Madam Lily Tan is 40 years old and has never had a mammogram.
A mammogram is an X-ray examination of breast tissue to detect breast cancer.
Although Madam Tan, a hospital administration staff member, knows that it is important to screen for breast cancer, she admits to being just too lazy to book an appointment.
But apart from that excuse, Madam Tan, who is married with no children, has heard that a mammogram is 'painful'. She is not alone in her fears.
She is among the thousands of women in Singapore above the age of 40 who have yet to go for the various tests which older women should be taking (see other report).
Associate Professor Tay Eng Hseon, chairman of the medical board and senior consultant of gynaecological oncology at KK Women's and Children's Hospital, put it succinctly: 'Forty is a significant age.'
A Singapore Cancer Registry's interim report on cancer trends in Singapore from 2001 to 2005 found that cancers of the breast, colorectum and cervix were among the top 10 cancers in women. Breast cancer topped the list with 6,405 cases.
All three cancers can be detected early with regular screenings and cervical cancer is highly preventable.
The risks of developing heart disease and osteoporosis can also be reduced by changing one's lifestyle and diet.
While breast cancer and colorectal cancer are caused by a combination of genetic and lifestyle factors, cervical cancer is caused by the human papilloma virus, or HPV, which is easily transmitted through sexual contact.
HPV is a skin virus which has more than 100 related types but only 15 are known to cause cancer. Of these, two types cause more than 70 per cent of all cervical cancers.
Regular Pap smears and vaccination are a woman's best defence against cervical cancer.
The vaccination targets HPV Type 16 and 18 and as long as you do not have these or meet the other types, you can prevent cervical cancer.
Dr Tay said: 'As a woman ages, the chances of encountering the different viruses increase so the younger you are, the more benefits there are of the vaccination.'
A Pap smear should be done once every three years. It has to be done regularly as it is only 80 per cent accurate and therefore prone to false results.
Singapore General Hospital's associate professor at the department of obstetrics and gynaecology Tay Sun Kuie said: 'If you repeat the test, you increase its sensitivity, that's why you need to keep repeating it.'
The 2004 National Health Survey showed that 70 per cent of women in Singapore have had a Pap smear but only 52 per cent had one in the last three years.
The same survey revealed that while 80 per cent of women aged 50 to 69 years knew what a mammogram was for, only 36 per cent had had a mammogram in the last two years.
KK Women's and Children's Hospital's DrTay said: 'The most common reasons women gave for not having the Pap smear are that they didn't have time or they felt well and didn't see the need for it.'
To counter this, the Singapore Cancer Society is offering free Pap smears to all women aged between 25 and 69 years this month.
But free Pap smears and subsidised mammograms may not be enough to convince older women to march into the doctor's office.
Asked why women here were reluctant to go for mammograms, Dr Patrick Chan, senior consultant at the department of general surgery at Tan Tock Seng Hospital, said: 'The problem is perhaps not about awareness but the misconception some women have that a breast cancer diagnosis is a death sentence.
'They see it as a hopeless situation so they don't want to know. We need to put across the message that breast cancer is very treatable if diagnosed early.'
