James Van Der Beek/Wikimedia/Super Festival

For fans of the late 90s TV series Dawson’s Creek, the passing of cast member James Van Der Beek, who played the teenage aspiring filmmaker Dawson Leery, was a shock. It has also brought into the spotlight the fact that colorectal cancer is no longer a disease only affecting older adults. More personalities, regardless of ethnicity, who have been diagnosed with, undergone treatment for, or succumbed to this type of cancer are often not even in their 50s.

According to the Globocan 2020 report from the World Health Organization (WHO), colorectal cancer is the third most common cancer among men worldwide, accounting for 10.6% of all male cancers, and the second most common among women at 9.4%. In Malaysia, the latest National Cancer Registry Report (2017–2021) shows that colorectal cancer accounts for 14.1% of all cancer cases, making it one of the most prevalent cancers nationwide. It remains the most common cancer among men at 18.8% and the second most common among women at 13.7%.

Despite its high prevalence, screening rates remain low, especially among younger adults, largely due to fear, misunderstanding, and the belief that colorectal cancer only affects the elderly.

Rising number of young colorectal cancer patients

Dr Premjeet Singh of Ara Damansara Medical Centre

In Malaysia, once considered a disease of older adults, colorectal cancer is increasingly being diagnosed in much younger people. Doctors are now seeing patients in their 20s, 30s, and even teens presenting with the disease, often at a more advanced stage, when treatment becomes more complex and outcomes less certain.

Dr Premjeet Singh, Consultant General Surgeon, Endoscopist, and Minimal Access Surgeon at Ara Damansara Medical Centre, commented, “In my practice, I am increasingly seeing colorectal cancer in patients in their 30s and 40s. The youngest patient I have treated was only 13 years old. Age alone does not protect anyone from colorectal cancer.”

Why younger people are not immune

One reason colorectal cancer is frequently detected late in younger individuals is that early symptoms are often mild and easy to dismiss.

“Many young patients experience symptoms such as constipation, rectal bleeding, or mild abdominal discomfort, but they tend to brush these off,” Dr Premjeet explains. “Rectal bleeding is commonly assumed to be piles, while changes in bowel habits are often blamed on stress or a busy lifestyle.”

Cultural discomfort around bowel health also plays a role, with many patients delaying consultation due to embarrassment or fear of invasive tests.

Diet and lifestyle habits also contribute. “We are seeing younger adults consuming more processed foods and less fibre. Over time, this affects gut health and increases colorectal cancer risk,” Dr Premjeet says. Diets high in red and processed meats, combined with low intake of fruits, vegetables, and whole grains, are known to affect bowel health and, over time, increase colorectal cancer risk.

Because these symptoms do not significantly disrupt daily life, many delay seeking medical attention. By the time they consult a doctor, the disease may already be at an advanced stage, requiring more complex treatment.

No early symptoms

Colorectal cancer is particularly dangerous because it can develop quietly. In its early stages, many patients feel completely well and have no obvious warning signs.

“Colorectal cancer can remain silent for a long time. When symptoms appear, it usually means the cancer has already grown significantly,” says Dr Premjeet. This is why waiting for symptoms can be risky. Screening allows doctors to detect problems before cancer fully develops or while it is still highly treatable, even in people who feel perfectly healthy.

Early detection and screening make the difference

When the disease is found early, treatment is often simpler and less invasive. Surgery can frequently be performed laparoscopically using a thin tube with a camera inserted through small incisions, which allows faster recovery and fewer complications.

Some patients may even avoid chemotherapy. In contrast, those diagnosed at a later stage often face major surgery, chemotherapy, longer recovery periods, and a greater impact on quality of life. Dr Premjeet said that patients whose cancer is detected through screening generally have more treatment options and a stronger chance of long-term survival.

He recalls a woman in her early 40s who underwent a colonoscopy due to family history despite having no symptoms. A one-centimeter polyp was found and completely removed during the procedure, and laboratory tests later revealed cancerous cells within it. Because it was detected and removed early, she did not require surgery or chemotherapy, and follow up scans with a repeat colonoscopy confirmed that the cancer was gone, giving her an excellent prognosis. This case shows how early screening can detect cancer at an early stage and, in some cases, prevent it from progressing further.

Colonoscopy: more than just a diagnostic test

For many, the word “colonoscopy” can make people feel uneasy. Common fears include pain, embarrassment, or safety concerns, which often discourage individuals from getting screened.

“In reality, colonoscopy today is a very safe and routine procedure,” Dr Premjeet explains. “Patients are sedated, so most do not feel pain or even remember the procedure. The risks are very low, especially when compared to the danger of undetected cancer.”

Beyond diagnosis, colonoscopy also plays a preventive role. During the procedure, doctors can detect and remove polyps, small growths in the colon that may turn cancerous if left untreated. “Removing a polyp early is essentially stopping cancer before it starts,” he says.

Don’t wait till you’re in your 50s

While routine colorectal cancer screening is generally recommended from age 50, preventive action should begin much earlier, with priorities varying at each life stage.

For children and teenagers, the focus should be on healthy habits. A high fiber diet, maintaining a healthy weight, regular physical activity, and limiting processed foods can reduce long term risk.

Colonoscopy is usually unnecessary unless symptoms persist or there is a strong family history. In rare cases, inherited conditions such as Familial Adenomatous Polyposis, Lynch syndrome, Juvenile polyposis, or Peutz–Jeghers syndrome may require screening as early as 10 to 20 years old under specialist care.

Adults in their 20s and early 30s generally do not need routine screening without symptoms or family history, but should stay alert to bowel health. Persistent constipation, rectal bleeding, or changes in bowel habits should not be ignored, and medical advice should be sought if symptoms appear.

For those in their mid to late 30s and 40s, especially with family history or ongoing symptoms, earlier screening may be recommended. “In higher risk individuals, a colonoscopy may be advised every three to five years, depending on individual risk and findings,” says Dr Premjeet. He adds that screening should begin at least 10 years earlier than the age at which an immediate family member was diagnosed. Those without risk factors should still discuss colon health during routine check-ups, with screening possibly deferred until their 50s unless symptoms arise.

“Colorectal cancer is one of the few cancers that we can prevent or cure early through screening,” Dr Premjeet says. “Being proactive can save you from major treatment later and, more importantly, save your life.” Early screening is about taking control of your health, and being “too young” should never be a reason to delay care.

LPPKN chairman Datuk Seri Rohani Abdul Karim said the programme aims to screen 32,000 women as part of early detection efforts to enable timely preventive and treatment measures.

“I urge women to set aside embarrassment and fear and not delay undergoing the HPV DNA test, as early detection of cervical cancer significantly improves the chances of recovery,” she said.

Rohani was speaking to reporters after officiating the Perak state-level Cervical Cancer Awareness Month programme at the General Operations Force Battalion 3 headquarters in Bidor, near here, today.

She said LPPKN has appointed Ethnic Ambassadors from various communities, including the Orang Asli, to promote awareness of cervical cancer screening and encourage greater participation.

“These ambassadors are trained with comprehensive information on screening procedures and specimen collection, enabling them to clearly explain the process to target groups in their respective dialects, including among the Chinese, Indian and Orang Asli communities,” she said.

Meanwhile, Rohani said a total of 198,001 women underwent HPV DNA screening from 2019 until last year, with 15,315 testing positive for HPV.

“Of that number, 210 women were diagnosed with precancerous conditions, while 24 were confirmed to have cervical cancer,” she said.

Source: Bernama

By Associate Professor Dr Ganesh Ramachandran and Associate Professor Dr Khine Pwint Phyu – School of Medicine, Faculty of Health & Medical Sciences at Taylor’s University.

Cervical cancer is the fourth most common cancer among women worldwide, with approximately 660,000 new cases in 2022. Low- and middle-income countries, particularly in Sub-Saharan Africa, Central America, and Southeast Asia, bear the highest incidence rates due to socio-economic factors, affecting vaccination uptakes, screening, and treatment. ¹

In Malaysia, 1,740 new cases were reported in 2020 with a mortality rate of 57%. ² This cancer, primarily linked to Human Papillomavirus (HPV) infection (especially types 16 and 18), is influenced by risk factors such as early sexual activity, pregnancy before the age of 20, promiscuity, unprotected sex, multiple full-term pregnancies, smoking, long-term oral contraceptive use, Human Immunodeficiency Virus (HIV) infection, and sexually transmitted infections. These factors are often exacerbated in lower socio-economic communities, increasing their vulnerability.

Global efforts and WHO’s call to action

The World Health Organization (WHO) issued a bold call for the global elimination of cervical cancer by 2030, achievable through effective HPV vaccination, screening mechanisms for detecting pre-cancerous and early cancer stages, and access to treatment. Elimination implies less than 4 cases per 100,000 population. WHO’s targets include fully vaccinating 90% of girls by age 15, ensuring 70% of women undergo high-performance screening by ages 35 and once more at 45, and treating 90% of women with cervical cancer.³  High-performance testing, which includes HPV testing alongside pap smears or visual inspections of the cervix with acetic acid, should be done every five years. Self-testing kits can improve screening uptake by eliminating the need to visit a health care provider thus saving time and addressing the stigma associated with the disease.

Malaysian scenario

Cancer of the cervix stands out as the second most common cancer among Malaysian women aged 15 to 44, primarily caused by HPV. The disease is largely preventable through vaccination, screening, and treatment.  Up to 1% of women may carry the virus, with 40% potentially becoming chronic carriers. ⁴These women are at high risk of developing cervical cancer.

Malaysia has implemented an HPV vaccination or primary prevention programme since 2010, targeting 13-year-old girls in schools. The WHO reported that 80% of girls received the final dose by age 15 in Malaysia. Although the COVID-19 pandemic slowed the programme, the untiring efforts of the Ministry of Health and non-governmental organizations (NGOs) such as the National Cancer Society of Malaysia in providing catch-up vaccination should ensure that Malaysia is likely to continue to do well in vaccinating the population at risk.

The Ministry of Health recommends yearly pap smears for sexually active women aged 21 to 65 for two years, followed by every three years if initial smears are normal as a secondary prevention method. High-performance HPV testing is recommended every five years and for women above the age of 65 who have never been screened. Despite the existence of a government-run cervical screening programme since 1969 and the availability of free screening since 1995, uptake remains poor at 35% to 48% which is far below the WHO requirements. A 2020 WHO report indicated only 4 in 10 women had been screened in the previous five years with educational status, awareness of the availability and the effectiveness of screening, knowledge of the disease, and family support being likely factors in determining access to screening. Other factors hindering screening were time constraints, embarrassment, and lack of knowledge.

Improving screening uptake

To improve screening acceptance, education about cervical cancer must begin early, and the stigma and embarrassment associated with pap smears must be addressed. This requires educating not only girls and women but also men, who play an important facilitative role.

Many women face significant barriers such as fear of discomfort from the invasive procedure and cultural sensitivities about male doctors. There are also technical challenges with the procedure that may necessitate retakes thus inconveniencing patients. Hence, accommodating patient preferences, such as the availability of female practitioners, improving procedural techniques, allaying anxiety, and promoting the use of less invasive HPV DNA testing and making available self-testing kits, can enhance the screening experience.

The final piece of the puzzle for eliminating cervical cancer is the availability and accessibility of diagnostic and treatment facilities. While diagnostic and treatment facilities exist in both the government and private sectors, costs are high in the private sector and waiting times are long in the public sector which compounds the problem. Smart partnerships between the government, private sector, and NGOs are being put into place to optimise resources, which will positively impact combating cervical cancer in the coming years.

High vaccination rates are a success story in Malaysia’s initiative to eliminate cervical cancer. Improving screening acceptance and building capacity in the form of gynaecological oncology surgeons, radiation, and medical oncologists are crucial to effectively combat cervical cancer and achieve the goal of elimination by 2030. With concerted efforts, collaboration, and education, we can indeed win the battle against cervical cancer.

Sources:

1. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
2. https://www.thestar.com.my/news/nation/2024/01/14/statistics-on-cervical-cancer-in-malaysia-alarming
3. https://www.who.int/initiatives/cervical-cancer-elimination-initiative
4. https://hpvcentre.net/statistics/reports/MYS_FS.pdf?t=1557678064474

PHKL underscores the importance of early detection and preventive measures for heart health. Their Heart Screening Package includes various assessments such as stress tests, echocardiograms, and cardiac CT heart scans, tailored to individual needs and lifestyles.

TAVI, a minimally invasive method conducted through a small incision in the groin, is suitable for high-risk surgical patients and uses a catheter to implant a new valve under x-ray guidance.

According to Dr. Yee, severely ill heart patients traditionally required open-heart surgery to replace damaged valves, a high-risk procedure, especially for the elderly or those with multiple comorbidities. He stated that TAVI now offers a minimally invasive and safer alternative for these patients. The new procedure also enables patients to recover quickly and resume normal activities.