seemingly healthy individuals.
While factors such as smoking, obesity and environmental exposures can increase cancer risk, they do not account for every case, said experts.
Early-onset cancers can occur sporadically, even in those without clear risk factors, said Assistant Professor Jeffrey Leow, a consultant in the urology department at Tan Tock Seng Hospital.
They may arise due to genetic mutations and are not always predictable, he added.
“The cancer gene mutates, and then the body loses its ability to regulate this cell division. So the abnormal cells multiply, then they end up being a visible tumour, for example, in a certain part of the body.”
Doctors stress that awareness of one’s own body remains critical.
Dr Jarrod Tan, a consultant at the National University Cancer Institute Singapore’s (NCIS) surgical oncology division, said a key warning sign for urothelial cancer is blood in the urine – even in small amounts.
“Cancer cells are metabolically active and consume energy as they grow and multiply, so this can often show up as chronic fatigue, unintentional loss of weight and appetite. But this can sometimes be very non-specific,” he added.
“So it's crucial that one understands his or her own body well, such that if there are any new symptoms, and especially if they persist over a period of time, to always seek medical help.”
Early detection, where possible, significantly improves outcomes, with survival rates for some cancers rising to as high as 90 per cent when treated early.
CONCERNS OVER UNPROVEN TESTING
Heightened awareness around cancer has led more people in Singapore to seek screening, according to some hospitals.
Over the past year, Tan Tock Seng Hospital saw about 40 per cent more people going for cancer check-ups. These are largely for common cancers such as colorectal, breast and cervical cancer.
Medical practitioners attribute the trend to national health initiatives like Healthier SG, as well as greater awareness on social media.
But with more people seeking reassurance, doctors are warning against over-testing and the use of unproven methods.
“Sometimes it leads to more unnecessary tests, but it can be a good thing if something serious or preventable or treatable is found early,” said Dr Leow.
“Healthcare resources are finite. So we want to avoid over-diagnosis or over-treatment, but we also want to avoid missing early treatable conditions that can affect someone's lifespan, such as cancer. So I think there's an intricate balance.”
NCIS has seen roughly 20 per cent more people going for cancer screenings since the COVID-19 pandemic. It calls for more public education to prevent over-testing.
“The more tests you do, the more you incur unnecessary healthcare costs,” said Dr Tan.
Excessive testing can lead to false positives, where scans detect abnormalities that are not cancer, he added.
“These can actually be quite debilitating to patients because it causes them to be very anxious and they might not be able to lead their lives properly after that.”
Experts also caution against the growing availability of unproven cancer screening tests, some of which are marketed commercially.
Prof Ravindran said: “Without the data to support the use of these tests, what's going to happen is a lot of times, we will just end up with a very anxious population.”
For now, doctors recommend following evidence-backed methods such as the health ministry's recommended cancer screening programmes for various age groups and genders.
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