Answer to Written Question PT16

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YANG BERHORMAT AWANG HAJI SALLEH BOSTAMAN BIN HAJI ZAINAL ABIDIN

QUESTION:

Yang Berhormat Awang Haji Salleh Bostaman bin Haji Zainal Abidin requests the Minister of Health to elaborate on cases of critical diseases that frequently recurrent visits to the hospital but are diagnosed late, overlooked, or misdiagnosed. In terminal cases, late diagnosis poses challenges in recovery treatment. How many such cases exist, and what mechanisms are used to assess weaknesses in the early diagnosis process to prevent treatable cases from becoming more serious?

YANG BERHORMAT MENTERI KESIHATAN

ANSWER:

The majority of cases that are detected late, overlooked, or misdiagnosed are likely to be reported or complained about through certain channels in the Ministry of Health, such as complaints to relevant departments, the MOH Care app, the Corporate Relations Division, or through incident reporting.

For some chronic diseases, one way to prevent delays in their detection is through the National Health Screening Programme (NHSP) introduced by the Ministry of Health since 2019.

Health screening allows us to detect diseases or risk factors at an early stage, before any signs or symptoms of disease appear. Diseases detected at an early stage are easier to treat and control and can prevent or reduce harmful disease complications.

Under the National Health Screening Programme, there are four (4) screening programmes namely screening for cardiovascular disease risk factors including obesity, hypertension, diabetes, and high cholesterol; and 3 types of cancer, namely colorectal, breast, and cervical cancer.

• The National Health Screening Programme is conducted by trained nurses at Health Centers, including in Maternal and Child Health Clinics. For breast cancer screening, mammograms are conducted at the Breast Imaging Centre located at Raja Isteri Pengiran Anak Saleha Hospital. The Ministry of Health has also collaborated with Early Detection and Prevention Services (EDCPS), Jerudong Park Medical Centre, which recruits participants especially those with a family history and those referred from The Brunei Cancer Centre;

• The findings from the National Health Screening Programme since its launch until the end of last year (November 2024) are as follows:

  • Cardiovascular disease risk factor screening: From the number of participants who have undergone the screening, about nearly 1 in 3 people (30%) were found to have a body mass index (BMI) over 30, categorizing them as obese; about 1 in 2 people (54%) were detected with high cholesterol levels; 18% were diagnosed with hypertension, and nearly 1 in 12 people (7%) had high blood sugar levels.

  • Colorectal cancer screening: From the number of participants who have undergone the screening, about 7.5% (1075) were found to have positive fecal occult blood samples and were referred for further examination (colonoscopy).

  • Breast cancer screening: From the number of participants who have undergone the screening, at least 1% of women obtained abnormal mammogram results and were referred.

  • Cervical cancer screening: Since cervical cancer screening was introduced in 2011, about 3% of women were found to have abnormal pap smear results. Meanwhile, for the new HPV test introduced from August 2024 to November 2024, about 6.5% of women were found to have abnormal results.

• Regarding cancer, it is undeniable that some cancer patients are only detected at a late stage. According to data from the Brunei Darussalam Cancer Registry Report 2002-2021, about 54% of cancer patients are diagnosed at the 'regional' and 'distant' stages, indicating that the cancer has spread from its primary site.

• This situation may be due to patients being unaware or uninformed about cancer symptoms (low health literacy), fears of meeting health personnel, or being in denial about their condition.

• To address these issues and as an improvement step for the National Health Screening Programme (NHSP), the Ministry of Health is planning several marketing and outreach activities, including roadshows and media campaigns to raise public awareness about this program. Another improvement step is to extend NHSP registration through the BruHealth app, known as the Risk Assessment feature. Among the benefits of registration through the BruHealth app are:

  • Appointment slots can be booked directly

  • Screening test results can be accessed through this app

• If additional opinions are desired, the Ministry of Health does not object if individuals wish to consult another doctor, whether in the government or private sector.