A close look at CANCER in Malaysia

Exploring  Malaysia cancer burden in 2018

  • Numbers at a glance:
    • Total population – 32042455
    • Number of new cases – 43837
    • Number of deaths – 26395

 

  • Number of new cases in 2018, both sexes, all ages

 

 

 

 

 

  • Number of new cases in 2018, males, all ages                                                                                             

 

  • Number of new cases in 2018, females, all ages                                                                                           

 

Summary statistic 2018

Males Females Both sexes
Population 16 526 726 15 515 729 32 042 455
Number of new cancer cases 20 619 23 218 43 837
Risk of developing cancer before the age of 75 years (%) 14.2 14.8 14.5
Number of cancer deaths 13 937 12 458 26 395
Risk of dying from cancer before the age of 75 years (%) 9.4 8.2 8.8
Top 5 most frequent cancers excluding non-melanoma skin cancer (ranked by cases) Lung Colorectum Prostate Nasopharynx Liver Breast
Colorectum
Cervix uteri
Ovary
Lung
Breast Colorectum Lung Nasopharynx Liver

 

Reference:

World Health Organization. International Agency for Research on Cancer (IARC). Globocan 2018 – Global Cancer Observatory. Review at: https://gco.iarc.fr/today/data/factsheets/populations/458-malaysia-fact-sheets.pdf

Cervical Cancer Facts

CERVICAL CANCER: MALAYSIA STATISTIC REPORT (2018)1

  • Every year 1682 women are diagnosed with cervical cancer and 944 die from the disease.
  • 2nd : Cervical cancer ranks as the 2nd most frequent cancer among women between 15 and 44 years of age.
  • 3rd : Cervical cancer ranks as the 3rd most frequent cancer among women in Malaysia

 

HOW TO PREVENT OR DETECT CERVICAL CANCER EARLY?2

  1. Pap test (or Pap smear): Screens for cervical cancer. It does not screen for any other gynecologic cancer²

 

  1. Human papillomavirus (HPV) test: Looks for HPV— the virus that can cause precancerous cell changes and cervical cancer²

 

HPV BURDEN IN WOMEN1

  • HPV causes virtually 100% of cervical cancer cases
  • Worldwide, HPV16 and 18 (the two vaccine-preventable types) contribute to over 70% of all cervical cancer cases
  • After HPV16/18, the six most common HPV types are the same in all world regions, namely 31, 33, 35, 45, 52 and 58

 

CERVICAL CANCER: 9 WARNING SIGNS

  1. Unusual vaginal discharge or bleeding.
  2. Heavier & longer menstrual periods.
  3. Discomfort while urinating.
  4. Loss of bladder control.
  5. Pain during intercourse.
  6. Pelvic pain.
  7. Constant fatigue.
  8. Leg pain.
  9. Unexpected weight loss.

 

HPV DNA VS PAP SMEAR TESTING

  • A combination of HPV DNA and Pap Smear Testing had almost 100% sensitivity and negative predictive value. 3
  • One of study in German showed that HPV tests are more effective than Pap tests at discovering high-grade dysplasia. Individual Pap tests fail to detect half of all cases of dysplasia. HPV tests help to detect a lot more cases.4
  • Therefore, screening of both Pap test and HPV testing are essential for early detection of cervical cancer and screening of abnormal cervical cells.

 

CERVICAL CANCER SCREENING RECOMMENDATION

  • In Malaysia, all women who are, or who have been sexually active, between the ages of 30 and 65 years, are recommended to undergo Pap smear testing. If the first two consecutive Pap results are negative, screening every three years is recommended.5
  • HPV DNA-based testing may be done every five years as a primary screening strategy or combined with Pap test in women over 30 years of age for an interval / frequency of at least three to five years in women who are negative on both tests in the annual screening. 6

 

REFERENCES:

  1. Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Malaysia. Summary Report 17 June 2019.
  2. What Should I Know About Screening?. Updated August 7, 2019. (Available at: https://www.cdc.gov/cancer/cervical/basic_info/screening.htm)
  3. Lörincz, A. T., & Richart, R. M. (2003). Human papillomavirus DNA testing as an adjunct to cytology in cervical screening programs. Archives of pathology & laboratory medicine127(8), 959-968.
  4. Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Benefit assessment of HPV test in primary screening for cervical cancer. Final report; Commission S10-01.
  5. (2003).Clinical Practice Guidelines: Management of Cervical Cancer
  6. Health Technology Assessment Report: HPV DNA-Based Screening Test for Cervical Cancer

Diabetes: Protect Your Family

Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces.

Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.

Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues.

 

Types of diabetes

There are three main types of diabetes – type 1, type 2 and gestational.

  • Type 1 diabetes can develop at any age, but occurs most frequently in children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control.
  • Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body does not make good use of the insulin that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet. However, over time most people with type 2 diabetes will require oral drugs and/or insulin to keep their blood glucose levels under control.
  • Gestational diabetes (GDM) is a type of diabetes that consists of high blood glucose during pregnancy and is associated with complications to both mother and child. GDM usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life.

 

Diabetes complications

People with diabetes have an increased risk of developing a number of serious health problems. Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vesselseyeskidneysnerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular diseaseblindnesskidney failure, and lower limb amputation.

Maintaining blood glucose levels, blood pressure, and cholesterol at or close to normal can help delay or prevent diabetes complications. Therefore, people with diabetes need regular monitoring.

Cardiovascular disease: affects the heart and blood vessels and may cause fatal complications such as coronary artery disease (leading to heart attack) and stroke. Cardiovascular disease is the most common cause of death in people with diabetes. High blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing the risk of cardiovascular complications.

Kidney disease (diabetic nephropathy): caused by damage to small blood vessels in the kidneys leading to the kidneys becoming less efficient or to fail altogether. Kidney disease is much more common in people with diabetes than in those without diabetes. Maintaining near normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease.

Nerve disease (diabetic neuropathy): diabetes can cause damage to the nerves throughout the body when blood glucose and blood pressure are too high. This can lead to problems with digestion, erectile dysfunction, and many other functions. Among the most commonly affected areas are the extremities, in particular the feet. Nerve damage in these areas is called peripheral neuropathy, and can lead to pain, tingling, and loss of feeling. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations. People with diabetes carry a risk of amputation that may be more than 25 times greater than that of people without diabetes. However, with comprehensive management, a large proportion of amputations related to diabetes can be prevented. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. People with diabetes should regularly examine their feet.

Eye disease (diabetic retinopathy): most people with diabetes will develop some form of eye disease (retinopathy) causing reduced vision or blindness. Consistently high levels of blood glucose, together with high blood pressure and high cholesterol, are the main causes of retinopathy. It can be managed through regular eye checks and keeping glucose and lipid levels at or close to normal.

Pregnancy complications: Women with any type of diabetes during pregnancy risk a number of complications if they do not carefully monitor and manage their condition. To prevent possible organ damage to the fetus, women with type 1 diabetes or type 2 diabetes should achieve target glucose levels before conception. All women with diabetes during pregnancy, type 1, type 2 or gestational should strive for target blood glucose levels throughout to minimize complications. High blood glucose during pregnancy can lead to the foetus putting on excess weight. This can lead to problems in delivery, trauma to the child and mother, and a sudden drop in blood glucose for the child after birth. Children who are exposed for a long time to high blood glucose in the womb are at higher risk of developing diabetes in the future.

Oral complications: People with diabetes have an increased risk of inflammation of the gums (periodontitis) if blood glucose is not properly managed. Periodontitis is a major cause of tooth loss and is associated with an increased risk of cardiovascular disease (CVD). Regular oral check-ups should be established to ensure early diagnosis, particularly among people with previously undiagnosed diabetes and prompt management of any oral complications in people with diabetes. Annual visits are recommended for symptoms of gum disease such as bleeding when brushing teeth or swollen gums.

 

Diabetes prevention

At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.

While there are a number of factors that influence the development of type 2 diabetes, it is evident that the most influential are lifestyle behaviours commonly associated with urbanization. These include consumption of unhealthy foods and inactive lifestyles with sedentary behaviour. Studies from different parts of the world have established that lifestyle modification with physical activity and/or healthy diet can delay or prevent the onset of type 2 diabetes.

Modern lifestyles are characterised by physical inactivity and long sedentary periods. Community-based interventions can reach individuals and families through campaigns, education, social marketing and encourage physical activity both inside and outside school and the workplace. IDF recommends physical activity at least between three to five days a week, for a minimum of 30-45 minutes.

Taking a life course perspective is essential for preventing type 2 diabetes and its complications. Early in life, when eating and physical activity habits are established and when the long-term regulation of energy balance may be programmed, there is an especially critical window to prevent the development of overweight and reduce the risk of type 2 diabetes. Healthy lifestyles can improve health outcomes at later stages of life as well.

Population based interventions and policies allow healthy choices through policies in trade, agriculture, transport and urban planning to become more accessible and easy. Healthy choices can be promoted in specific settings (school, workplace and home) and contribute to better health for everyone. They include exercising regularly and eating wisely which will help to maintain normal levels of blood glucose, blood pressure and lipids.

 

Source: World Diabetes Day, International Diabetes Federation (https://worlddiabetesday.org/about/discover-diabetes/)

PPP – Penang Sihat programme collaboration

Penang Sihat collaboration with Pantai Premier Pathology

 

Pantai Premier Pathology has been collaborated with Penang state government in the Penang Sihat programme which has been launched at Seberang Jaya on 5th October 2019. The Penang Sihat programme launching was graced by YB Dato’ Ir. Haji Ahmad Zakiyuddin Bin Abdul Rahman, Deputy Chief Minister of Penang State. Also present at the ceremony were YB Dr. Afif Bahardin, Penang State Exco and En. Hareeff Muhammed, the CEO of Pantai Premier Pathology.

This programme is an initiative from Penang state government to give the people, especially the low-income B40 group better healthcare access. It had been difficult for most people in this category to have access to healthcare treatment or early detection of diseases due to lack of information.

Pantai Premier Pathology has been providing complimentary HPV screening (self-collection kit) to the public for cervical cancer. The objective of this collaboration is to increase awareness of HPV primary screening in collaboration with Bahagian Pembangunan Kesihatan Keluarga (BPKK). Pantai Premier Pathology works conjunctively with BPKK and Ministry of Health Malaysia in the establishment and standardization of the cervical cancer primary screening program in Malaysia in line with Rancangan Malaysia ke-12 (RMK-12) for Public-Private Partnerships to achieve the National Goal. Penang Sihat programme has been running in various districts in Penang such as Seberang Jaya, Batu Maung, Georgetown and will be continued in other districts too.

 

 

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