Timely diagnosis of cancer remains a problem

I REFER to the letter “Changing attitudes on non-proven therapies” ( The Star, July 30) on discouraging cancer patients from seeking unscientific alternative treatments.

Factors affecting delays in presentation, diagnosis and treatments and the use of unproven alternative medications in cancer were presented very well in the letter.

I would like to add that false claims on alternative medicine being able to cure cancer and other unproven cancer screening technologies that may come from the industry as well as academia must be regulated and controlled.

Besides this long-standing problem, two major matters also need to be addressed – poor recognition of cancer symptoms and early diagnosis.

Late presentation remains a major problem that has resulted in a poor overall five-year survival rate of 49% for breast cancer patients in Malaysia compared to beyond 80% in developed nations. Recognising the early warning signs of cancer and the diagnostic pathways is very important and hence our community and primary care health practitioners must be well versed in this.

But timely diagnosis of cancer is still not attainable as there are multiple sectors involved. The process often includes imaging and biopsy, and sometimes specialised procedures such as image-guided biopsies, endoscopic procedures like Oesophago-GastricDuodeno-Scopy (OGDS) and colonoscopy. These procedures are expensive in the private sector and may not be reimbursable by insurance.

The cost of diagnosis in the private sector may be between RM2,000 and RM6,000. In comparison, it could be RM600 in university hospitals and free of charge or minimal in government hospitals for Malaysians.

The long queue in the public sector may discourage the public but for most in the low-income group, this is the only option available to them. Thus, inundated by a huge volume of patients and with scarce specialised human resources, a delay in diagnosis is inevitable.

Furthermore, collaboration among the different disciplines and departments, including the surgeon, radiologist and pathologist, is required to expedite a timely resolution of the diagnosis.

A study has shown that there are delays in diagnosis beyond one month for up to 40% of public sector patients in this country. We must therefore strengthen our health systems to provide timely and affordable diagnosis, and eventually access to timely and affordable treatments.

We can develop better education and interventions on early cancer warning signs for community and healthcare providers that are culturally appropriate and reduces the fear factor and stigma of cancer. By doing studies measuring the effectiveness of these programmes, Malaysian-centric solutions can be made.

There is also an urgent need to strengthen the existing referral diagnostic pathways among the multidisciplinary providers. But these complex challenges can be broken down and with multi-sectoral collaboration among ministries, academia and healthcare professionals, we can draw up the Malaysian-centric solutions we need.