Establishing a Cancer Genetics Programme in Asia - the Singapore Experience

About five to ten percent of all cancers are hereditary and due to germline mutations in cancer predisposition genes [1]. Advancements in molecular biology and genetics in the last 1-2 decades have enabled the cloning of key cancer predisposition genes, resulting in better characterization of major hereditary cancer syndromes. These include hereditary breast and ovarian cancer syndrome due to the BRCA1/2 genes [2,3], hereditary non-polyposis colorectal cancer syndrome due to the mismatch repair genes [4-6], and familial adenomatous polyposis due to mutations in the APC gene [7]. The recognition of these syndromes and the establishment of management guidelines have led to the development of cancer genetics as a subspecialty in oncology [8-13]. Cancer genetics services have been incorporated into routine cancer services in major oncology centres in the West since the late 1990s. Such services represent an important primary prevention arm of oncology in its role of identifying high-risk individuals through family history assessment or genetic testing, and to enrol them into early cancer detection and prevention programmes, with the ultimate goal of reducing cancer burden and mortality.Singapore is a small country of 699 km2 in South East Asia and home to 4 million people. Cancer is one of the major causes of mortality, and about 7800 cancer cases are diagnosed every year, with the leading cancers being lung, colorectal and breast cancers [14]. Health care in Singapore is provided through 9 public hospitals, 7 private hospitals, 16 government outpatient polyclinics, and some 1900 private medical clinics. Of the 9 public hospitals, two are tertiary hospitals that offer comprehensive cancer services, encompassing surgical, medical, and radiation oncology specialties. Cancer genetics services have been formally incorporated into the cancer services of both tertiary hospitals since 2001.Singapore is a multi-ethnic country comprising three major Asian ethnic populations: Chi