Breast cancer risk assessment tools: What to know, what they don’t tell you, and what works for early detection

Will the breast cancer risk assessment tool work well in Singapore? In short, not really. 

First, there’s the issue of applicability.

Dr Andrew Clayton Lee, a general surgeon and oncoplastic breast surgeon at Gleneagles Hospital, explained that these breast cancer risk calculators are designed based on data from North American women. The demographics of Singapore women, consisting mostly of Southeast Asian Malays, Indians, and Chinese, are unlikely to be accurately represented in these models.

“If women in Singapore were to take the test, results can be inaccurate,” Dr Lee said. “We don’t want women with high risks to have a false sense of security, or cause worry for those with low risks.”

Second, health checks need professional guidance.

Dr Choo Bok Ai, a senior radiation oncologist at Icon Cancer Centre and a Breast Cancer Foundation committee member, told CNA Women that due to their easy access, breast cancer risk calculators are often used in isolation without the involvement of a healthcare professional. Women may misinterpret the results, particularly if they receive a high-risk score. 

They may avoid getting proper medical consultation or opt for alternative care that doesn’t address the actual health concern. This could result in unnecessary fear or even misdiagnosis or mistreatment of existing conditions.

While some women may see their doctor to review the results, Dr Choo said the concern is for those who don’t.

Third, the tool does not solve the underlying reasons why women in Singapore hesitate to go for breast checkups.

“Prevention and education are more important than assessment tools when it comes to early detection and management of breast cancer,” Dr Choo said.

He pointed out that the primary challenge in reducing late-stage breast cancer diagnoses is the lack of education and awareness. Some women are deterred by cultural taboos surrounding discussions about breast health, the fear of diagnosis, social ostracisation, and misconceptions about cancer. 

Dr Choo referred to the 2022 National Population Health Survey, where roughly 40 per cent of Singapore women aged 50 to 69 get regular mammograms. CNA Women found that in 2023, mammogram screening rates for the same age group have dropped, to below 35 per cent. 

Societal barriers, including caregiving responsibilities and financial constraints, further discourage women from prioritising regular screenings like mammograms or seeking medical help when they discover a lump or notice irregularities. 

EXISTING TOOLS FOR EARLY DETECTION OF BREAST CANCER MAY NOT BE ENOUGH

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CNA Explains: Could Low Thia Khiang have refused to testify in Pritam Singh’s trial?

SINGAPORE: Former Workers’ Party (WP) chief and seasoned opposition politician Low Thia Khiang made headlines after he took the stand as a prosecution witness in the trial of his successor, Pritam Singh.

Before and after his brief turn on the stand last week, online voices were buzzing about why he might have chosen to testify against Singh, and whether he could have declined to be a witness for the prosecution.

CNA spoke to lawyers who have handled trials to address this and other questions about the process of being a witness in a criminal trial.

How are witnesses identified?

The process begins at the investigations stage, said Mr Anil Balchandani of Red Lion Circle Advocates and Solicitors.

“In criminal matters, the police usually will conduct investigations and identify witnesses,” said Mr Balchandani, who is known for securing the acquittal of Ms Parti Liyani, the former maid of then-Changi Airport Group chairman Liew Mun Leong.

Neither the prosecution nor the defence can exclude or “chope” – using a Singlish term for “reserve” – witnesses from the other party, he added.

The police have the power to require witnesses to attend court under Section 21 of the Criminal Procedure Code. If the witness does not show up, a warrant could be issued by a magistrate.

“When interviewed by the police, a witness is bound to state truly what he knows of the facts and circumstances of the case,” said Mr Balchandani.

However, the witness has the right to remain silent if what he says would expose him to a criminal charge, for example.

Whoever the police interviews as part of their investigations may potentially be called as a witness, said Mr Mark Yeo, director at Fortress Law and former deputy public prosecutor.

“When preparing for the trial, the prosecution would consider what facts they need to prove their case beyond a reasonable doubt. They will then consider what type of evidence (whether documentary or from oral testimony) they require to prove those facts. They will then decide which witnesses they would need to call,” he said.

Under directions from the prosecution, the investigating office will apply to the court for a summons to appear in court, which is then personally served on the witness by the investigating officer, said Mr Yeo.

“That witness will then be under an order to attend court on the date and time specified in the summons.” 

Can a person refuse to be called as a witness?

Technically yes, said Ms Harjeet Kaur, senior associate at Withers KhattarWong. 

But if the witness refuses, the prosecution or defence can issue a Summons To a Witness. Once this is served, failing to attend court will be a breach of the summons, which is a court order, said Mr Yeo.

The court may issue a warrant of arrest and the witness is liable for contempt of court.

Veteran lawyer Ramesh Tiwary said “nobody has a choice” in terms of being a witness, whether for the prosecution or defence.

“Once you are subpoenaed to attend, you have to attend.” 

Asked if anyone has ever fled before, he said: “I think at least once, there was a witness who, midway through cross-examination, just returned to their own country.”

Nothing could be done then, as the person was out of Singapore authorities’ jurisdiction.

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Why young Singaporeans feel they have no one to talk to about their loneliness

When surveyed about the last time they felt lonely, respondents’ stories fell into three broad categories.

Some of them felt a mismatch of expectations, where one party valued a friendship more than the other party did. There were those who said they always felt like an outsider to their group of friends or family.

Others were worried about imposing on others and their busy lives.

“Everyone has to go through life somehow. You can’t be sharing your problems everywhere. Your problem is yours to solve,” said Sarah Fam, 33.

‘A DIRTY WORD’ AND A HEALTH THREAT

Given the social stigma around mental health issues in general, many youths remain reluctant to open up to others about their struggles.

“It does take a lot of vulnerability to admit to feeling lonely. Because it’s a bit of a dirty word, I feel, among my peers,” said Sheena Lim, 24.

Youths who felt lonely also indicated feelings of shame. Some wondered whether their struggle to feel accepted and be well-liked by their peers was a result of their own social failings.

Here are some of your responses:

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‘Delighted I can truly call Singapore my home’: Japan-born Kyoga Nakamura granted citizenship

SINGAPORE: It has been a nervous wait for Tampines Rovers midfielder Kyoga Nakamura, but his dream of being a Singapore citizen has finally materialised.

Nakamura confirmed the news with CNA on Friday (Oct 25).

“I was a little nervous going into the room at ICA to take the oath, but I knew this was what I wanted to do – and I’m delighted that I can truly call Singapore my home now,” he said, referring to the Immigration and Checkpoints Authority building. 

“My family and I are grateful for all the help I’ve received from the Tampines community, the club, the Football Association of Singapore and our friends across the country, they were very important in my journey.”

The 28-year-old became a permanent resident earlier this year. He is Singapore’s first naturalised footballer since Song Ui-young in 2021.

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Pritam Singh trial: A timeline of the allegations, who said what and when

Oct 7, 2021

The authorities ask Ms. Khan to speak with her for an appointment to provide more information about the rape victim anecdote.

Ms. Loh suggests that Ms. Khan contact her to say that she has not spoken to the target of the assault, and that she should gather information from other victims of sexual assault.

According to Mr. Nathan, Ms. Khan should not speak out to the WP’s Central Executive Committee ( CEC ) because it is” too risky” and they might not be helpful.

Oct 11, 2021

Low Thia Khiang, the original WP chief, and Mr. Faisal Manap are greeted at his home by Singh, Ms. Lim, and Mr. Faisal Manap.

At this appointment, Mr Low says Ms Lim told him about the rest and a strategy to get Ms Khan to repent.

Since the rest was made in parliament, Mr. Low replies that the appropriate place to apologize and understand is in parliament.

He inquires as to whether the government was aware of the rest, and Ms. Lim replies that given the number of police stations, it was difficult to determine.

Mr Low replies that this is not the place, and that if Ms Khan told a lie, she really sorry.

According to Mr. Low, Ms. Lim and Singh mentioned their intention to have Ms. Khan leave the party.

He claims that Singh and Ms. Lim did not state that they had already instructed Ms. Khan to correct her lying in congress. They did not claim to have spoken with Ms. Khan’s relatives about the physical abuse. They did not state when they first learned that Ms. Khan had lied, and they did not say when they did. They did not say Singh had told her at her home on October 3 to explain the rest in parliament on October 4.

Oct 12, 2021

Ms. Khan visits Singh at his residence.

Mr. Nathan finally discovers that Ms. Singh and Ms. Lim want her to speak out.

At 5.13pm, he sends Ms Khan and Ms Loh this message: &nbsp,” In the first place I think we should really not offer to some details. At most apologise for not having the facts ( about ) ( the rape victim’s ) age accurate”.

This information is later removed from Mr. Nathan and Ms. Loh’s separate versions of the communications they give to the COP. Miss Loh admits in jury that Mr. Nathan suggested that they continue to lie in a cross-examination.

Mr. Nathan likewise acknowledges during his cross-examination that at this point, he was in favor of “actively maintaining the rest” because he believed Ms. Khan should come clean about the party’s lack of a” appropriate plan.”

Ms. Loh and Mr. Nathan meet Singh at his home that evening.

Ms. Loh claims that they discussed whether to come clean or keep the rest and whether it was “impossible” for them because Mr. Shanmugam may pursue the matter.

Ms. Loh claims that Mr. Nathan suggested that Ms. Khan continue to tell the rest at this meeting. She later acknowledges Singh’s response by saying,” Do n’t even suggest covering this up with another lie.”

Mr. Nathan claims he is unable to recognize whether he suggested that Ms. Khan continue to lie.

Mr. Nathan claims that Singh claimed he told Ms. Khan on October 3 that he would not justice her if she continued the story or told the truth.

Ms. Loh claims that Singh told her on October 3, that he would not let her speak out against her in congress.

Ms Loh says Singh said Mr Low thought the best actions was to understand in congress, and the WP may endure the consequences, assuaging her and Mr Nathan’s thoughts.

Ms. Loh and Mr. Nathan claimed that they had agreed that Ms. Khan really tell the truth about her rest after leaving the appointment.

Oct 18, 2021

Mr. Low claims that Ms. Lim requested a meeting with him at his home, where she claimed Ms. Khan had agreed to apologize. Mr. Low responds that they should examine the apology’s draft first so that it does n’t turn into yet another lie.

Oct 20, 2021

According to the authorities, Ms. Khan has never responded to numerous inquiries for an interview.

Ms. Khan informs the press that she will address legislature on November 1, 2021.

Nov 1, 2021

Ms. Khan makes a statement in parliament admitting that the story about her assault victim was fake.

Mr. Low suggests a administrative board be set up for Ms. Khan, suggesting that Ms. Lim, Faisal, and Singh be on the screen, either this day or the following day.

At this point, he did not know that the WP officials had known since Aug 8, 2021 that the tale was false.

Nov 2, 2021

A administrative board has been established, according to the WP, and it has issued a statement claiming this.

Nov 8, 2021

Ms. Khan has her first interaction with the Singh, Ms. Lim, and Mr. Faisal WP administrative board.

She claims that they focused on her individuality and do as MP for Sengkang Group Representation Constituency and that they did not ask her a lot about her rest.

Nov 10, 2021

WP people are asked to submit submissions to the administrative panel, according to Ms. Loh and Ms. Nathan.

Ms. Loh claims that she was “extremly angry” and that she thought the individuals “had no business” making comments on the matter when they were unaware of the” correct timeline of events” and that WP leaders had been aware of the rest a week after it was released.

This is a small forward pedaling, according to Ms Loh, who messages Singh. She thinks the administrative panel was set up to suppress public and political angst.

Nov 22, 2021

Ms. Khan messages Singh to request a second meeting with the WP administrative board.

She claims that Singh said that her behavior and figure were being scrutinized because she chose to continue to tell a rest. She is shocked by this email.

When Ms Khan shares Singh’s message with Mr Nathan and Ms Loh, Mr Nathan replies” What happened to ‘ I wo n’t judge you'”?

Nov 25, 2021

Mr. Nathan claims that he and Ms. Loh met with the administrative board and that, among other things, they should have informed them that WP leaders had been aware of the rest since August.

Ms Loh says that she described Ms Khan as “lao new” to the board, meaning that she was prone to condemnation.

The Hokkien term” Chinese chi” literally means “leak air,” but it can also mean something sour or gone soft.

Nov 29, 2021

The WP administrative panel has met with Ms. Khan for her next time. She claims that she became aware at this conference that the officials wanted her to step down and that she felt defeated and betrayed.

At this appointment, the following change is noted down by Ms Lim:

Singh: Before Oct program, I met you I told you it was your phone. Did you ever feel the need to tell the facts in Parl?

Ms Khan: Well but consumed with grief unique experience. Thought it would n’t come up.

Singh: Can’t lay correctly?

Ms Khan: Well.

However, the COP meets for the first time over Ms Khan’s exist.

Nov 30, 2021

Ms Khan quits as MP and WP part.

Dec 1, 2021

Mr. Nathan claims to have dinner with Ms. Loh, Ms. Loh, and Mike Lim, Ms. Khan’s congressional associate.

Mr. Nathan claims that Mr. Lim assisted Ms. Loh in making a phone call to Singh:” Please notify Pritam that I’ve been called to the COP and I’m not going to lie the party.” Singh replies, telling Ms Loh to “tell the fact” to the COP.

Dec 2, 2021

The WP holds a media conference&nbsp, where&nbsp, Singh says formally that the party authority knew about Ms Khan’s rest a week after she told it on Aug 3.

Dec 10 and Dec 15, 2021

The COP hears Singh’s dental witness. Under the Parliament ( Privileges, Immunities, and Powers ) Act, Singh will eventually bring two charges against him for what he tells them about what he wanted Ms Khan to do with her lying.

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This 27-year-old woman started menopause platform Surety. It was her mum’s own experience that convinced her

Tan has always been a businessperson. In extra school, she sold limited-edition Air Jordan sneakers on society industry Carousell. During the pandemic, she launched an Instagram website to promote home-based companies.

Tan, who is in her 20s, acknowledged that she did n’t have first-hand knowledge of menopause because she was able to see how her mother had experienced it. However, Tan made a personal connection to the issue.

She believes that having a young team will help to spread the message and produce menopause more friendly conversation. &nbsp,

” By integrating a more contemporary, tech-savvy approach, we’re even reaching the girls, acquaintances and younger family members of people going through menopause, helping them understand how they can provide help”, she said.

STARTING IMPORTANT CONVERSATIONS ABOUT MENOPAUSE

Tan revealed that the general reaction to Surety’s work has been overwhelmingly positive,” but there’s still a long way to go in terms of open dialogue”. She has been surprised by the fact that middle-aged women are not as shy as she thought.

” In Singapore, many women still find it uncomfortable to talk about menopause, largely because it’s seen as taboo or as something too private to discuss publicly”, she said. ” However, once we start these conversations, I’ve noticed a sense of relief among many women – they want to talk about it, they just do n’t always know how to start.

” The younger generation, too, is becoming more receptive to discussing women’s health issues but, overall, there’s still a lot of learning and unlearning that needs to happen. Surety’s mission is to help foster that dialogue and remove the stigma surrounding menopause,” she added.

The Menopause Festival 2024, which will take place on November 9 and is Surety’s biggest event yet, is in preparation. It brings together experts, healthcare providers and women from all walks of life to talk openly about menopause, with panel discussions, interactive sessions and networking opportunities.

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