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Breast cancer is the commonest malignancy among Singapore women, accounting for 29.7% of all female cancers, with an age-standardized rate of 54.9 per 100,000 per year. It has been the most frequent cancer in Singapore women for the last 30 years, with the highest rates previously reported in those aged between 45 and 49 years, but with a more recent observation of a change in peak age group to women in their late 50s. About 1,100 new cases are diagnosed annually and approximately 270 women die in Singapore each year from breast cancer. In the multiethnic population of Singapore, it has been noted that rising breast cancer incidence is consistent across all three ethnic groups (Chinese, Malays, and Indians). Singapore has among the highest breast cancer incidence in Asia. Possible explanations include rapid urbanization, improvement in socio-economic status, and adoption of a western lifestyle. Our experience with the Singapore breast screening pilot project (1994-1997) and the national breast-screening program (BreastScreen Singapore) has led to increased understanding of this disease in the country. Data from the pilot project showed that breast screening is just as effective in a predominantly Asian population as in the west. Early breast cancer accounted for most breast cancers detected, with pre-invasive ductal carcinoma in situ (DCIS) comprising 26% of all screen-detected cancers in the pilot study. In the currently on-going BreastScreen Singapore, DCIS forms >30% of all breast cancers among pre-menopausal women, a relatively high proportion probably accounted for partially by the greater participation of women aged between 40 and 49 years. Despite the ready availability of subsidized mammographic screening, there are still women in Singapore who present with locally advanced breast cancer. Clinical management of an increasing number of women with breast cancer embraces a multidisciplinary team-based approach, with regular discussions of therapeutic strategies at tumor boards. In order to improve breast cancer diagnostics and therapeutics in our country, it is important that there are continual breast cancer and breast disease-related educational activities for medical professionals engaged in diagnosing and managing breast cancer. The role of public education in raising awareness is also essential.

Introduction: School-based scoliosis screening was implemented in Singapore in 1981. The rationale for the programme was so that conservative treatment (bracing) can be initiated early to prevent progression of curves, avoid the complications of severe scoliosis and reduce the need for surgery. The evidence for, or against, scoliosis screening and regular follow-up remains controversial. To date, there has been no formal cost analysis of Singapore's screening programme. The aim of this paper was to examine if there are economic justifications to continue with school-based scoliosis screening., Methods: This cost-effectiveness analysis was done by comparing Singapore's existing school-based scoliosis screening and follow-up programme with the alternative of not having a programme. As the aim of the existing programme was to detect curves early, allowing bracing to be initiated and reducing the need for surgery, this analysis assumed that without the programme, students who otherwise would have received bracing and not needed surgery, would have required surgery instead. This retrospective analysis was based on School Health Service data obtained from screening 45,485 students in 1999 and 44,051 of this same cohort in 2001. Nett programme costs and health effects were computed, and a decision rule applied., Results: The nett cost of the current mass screening programme was negative, while the nett health effects, albeit mostly intangible, positive; which made the programme an economically valuable one., Conclusion: Singapore's school-based scoliosis screening programme, which is implemented as part of a larger school screening and immunisation programme, is cost-effective. Cost-effectiveness may be further improved by targeting screening at high-risk groups, such as prepubertal females. More research is needed to quantify the positive health effects of scoliosis screening.