Colorectal cancer is the commonest cancer affecting men and second commonest cancer affecting women in Malaysia. It accounts for one of the highest causes of cancer related mortalities globally. Although colorectal cancer screening is an established practice in developed parts of the world, it has not as yet been widely applied in most parts of the developing world. Earlier national initiatives such as the Australian Task Force and the UK Colorectal Cancer Screening Project have reported a fall in mortality through the implementation of faecal occult blood testing.

Malaysians living in under-resourced communities are faced with numerous unmet basic needs. EMPOWERED - The Cancer Advocacy Society of Malaysia has had first hand experience of their poor understanding of cancer, its prevalence and fatal outcomes if not picked up early. EMPOWERED’s tireless efforts to bridge the health gap in poor Malaysian communities since 2010 is fuelled by the many lives saved through the implementation of its early detection and treatment programs for colorectal cancer. Today, EMPOWERED’s 2013 Colorectal Cancer Screening and Treatment Project will reach nearly 10,000 Malaysians living in target low income communities in Setapak, Kuala Lumpur.

Since 2010, EMPOWERED’s incessant efforts to execute vital colorectal cancer screening and treatment programs has reached the homes of nearly 55,000 under-privileged Malaysians. This year, the project blueprint has been further customized to encourage maximal uptake by the residents living in EMPOWERED’s target communities in Setapak. EMPOWERED is working closely with the Setapak community leaders to execute this year’s project in four phases.

Phase 1 – Pre-Selection & Awareness Workshop

Pre-Selection

• EMPOWERED works with the community leaders to conduct demographic surveys which aim to identify the number of individuals at risk of developing colorectal cancer.

Awareness Workshop

• Awareness workshops are organized at the communities to raise awareness about colorectal cancer through customized educational sessions, healthy diet and lifestyle.

Phase 2 – Screening Workshop

• Screening workshops are conducted in Bahasa Malaysia, Mandarin & Tamil. Residents will be registered and instructed on how to use the faecal immunohistochemical test (FIT) kit. FIT has been shown in recent studies to have superior detection rates of advanced colonic lesions compared with the older guaiac-based faecal occult blood test with greater simplicity of sample collection and better patient adherence rate.

Phase 3 – Return of Used Test (FIT) Kits

Collection of Stool Sample At Home

• Residents are given 2 days to have their stool sample collected using the FIT kits at home.

Return of Used FIT Kits

• Used FIT kits are dropped off by participating residents at respective collection stations within their communities. The kits are collected and sent off for processing at Sunway Medical Center.

Phase 4 – Patient Support Program

Counselling and Hospital Visits

• EMPOWERED’s volunteers from the Malaysian Enterostomal Nurses Association will break news to the affected residents, in the privacy of their homes, about positive blood findings in their stool.
• Appointments for colonoscopy at Hospital Selayang is arranged.
• Appropriate medical management is administered for all diagnosed conditions including cancer.
• Transportation for all hospital visits is provided for these residents.
• An elaborate support mechanism is put in place to provide the beneficiaries with complete emotional and moral support throughout their medical journey.

Dr Christina Ng, President and Founder of EMPOWERED and Consultant Medical Oncologist, is the brainchild of this project. She shared, “In the last 3 years, we have seen a significant improvement in the rate of return of used FIT kits from 66% in 2010 to 85% in 2012 by our participating subjects. I would attribute this to EMPOWERED’s continuous efforts to make this program more tailored and personalised for our beneficiaries based on learnings from each yearly campaign. The rate of compliance to colonoscopic assessment for our subjects who are found to have blood in the stool remained high at about 90% every year.” She added, “About 7-8% of our entire population who participated in the program tested positive for occult blood in the stool and about 1-2% of all subjects were diagnosed with asymptomatic stage 1 to 2 colorectal cancer. Those diagnosed with pre-cancerous polyps underwent appropriate endoscopic therapeutic procedures and were subsequently placed in medical surveillance programs”.

Dr Ng also explained, “It is interesting to note that whilst the Malays formed the largest racial group within our screened population, the Chinese subjects were more likely to have blood picked up on FIT and more likely to have significant pathology found during colonoscopic assessment including cancer in comparison with subjects from other racial groups.”

EMPOWERED’s relentless efforts to enable under-resourced Malaysians make important health changes in their lives is well received on the ground. Mr Tan Chu Tea, a 53 year old colorectal cancer survivor and beneficiary of EMPOWERED’s screening campaign in Nov 2011, shared his testimonial at today’s opening event in Setapak. As he spoke about his brave journey through cancer, Mr Tan added, “I am very thankful to EMPOWERED for holding this program in our community. I have not come across a charitable organization that is so caring and dedicated to helping the poor people by providing colon cancer screening and then making all the arrangements to send them to government hospital for colonoscopy and further treatment. EMPOWERED had even paid for all our hospital fees and charges. For this, I want to say a big thank you to EMPOWERED.”

Dr Ng recognised that the support of corporate partners is critical in realising such vital initiatives. “Outreach projects like these are critical for the well being of the community. As an organisation, we are proud to fund an initiative that opens access for all segments of Malaysians to education, information and total disease support for a morbid disease such as cancer”, said Mr C.M. Phang, Operating Officer of Scientex Foundation who is the main sponsor for EMPOWERED’s 2013 Colorectal Cancer Screening and Treatment Project.