Assessment of Taiwan's National Lung Cancer Early Detection Programme
Ministry of HealthSpeakers
Summary
This question concerns the relevance of Taiwan's National Lung Cancer Early Detection Programme for adoption in Singapore, as raised by Ms Mariam Jaafar. Minister for Health Ong Ye Kung clarified that Singapore currently recommends low-dose computed tomography (LDCT) only for heavy smokers, as they constitute 60% of local lung cancer cases. He highlighted that routine LDCT for non-smokers carries risks of cumulative radiation exposure and high false-positive rates, which can lead to unnecessary anxiety and invasive procedures. Current evidence indicates that the benefits of screening non-smokers do not yet outweigh these potential downsides and associated clinical risks. The Ministry of Health will continue to monitor emerging evidence and technological advances to determine the future suitability of expanded lung cancer screening for the general population.
Transcript
15 Ms Mariam Jaafar asked the Coordinating Minister for Social Policies and Minister for Health whether Taiwan's National Lung Cancer Early Detection Programme is relevant for adoption in Singapore.
Mr Ong Ye Kung: The Ministry of Health is aware of Taiwan's programme, which provides low-dose computed tomography (LDCT) scan for lung cancer screening for the general population, so long as individuals are either heavy smokers or have a family history of lung cancer.
In Singapore, lung cancer screening with LDCT is currently recommended only for current or previous heavy smokers in Singapore. This is based on the recommendations of the Screening Test Review Committee, after it reviewed relevant evidence.
The salient facts are: First, smokers make up around 60% of lung cancer cases in Singapore, which is far higher than the proportion of smokers in the population. Healthcare providers can exercise clinical discretion to offer lung cancer screening to patients with a history of heavy smoking, who are eligible and at risk.
Second, each LDCT exposes the individual to over half a year's worth of background radiation. This is within safe limits, but if LDCT becomes part of routine and recurrent preventive care screening – like a blood test – we cannot rule out the negative effects of repeated exposure, which may lead to accumulation of risk to health over one's lifetime.
Finally, LDCT scans have a relatively high false positive detection rate which leads to unnecessary tests and invasive procedures being performed to exclude the diagnosis of cancer. This causes distress, anxiety and further risk exposure from additional invasive procedures, such as biopsies.
The current evidence therefore does not show that the benefits of screening non-smokers for lung cancer outweigh the potential downsides of screening. With healthcare technology advancing rapidly, the Ministry of Health will continue to monitor any emerging evidence on the suitability of lung cancer screening for non-smokers.