Introduction

Health screening for patients is always tricky – extensive screening in many cases has neither shown to be effective in picking up the disease nor ruling out disease that is being screened.

For example, the use of a resting ECG to pick up asymptomatic coronary heart disease has not been shown to be effective. Hence a well person with normal ECG is at no lower risk than another well person who has not done any ECG prior. The same issues also stand out for other tests such as tumour markers.

We do not offer resting ECG in our clinic as part of a routine screening package because there is no evidence that routine screening of resting ECGs is beneficial. This is acknowledged both by the USPTF as well as our own local Ministry of Health[1]. We can provide it and there is seldom much harm for patients who wish to have one. It costs $50 at the time of writing.

There are many tumour markers for different types of cancers. The commonly done ones are CEA, CA19.9, CA 125. We do not include these as part of our screenings because there is no evidence that screening for cancers in this manner are accurate. A negative result doesn’t mean that the probability of cancer is low. Our local professional body Academy of Medicine of Singapore recommends not using it for screening[2]. A rational use of such markers are for patients who have been diagnosed with cancer AND found to have concurrent high levels of such markers. These markers can then be used as one of the several parameters to follow up. Commonly many patients diagnosed with cancer will NOT have elevated tumour markers and there is no utility of these tests in those patients.

[1] cpg_ecg-for-screening-for-hypertension-patient.pdf (moh.gov.sg)
[2]https://www.ams.edu.sg/view-pdf.aspx?file=media%5c4817_fi_59.pdf&ofile=STRC+Report+March+2019.pdf