Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in Singapore today is as a result of cancer. It is therefore unsurprising that cancer screening has become an integral part of health screening in primary health care today. The current Singapore’s Ministry of Health as well as Academy of Medicine’s guidelines are in keeping with most screening guidelines in the world in their recommendations of routine screening for breast, cervical and colorectal cancers in those with average risks based on appropriate age cutoff, as well as screening for additional cancers based on elevated risks such as family history. Nowhere in the guidelines are serum tumour markers recommended as a method of routine screening. Despite this, every day in primary health care setting in Singapore, serum tumour markers such as carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), CA153, alpha-fetoprotein (AFP), Epstein-Barr virus (EBV) serology are commonly included in packages of health screening. Indeed, an entire industry surrounding this concept of healthy living and early disease detection has sprung up locally in which one can spend a day in a spa-like “health screening centre” where health screening packages can be selected from a menu by a consumer. These packages are often dressed up in attractive sounding hyperboles such as “Premium”, “Executive”, “Deluxe”, “Luxury” as well as the rather bland and less persuasive sounding “Basic” package. The last of which, ironically, is often the only one that is usually driven by guidelines. To compound this further, many of these health screening endeavours are not truly individualised according to personal risk factors despite their claims as such. In fact, the only personalised aspect of the screening appears to be based primarily on consumer request and how much he or she is willing to spend. Indeed, a healthy 30-year-old with no risk factors or symptoms can request and undergo a package that will include among them, a colonoscopy, an oesophago-gastroduodenoscopy and all the various serum tumour markers despite the fact that the likelihood of him being harmed far outweighs any potential miniscule benefit that may arise.
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