KUALA LUMPUR, March 22 ― Choo Mei Sze was 27 when she was diagnosed with Stage 2 rectal cancer, a type of cancer that is considered rare among young people.
Now 30, Choo went for a colonoscopy on her father’s insistence after she had a three-week long bout of diarrhoea. This led to the discovery of a tumour in her rectum.
Ten days later, she went for surgery and had most of her rectum and 12 centimetres of her colon removed.
Choo did another surgery to rejoin her rectum to her colon. She did not undergo chemotherapy and currently only takes medicine for acid reflux.
“I definitely encourage people [to go for] early detection [as it] is very important because it saves lives and it saved mine,” Choo, who is National Cancer Society Malaysia’s (NCSM) youth ambassador and has a PhD in developmental psychology, told Malay Mail Online in an interview.
“It’s almost impossible for me to get this type of cancer because I don’t have any genetic history, I’m very young, I’m female. Usually, it happens to males above 50 and with genetic history. So to my doctors and surgeon and everything, it was quite a shock,” added Choo who runs a social media business and also emcees events.
The New York Times reported last month that scientists are observing a sharp rise in cancers of the colon and rectum, known as colorectal cancer, in adults in their 20s and 30s in the US, although the vast majority of such cancers are still found in older people as almost 90 per cent of all cases are diagnosed in those over 50.
The latest statistics showed that colorectal cancer was the second-most common cancer in Malaysia after breast cancer in 2012, according to the Globocan 2012 study by the International Agency for Research on Cancer under the World Health Organization. The study estimated 4,539 new cases of colorectal cancer in Malaysia in 2012.
Choo, who also runs a youth support group under the National Cancer Society Malaysia (NCSM), is among those advocating for the early detection and screening of cancer.
Another colorectal cancer survivor, Mariana Zaine, was diagnosed in 2011 with Stage 3 colon cancer when she was 49.
Mariana, who is now in remission, underwent surgery to remove 22 centimetres of her colon and did 12 sessions of chemotherapy.
“Everybody should have early screenings,” Mariana told Malay Mail Online in an interview.
“I advise everybody after 50 to do complete medical screenings,” the 55-year-old added.
“Most colorectal cancers are from polyps. Before it becomes cancerous, if they do a colonoscopy, the doctor can just take it out and that’s it.”
Mariana, who is a single mother with three adult children, urged people to “listen to your body.” Initially, doctors thought her bouts of bad stomach pain were gastric or menstrual in origin.
Financial cost
Choo said her two surgeries cost RM70,000 at a private hospital.
Her family had to use credit cards due to initial problems with her insurance, with relatives chipping in as well.
Choo, who had to wear a colostomy bag for six weeks after her first surgery, said she spent between RM4,000 and RM5,000 on the bags during that period.
“I’ve seen many of the young cancer survivors. They have no money, they cannot get a job. It’s very difficult for them,” she said, adding that young people with cancer suffered discrimination when seeking employment.
“The company cannot hire you because they’re not going to take the risk of bearing your medical expenses, because you can never ever get insurance again. You’re a medical liability; no company will hire you,” said Choo.
Mariana, on the other hand, had no insurance to pay for her surgery, hospitalisation and chemotherapy in a private hospital that cost overall RM80,000. She now urges people to get insurance.
“I’m very blessed,” she said. “My family chipped in, my parents, siblings, brothers-in-law.”
National screening needed
NCSM president Dr Saunthari Somasundaram urged the government to start a national screening programme for colorectal cancer.
She said although the fecal occult blood test (FOBT) ― a screening that checks for blood in one’s stool ― was available in government clinics, it was on an ad hoc basis.
“It’s not a dedicated service which is provided, which is what a national screening programme is all about,” said Dr Saunthari.
“A national screening programme is: you have education, you are educating people what needs to be done, on the risk factors etc. Then you actually invite them for screenings, you invite them for screenings in different methods. For colorectal cancer in certain countries, you just send it in the post, you just mail people the kit, they do it at home, they send it back,” she added.
Dr Saunthari said early diagnosis of cancer would cut treatment costs for the patient and the economic burden on the country, as well as result in greater survival rates.
The economic burden of colorectal cancer management of new cases alone is estimated at about RM108 million a year, according to a 2016 study by Veettil SK et al on colorectal cancer in Malaysia.
According to Malaysia’s National Cancer Registry Report 2007, 63 per cent of colorectal cancer cases were diagnosed at Stages 3 and 4.
Dr Saunthari recommended that people take the FOBT annually, which costs about RM30, while a colonoscopy should be done once every 10 years after one reaches age 50.
“What they have found in Singapore is because they have a national colorectal screening programme, they’re finding it early, so survival, mortality, people dying from colorectal cancer has gone down,” she said.
Dr Saunthari, citing statistics from Cancer Research UK, said 54 per cent of colorectal cancer was linked to lifestyle, with 21 per cent of colorectal cancer linked to processed meat, being overweight or obese (13 per cent), consuming alcohol (12 per cent), and smoking (8 per cent).
“If you don’t eat enough fibre, you actually increase your risk by 12 per cent, or if you don’t do enough physical activity, you increase your risk by 3 per cent,” she said.
