More money for free breast cancer screening

$2m fund will provide low-income women with free mammograms

By Linette Lai, The Straits Times, 10 Apr 2014

LAST year, the Breast Cancer Foundation (BCF) budgeted more than $300,000 for a scheme to provide free mammograms for lower-income women.

This amount was supposed to last two years but was used up within seven weeks due to overwhelming response - 6,000 women signed up.

The BCF added almost $150,000 more, bringing the total number screened under BCF Encouragement for Active Mammograms (BEAM15) to about 8,700.

Post by Ministry of Health.

This year, the BCF is setting aside $2 million for the programme, so that it can reach 40,000 checks over the next five years. This is nearly seven times last year's target of 6,000 checks.

Senior Minister of State for Health Amy Khor, in announcing this yesterday, said: "In Singapore, women generally fare quite well in terms of health. But despite this, there are areas for improvement, and one of the key areas is in breast cancer screening."

Only about four in 10 Singaporean women aged between 50 and 69 go for regular mammograms, Dr Khor said. The average for countries in the Organisation for Economic Cooperation and Development is six in 10.

Dr Khor said: "Early detection through screening is important so you can get... appropriate treatment, and that will really improve the long-term outcomes."

For Singaporean women, breast cancer is not only the most common cancer, but also the top cause of cancer death. Each year, about 1,600 are diagnosed with the disease, and about 400 die.

The Health Promotion Board (HPB) has made an effort to raise the breast screening rate. In 2002, it started BreastScreen Singapore, which subsidises half the cost of screening for women aged 50 and above, meaning most pay about $50 each. BEAM15 - launched in March last year by the BCF and the HPB - pays the remainder for low-income women. Those aged 50 and above with Community Health Assist Scheme (CHAS) cards are eligible, and will receive a letter inviting them to go for screening.

BCF president Noor Quek said a key obstacle to lower-income women going for breast cancer screening is their financial difficulty. Many, she said, are "totally dependent on their children and husbands for an allowance".

They also fear losing their husbands if abnormalities are found and they require a mastectomy.

Luckily, this was not the case for housewife Jaharah Mohamed, 61, who has had surgery to remove part of one breast. Some abnormalities were found in her breast after she had been screened under BEAM15. "I was scared, but my husband hugged me and told me not to worry," she said.

1 in 4 skips follow-up breast cancer tests
This is despite indications of possible abnormalities during scans last year
By Linette Lai, The Straits Times, 22 Apr 2014

ONE in four women who had free mammograms last year failed to return for follow-up tests, despite their scans indicating possible abnormalities.

The women had gone for screening under the Breast Cancer Foundation Encouragement for Active Mammograms (BEAM15) programme, launched in March last year.

BEAM15 targets low-income women aged 50 and above. The initiative - a collaboration with the Health Promotion Board (HPB) - screened about 8,700 women last year. Of this group, 1,200 had screening results which required further assessment. But about 300 never came back.

These numbers are "worrying" because they suggest women do not fully understand the point of screening, said Dr Esther Chuwa, a consultant breast surgeon at Gleneagles Hospital.

For Singaporean women, breast cancer is the most common type of cancer. It is also the top cause of cancer death. About 1,600 women were diagnosed with breast cancer each year between 2008 and 2012. During the same period, nearly 400 died from it every year.

"A lot of women get stuck at the stage where they don't go back for follow-ups because they're afraid they cannot afford treatment," said Dr Chuwa. "But treatment at an early stage is less complicated, and will end up in more cost savings."

In fact, nine in 10 who return for further tests are likely to find out they do not have cancer at all.

HPB said only 53 of the 890 who returned for follow-ups under BEAM15 were eventually diagnosed with cancer.

The cost of additional tests was a major reason why many women under the BEAM15 programme did not return, said Dr Shyamala Thilagaratnam, director of the preventive health programmes division at HPB.

"HPB nurse educators conduct one-on-one phone counselling with the participants to encourage them to go for follow-ups and explain the financial schemes available," Dr Shyamala said.

Another common reason was lack of time. Typically, additional tests include a repeat mammogram, a breast ultrasound or a biopsy to extract breast tissue for examination.

Breast Cancer Foundation president Noor Quek suggested getting women in the same peer group to tell others about the importance of screening. "It helps them overcome the fear of the unknown... and that gives them encouragement."