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FACT: Over 40% of all cancers are caused by factors we can change.

“You can make a real difference to your cancer risk by maintaining
a healthy weight, being physically active
and eating a plant-based diet
without too much
red or processed meat, alcohol or salt
– as well as of course not smoking”
Prof Martin Wiseman, Medical and Scientific adviser to World Cancer Research Fund

If someone were to offer to share with you a way of reducing your risk of cancer and chronic diseases such as diabetes, hypertension, heart disease and stroke, wouldn’t you want to know what it is? The ‘secret’ is surprisingly simple and easily achievable with no need for expensive technology. It is - Healthy lifestyle and Healthy diet.

In a recently published research study by Cancer Research UK, it was found that in the UK each year over 100 000 cases of cancer (which accounts for over a third of all cancers diagnosed there) are caused by smoking, unhealthy diets, alcohol and excessive weight. Tobacco smoking is by far the biggest culprit, in itself accounting for 1 in 4 cancers in men, and 1 in 5 cancers in women.

Overall, looking at 14 lifestyle and environmental risk factors, it was estimated that over 40% of all cancers are caused by factors we can change.  Genetic factors and advancing age play undeniably important roles, but these cannot be changed. By focusing on something which is within our ability to control, we can shift the odds in our favour. No longer should we accept cancer as our fate, and be entirely helpless.

Much has been said of the tremendous progress in the last few decades in developing better and more effective treatment for various cancers. Examples include new and safer surgical techniques, chemotherapy agents, targeted therapy etc. The medical and scientific community rightfully deserves to take pride in these achievements.

Perhaps, it is timely to take a step back and make sure people are aware of what factors are associated with the risk of getting the disease in the first place, so they can take positive steps toward a healthy lifestyle. While medical doctors and organisations such as the Health Promotion Board can provide us with information and guidelines to encourage us to lead a healthy life, it is ultimately ourselves who have to take individual responsibility in order to maintain these measures in the long term.

How can I reduce my cancer risk ?

While there are no proven ways to entirely prevent cancer, there is much we can do to reduce our risk of getting it. In addition, it is also important that we know our own bodies, to be aware and alert to changes such as lumps, skin growths or unexplained bleeding, and to get prompt medical attention.

Leading a healthy lifestyle lowers the risk of us getting certain types of cancer.

What exactly does this entail?

✓ Eating a healthy balanced diet
✓ A regular exercise programme
✓ Maintaining a healthy weight
✓ Drinking less alcohol
✓ Stop smoking
✓ Protecting our skin from sun damage


healthyLiving diet  

A healthy diet should be high in fibre, and low in cholesterol, fat, sugar as well as salt. It should be balanced in that it should consist of different food types in the right amounts, and not too much of any particular type.

While there is much research into the link between diet and cancers, it is often difficult to show a direct cause and effect between a specific food and cancer, as multiple factors contribute to the development of cancer. Moreover, it typically takes years for a cancer to become evident.

What has been shown convincingly is that there is an association between eating certain food groups and reduction in the risk of cancer.

Taking foods rich in fibre helps to keep the bowel healthy, prevents constipation and reduces the risk of bowel cancer. Fibre-rich foods include wholemeal bread, cereals, fruits and vegetables.

Bowel cancer is more likely to develop in people who consume a lot of red meat and processed meats. Red meat includes beef, pork, and lamb. Examples of processed meats include ham, sausages, and bacon.


healthyLiving exercise  

Regular moderate exercise has been shown to have beneficial effects on one’s physical and mental health. It helps in improving control of chronic diseases such as hypertension, diabetes mellitus and hypercholesterolaemia. Some types of cancer have also been found to be less common in people who exercise more.

What is an effective exercise programme?

If a person desires cardiorespiratory or aerobic fitness, the conventional teaching is to adopt the F.I.T.T. principle of training.

“F” stands for frequency. Ideally one should exercise minimum of three times per week, up to five sessions per week. Time for rest should be given for muscles to heal, especially if the form of exercise chosen is intense.

“I” stands for intensity. Heart rate has been used to measure the intensity of cardiorespiratory training. Heart rate is measured in beats per min (bpm). It helps a person determine how much effort he / she should put in during the exercise, by defining what is the Target Heart Rate (THR). To know the Target Heart Rate, you must first calculate what is the Maximum Heart Rate (MHR):

MHR = 220 – age (years)

So the MHR for a 40 year-old person is 180 bpm.

So, a good intensity for someone who just started an exercise program would be 50%-70% of the calculated MHR. So for a 40 year-old person, the target heart rate would be 90 to 126 bpm. When a person becomes fitter, he can push himself to 70%-85% of his MHR.

“T” stands for type of exercise. The ideal type of exercise for aerobic fitness should be one that is continuous in nature and make use of large muscle groups. Examples include running, brisk walking, swimming, dancing, cycling, aerobics classes, circuit training, cycling etc.

The second “T” stands for time. Those with lower fitness levels should aim to maintain their heart rate within the target heart rate zone for a minimum of 20-30 minutes. This can increase to as much as 45-60 minutes when your fitness increases.

How about exercise just to maintain good health and prevent cancer?

Studies have shown that regular moderate exercise can reduce the risk of cancer, in particular breast and colon cancer.

The intensity of a particular type of exercise is measured by MET (or metabolic equivalent). Moderate exercises are exercise types that have a MET of between 3 to 6, and these include brisk walking and cycling.

More recently, researchers have found that just 15 minutes a day of moderate exercise can prolong your life, by 3 years to be exact.

So don’t hesitate anymore. Start today. Choose a form of exercise that is appropriate for your level of health and physical status.  Try to incorporate physical activity into your daily activities, e.g. walking to the market instead of driving, climbing stairs in place of taking the lift.


Combining healthy eating habits with regular exercise, one can maintain a healthy weight. Being overweight is a serious health problem. Positive lifestyle modifications will go a long way in helping one achieve a better, happier and longer life.

healthyLiving weightManagement  

You need to maintain your weight within a healthy range so as to avoid obesity.

What is obesity?

Obesity is a serious health problem. It is a disease where excess body fat has accumulated to the extent that health may be adversely affected.

Why is it so bad?

Obesity has been shown to predispose to various diseases including diabetes mellitus, hypertension, heart disease and joint disorders. Importantly, it also increases one’s risk of developing many types of cancers, namely bowel, pancreatic, oesophageal, kidney, uterine, and breast cancers.

How do I know if I am overweight /obese?

The Body Mass Index (BMI), calculated as weight divided by the square of height, by means of kilograms per square meter as the unit of measurement is the recommended index to define obesity.

bmi adults

The relationship between body mass index (BMI) and body fat percentage (BF%) in Asian populations—is different from that of Caucasians. At any given BMI, the BF% of Asians tends to be higher than that of Caucasians. Furthermore, the risks for comorbidities exist at lower BMI points for Asian populations.

bmi asians

What can I do if I am overweight / obese?

Weight reduction can be achieved by various measures, such as dietary therapy, physical activity, behavioural therapy, medications and weight loss surgery.

When is weight loss surgery necessary?

Bariatric (weight loss) surgery, as part of a multi-disciplinary approach, is the most effective method to reduce weight and maintain weight loss in the morbidly obese.

Bariatric surgery should be considered for individuals with a BMI > 37.5 kg/m2 or a BMI > 32.5 kg/m2 and significant comorbidities (for Asians). They should be fit for surgery and agrees to lifelong follow-up.

The various surgical options can be classified into the following categories: restrictive procedures, malabsorptive procedures, and combined restrictive/malabsorptive procedures. Restrictive procedures limit the patient’s ability to take in food whereas malabsorptive procedures interrupt the digestive process.

Nexus Surgical Weight Loss Centre

Nexus Surgical Weight Loss Centre has formed a team that provides the entire spectrum of weight loss options including dietary adjustments, behavioural therapy, exercise programs and weight loss surgery. The centre also works closely with endocrinologists who will manage the associated metabolic problems such as diabetes.

Visit us at the Nexus Surgical Weight Loss Centre if you wish to know more about how we can be of assistance to you.


Classification of adults according to BMI >

healthyLiving smokingCessation  

The ill effects of smoking are well known. It harms the person who smokes as well as those around him or her.  It is strongly associated with many diseases such as lung disease, peptic ulcers, hypertension, heart disease, stroke, and many cancers.

Eliminating smoking is one positive step we can take to improve our own health and others around us. Despite extensive public education programmes, smoking rates have not gone down significantly. There are complex psycho-social factors which making quitting difficult. Economical and political factors so far have prevented an outright ban on tobacco smoking.

The individual smoker who realizes the benefits from kicking the habit, but finds it difficult, may get help in the form of helplines, smoking cessation clinics, and support groups. For example, the Health Promotion Board of Singapore operates a helpline called “Quitline” (dial 1800-438-2000). Support services are also available at all public polyclinics, and selected retail pharmacies.

Nexus Surgical Associates works closely with psychiatrists who have a special interest in managing addictions.

healthyLiving alcohol  

While there is scientific evidence that consumption of red wine in moderation confers potential health benefits, excessive alcohol consumption is one of the leading lifestyle-related causes of death.

The long-term health risks of excessive alcohol consumption include:

  • neurological ( e.g. dementia, degeneration of nerves, stroke )
  •  cardiovascular ( e.g. hypertension, cardiomyopathy, heart attack)
  •  psychiatric  ( anxiety, depression,  suicide)
  •  social problems ( family problems, unemployment, lost productivity)
  •  liver disease ( hepatitis, cirrhosis , liver failure)
  •  cancers like oral cancer, pancreas cancer, liver cancer, breast cancer and colon cancer

So how much is too much?

First, we need to introduce the term “standard drink”. One standard drink has 10g of alcohol.

Based on this,

Males should not have more than 5 standard drinks per day, and
 Females should not have more than 4 standard drinks per day.

The above recommendations are for the Caucasians. As Asians are generally smaller in stature compared to their Caucasian counterparts, the recommendations for Asians are:

Asian Males should not have more than 3 standard drinks per day, and
 Asian Females should not have more than 2 standard drinks per day.

So how to order my drinks?

Bartenders or service staffs probably do not know what is a standard drink. To make it easier, one standard drink is equal to

  • 2/3s of a can of beer (1 can of beer = 220mls)
  • 100 mls of wine
  • 30 mls (2 tablespoonful) of whiskey / brandy / gin / vodka

Hence, you should not drink more than

2 cans of beer a day, or
3 glasses of wine a day, or
6 tablespoonfuls of hard liquor a day

Some may ask why not use the measurement  “shot” to measure the amount of hard liquor like whiskey. The problem is that there is no standard size for a single shot. Different countries use different definition of a shot.

If we use the United Kingdom standard of “a single shot”, a single shot is about 25 to 35mls.

Hence one should not take more than 3 shots of hard liquor in a single day.

How about if I drink only on occasions?

Social drinking is common, but beware of binge drinking.

Binge drinking is the consumption of large amounts of alcohol within a short period.

Anything more than 5 standard drinks for males, and 4 standard drinks for females within one single drinking session are considered binge drinking.

Binge drinking has a higher risk of stroke, hypertension and liver disease.

In addition, remember the useful advice from our friendly traffic authority: if you drink, don’t drive.


As with most things in life, the keyword is moderation.

healthyLiving cancerScreening  

Cancer screening refers to conducting tests to diagnose a cancer early in its development. The aim for cancer screening is therefore to increase the chance of early cancer detection. With early detection of cancers, patients have more treatment options and the likelihood of successful treatment is higher.

It is important to note that for such early cancers, the tumours are likely to be small and localized (have not spread yet). As a result, such tumours usually do not have any symptoms.  Hence, screening is applicable for a healthy population without symptoms.

While the benefits seem quite obvious, what is often not emphasized is the potential harm that some screening tests or procedures may pose, e.g. a biopsy procedure may result in a complication such as injury to organs, bleeding, infection and even rarely, mortality. The psychological burden of a false positive test (i.e. a test indicating a positive diagnosis for a condition when in actual fact that condition is not present) should also be kept in mind. Conversely, a false negative (a test indicating a negative diagnosis when in reality the disease condition is present) can lead to false sense of security, and consequent delay in diagnosis and treatment. Your doctor will elaborate more on these.

Cancer screening programmes are usually recommended when the cancers to be screened are common, the effectiveness of screening has been demonstrated and effective treatments are available.

In Singapore, screening tests for the general population are being conducted only for selected cancers, based on established principles and available scientific evidence. Presently, these include colon cancer, breast cancer and cervical cancer, just to name a few.

For an individual considering screening, one should have a discussion with his or her doctor. Based on one’s medical/family history and lifestyle/risk profile, the doctor would ascertain what conditions to screen for, and what tests to perform. Depending on your risk factors and family history, your doctor may recommend either general cancer screening or selected cancer screening.

Nexus Surgical Associates provides some of the screening programmes recommended by the health authorities of Singapore. These are:

To know more, just click on the relevant links.

Nexus Surgical also provides screening for other cancers. Singapore does not implement nationwide screening programmes for these cancers as they are not so prevalent amongst Singaporeans. However, screening is recommended for certain at-risk populations. Examples include:

You can also read about cancer screening from this brochure produced by the Ministry of Health of Singapore, titled "A patient's guide to understanding cancer screening"

healthyLiving other  

Chronic conditions such as hypertension, diabetes mellitus, high cholesterol and obesity are highly prevalent in developed countries, and if untreated, lead to serious consequences such as heart attack, stroke, vascular disease, and other organ failure.  In Singapore, it was found in a survey in 2004 that up to 1 million people suffer from these chronic conditions.

The Health Promotion Board recommends that those above 40 years of age should undergo screening tests for these conditions.

Nexus Surgical Associates do provide opportunistic screening for some of the above conditions, in particularly obesity and abdominal aortic aneurysm.

Abdominal aortic aneurysm is an abnormal dilatation of the aorta. Many patients with such a condition have no symptoms, and only present to the hospital when the aneurysm has burst, by which time, treatment may be too late. Even if treatment was possible, most patients will need to be hospitalized for a long period, and possibly spent many days in the intensive care unit.

Abdominal aortic aneurysms are most often seen in males over 60 who have one or more of the following risk factors:

  • Hypertension
  • Diabetes mellitus
  • Hypercholesterolemia
  • Smokers
  • Emphysema
  • Obesity

A quick screening test would be a clinic abdominal ultrasound to measure the diameter of the aorta. This test is non-invasive and has no risk.

Call the Nexus Surgical Vascular and Vein Centre if you need more information on this.



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