By Salma Khalik, Health Correspondent
MANY of the 400 people who die of liver cancer here each year could have been saved if they had gone for regular screening to catch the disease early.
Doctors calling for more people to get checked point to how the test could more than double the chances of survival for people at high risk.
In Japan, three in five liver cancer patients are still alive five years after diagnosis. The number for Singapore is fewer than one in five.
The main reason: their cancers are caught too late since there are no symptoms in the early stages.
Ultrasound screening can detect cancer tumours smaller than 1cm in length. The screening costs about $190 for a private patient and $90 for a subsidised patient.
It is available at public hospitals, but surprisingly, it is little used, much to the frustration of doctors.
This screening is recommended only for patients at high risk of getting liver cancer - generally, people with hepatitis.
This is why the cancer is more frequently found in Asia and Africa than in Western countries, where incidence of hepatitis B is less common.
With routine hepatitis B vaccinations for babies, started here more than 20 years ago, the high rate of liver cancer will taper off eventually.
But meanwhile, the Health Promotion Board estimates that one in 35 adults carries the hepatitis B virus. Aside from liver cancer, the virus can also cause scarring of the liver, destroying those parts.
Associate Professor Lim Seng Gee, who heads the gastroenterology and hepatology department at the National University Hospital (NUH), said these people should have their livers screened every three to six months.
This is because the cancer can grow very rapidly. Ultrasound scans are safe and non-invasive. It is done by running a hand-held device over the abdomen.
Prof Lim said that roughly 160,000 people would benefit from such regular scans to catch the cancer early and have the tumours surgically removed before they can do much harm.
The quality of the scans depends on the experience of the radiologists. Professor Lenny Tan said it is sometimes difficult to distinguish between scars in the liver and tiny tumours.
But the radiologist from NUH said regular screening would definitely pick up many more cancers at the early stage.
Prof Lim agreed that regular screening improves survival rates in countries where the procedure is done routinely.
For non-hepatitis B carriers, a vaccine offers 95 per cent protection against ever getting the disease. The three shots needed cost about $130 at GP clinics and $66 at polyclinics for residents, and can be paid for with Medisave.
But two in three people here who know they are hepatitis B carriers do not bother getting screened, in spite of doctors' recommendations.
Screening could also prove cost effective on a national level.
A 2004 study carried out in Singapore and Hong Kong found that the cost of treating patients with liver disease rises rapidly as the disease progresses.
In Singapore, the annual cost per patient of treating chronic hepatitis B was $718 in 2004.
When the virus causes scar tissues to form in the liver, called cirrhosis, the cost goes up to $1,175-$15,389, depending on how much of the liver has been damaged.
Treating liver cancer costs $12,314 and a transplant brings the cost up to $86,369.
Dr Pierce Chow, who specialises in liver cancer surgery at Singapore General Hospital, said survival chances are best in patients with three or fewer tumours that are no bigger than 5cm.
Following surgery, two in three patients live five years or more. In cancer, five years is the watershed signalling successful treatment.
Unfortunately, the vast majority of patients either have large tumours, several tumours, or worse, the cancer has spread beyond the liver, making it almost impossible to contain.
Who should be screened
WHO: Anyone with hepatitis B or C, liver cirrhosis, or scarred liver tissue.
HOW: Ultrasound screening done every three to six months.
HOW MUCH: $190 for private patients and $90 for subsidised patients