Saturday 26 May 2012

Have baby before 30, get 20% off HDB flat?

On Cervical Cancer Awareness Month, specialist in women's cancer Tay Eng Hseon talks to Susan Long about women's cancer, fertility and how the state can incentivise young women to have babies.
The Straits Times, 25 May 2012

DON'T cave in and allow women to freeze their eggs while waiting for Mr Right to show up. It won't boost Singapore's flagging fertility. Instead, it will probably cause it to plummet further, warns one of Singapore's top gynaecological oncologists.

Dr Tay Eng Hseon argues that it will lull women into a false sense of security that they can afford to wait to settle down, since they have stashed away their 'young eggs'.

This may worsen the trend of late marriages and births here. 'In time, we will have more and more older pregnant women with increased medical risks,' he fears.

It will make child-bearing costlier as in-vitro fertilisations (IVF) and embryo transfers may become the norm, using banked eggs.

The medical director of Thomson Women Cancer Centre, who has helped several cancer patients here freeze their eggs and embryos, estimates a cycle of egg collection costs between $5,000 and $15,000. Storing the eggs costs between $250 and $500 a year.

Right now, women here are allowed to freeze their eggs for future use only if there is a medical reason, such as if they need chemotherapy or radiotherapy for cancer that could damage their eggs.

Another consequence, he fears, is that egg trading will happen on the pretext of egg donation. And human eggs may be used to make stem cells or for cloning purposes.

Today, the Health Ministry's objection against social egg freezing is that it is still experimental. But as it becomes safer and more countries offer it - Malaysia, Australia, Britain and the United States already do - the realist in him says that Singapore will not hold out for long.

A likely recourse will be to sanction it with safeguards built in, just as how casinos are heavily regulated here. 'But it's only as safe as you can police it or there will be abuses... This is how the solutions of today create problems for tomorrow,' he laments.

Barking up the wrong tree

INSTEAD, the former medical board chairman at KK Women's & Children's Hospital (KKH) and former president of the Obstetrical and Gynaecological Society of Singapore has this recommendation for the Government on how to arrest the tumbling birth rate: Don't focus on solving the problem of sub-fertility, work on promoting fertility.

He suggests pouring less money into subsidising IVF treatments and more into incentivising the majority of men and women who are born fertile to procreate 'at the right time'.

'If I am a social policymaker,' he declares, 'I will look at every step of a young Singaporean's life and find ways to facilitate a woman to have her first child before 30. Once she has achieved that, she is likely to have another before 35.'

For starters, the Government should dish out more housing and health-care carrots to encourage early child-bearing. A woman aged 23 to 27 who wants to get married should be given top priority when applying for an HDB flat. If she bears her first child before 30, give her family a 20 per cent rebate off the flat's price, he says.

The state should also consider purchasing health-care insurance for all first-born children of women aged 25 to 30 and all second-born children of women below 35. If parents feel their children's health-care financing is taken care of, they are more likely to want more children, he says.

Doesn't all this sound too prescriptive and smack of ageism? He disagrees, saying that nature is inherently ageist.

'Fertility wanes with age or may be damaged by diseases. A woman loses the opportunity to bear a child easily if she does not do it in a timely manner,' he says.

He also sounds the alarm that the dippng fertility rate in East Asian cities like Singapore, Taiwan and Hong Kong has led to a doubling in rates of ovarian cancer. The medical impact of not bearing offspring is an increased risk of breast cancer, womb cancer and ovarian cancer for women, he forewarns.

So despite the political incorrectness of telling women what to do with their womb these days, he unflinchingly advises all patients: 'Best to have a child before 30 and definitely by 35. Do it for your own health and sanity when you grow old.'

Walking the talk

HE HAS walked the talk. At 27, he married his college sweetheart. She was 26.

Their first son arrived a year later. The next, three years later. Today, at 48, he and his wife, Ivy, who works in the pharmaceutical industry, are almost home free. Keson, 21, is a second-year medical student here and Jamos, 18, is finishing up at NUS High School of Mathematics and Science.

The stork's early arrival was unplanned but, looking back, well- timed. 'When you're a young couple, your parents are still energetic enough to want to help you,' says the middle child of owners of a commercial art company. His parents moved into his Upper Bukit Timah semi-detached home to help mind his children.

The former Raffles Institution boy first aspired to be a family physician to 'reach out to many people in society'. Ironically, as a medical student at the National University of Singapore, he almost fainted watching his first live birth. But during a four- month posting at KKH in 1987, he helped to deliver 55 babies. He was so seized by the 'joy of bringing life into the world' that he settled on gynaecology.

His early years as a father while pursuing gynae-oncology training in Australia were a juggle. He spent all his allowance flying his wife and sons, then aged three and six, over several times a year.

In 1999, he returned - the first Singaporean to complete a three-year diploma in gynae-oncology in Australia - focused on setting up a full-facility women's cancer centre here that would do one-stop screening, diagnosis and treatment like the ones he saw abroad.

Dr Chia Yin Nin, head of KKH's gynae-cancer unit, says he was 'so dedicated, passionate and somewhat fearless about his pursuit' that he gave up his lucrative obstetrics practice to focus on treating gynaecological cancers.

By 2002, the centre he started was recognised as an overseas gynae-oncology training centre to train others in his sub-speciality. He turned out at least 15 other fellows, mostly from Malaysia, India, Nepal and Pakistan.

Although there were initial fears about the taboo and stigma of calling it a cancer centre, women began rallying on its doorstep. Even those with non-malignant tumours came to seek an opinion.

In 2004, at age 40, he became chairman of KKH's medical board, where he oversaw some 300 doctors.

He says he spent 50 per cent of his time on 'human resource management', creating individual career paths and instituting merit-based and market-based pay structures, to stem the outflow of specialists to the private sector.

The trouble today, he says, is that droves of specialists are leaving prematurely in their 30s, 'without fulfilling their social obligation to taxpayers' who helped finance their training. Aside from long hours, patient loads and pay issues, he notes a disturbing disconnect between how doctors are wired and the way public hospitals are run.

'Doctors have three characteristics. One, they want to be treated as individuals. Two, most of them studied medicine for the purpose of treating patients. Three, they are intellectually potent and used to doing things their own way.' However, the reality in public hospitals is the opposite.

'First, doctors are managed in groups. Second, in addition to patient care, they have to do research, train and manage other doctors. Third, they have to comply with another doctor's - usually the head of department's - way of treating a patient, which may not necessarily be better.'

Until the public hospitals treat doctors less like digits, he says, they are unlikely to keep good ones for long. But the question they need to settle first, he continues, is what kind of service they aspire to provide: a mediocre foodcourt experience or outstanding hawker fare?

'I believe if we manage doctors as groups and with limitations, we get a foodcourt - good ambience, reasonably good food but nothing to crow about. But if we nurture and manage doctors as individuals, we will build gourmet hawker stalls,' he says.

A new crusade

IN 2009, he left at age 45 after 22 years in public service to set up his own women's cancer centre at Novena Medical Centre and proliferate more of such centres across Asia.

He also became the group medical director for listed China Healthcare Limited, to help conceptualise nursing homes of the future.

Today the man who lives by the adage: 'Don't do different things in life, but do things differently', is on a new crusade.

He is taking on cervical cancer, the most preventable of all cancers if detected early through screening, which claims about 200 lives here a year.

It is the No. 9 cancer among women in Singapore, although it has dropped off the top 10 in most developed countries.

It is a silent and deadly killer with few symptoms. One out of every six women diagnosed with early stage cervical cancer dies from it, half of them within five years.

Yet, he notes that one-third of women aged 25 to 69 here have never been screened for cervical cancer.

His weapon is a self-screening tool called the Delphi Screener, which he has been working on since 2006 with Dutch cancer researchers and clinicians.

In Europe, such home-testing devices have proven popular with women who, because of culture, shyness or fear of pain, avoid having a Pap smear done.

The screener is inserted by the user into her vagina to collect a cervical cell sample in the privacy of her home, then sent to an authorised lab for testing. It is now available over the counter at more than 50 family clinics for $79.90, inclusive of lab test.

He plans to roll it out to the region, starting with Muslim nations where there is reticence about getting a Pap smear and where cervical cancer remains the No. 2 cancer among women. His next stops are Indonesia, Malaysia and the Middle East.

The medical innovator, who works 15-hour days and eschews the 'conventional path that leads to a predictable life', is also knee-deep in exploring new shores and new solutions.

Since 2009, he has been helping to set up a women's cancer centre in Ho Chi Minh City.

'Those who watch the winds will never plant,' says the Presbyterian, quoting a Bible verse.

'You just have to do it because you don't know which seed will grow and bear fruit.'

1 comment:

  1. I like this article. However the good doc should also look into nutrition and hormones as well as lifestyle to complete his knowledge on onco-gynaecology.