Skin Cancer's Deadly Toll In Brunei

Skin cancer is a serious global health issue, and the most common form of cancer in the United States. It is the 17th most common cancer worldwide and is responsible for a significant number of deaths each year. In Brunei, skin cancer is not among the leading causes of cancer-related deaths. According to the latest data from 2020, there were 2 deaths from skin cancer, accounting for 0.11% of total deaths in the country. While skin cancer is not a leading cause of cancer deaths in Brunei, cancer, in general, is the leading cause of death in the country, accounting for about 19% of total mortalities. The most common cancers in Brunei include colorectal, lung, breast, stomach, and cervical cancer.

The lifetime risk of being diagnosed with cancer in Brunei is about one in four for men and one in three for women

In Brunei, the lifetime risk of being diagnosed with cancer is about one in four for men and one in three for women. This means that, statistically, for every four men in the country, one will be diagnosed with cancer at some point in their life, and for every three women, one will receive a cancer diagnosis.

This disparity between the sexes is reflected in the number of new cancer cases recorded in 2020, with 448 out of 987 (45%) of the new cases being males. The most common cancers affecting males in Brunei are colorectal, lung, prostate, liver, and stomach cancers. Testicular and penile cancers are also male-specific.

The lifetime risk of cancer diagnosis in Brunei is much higher than in neighbouring countries like Malaysia and Singapore. This may be due to a combination of modifiable and non-modifiable risk factors. Modifiable risk factors include individual behaviours and habits such as smoking, diet, and physical activity, while non-modifiable risk factors include genetic predispositions.

The Brunei Cancer Centre (TBCC) Director, Dato Seri Laila Jasa Dr Babu Sukumaran, has attributed the projected rise in cancer cases to factors such as population growth, increased life expectancy, an ageing population, and changes in lifestyle, including obesity, smoking, alcohol consumption, and diet.

Cancer is the leading cause of death in Brunei, accounting for about 19% of total mortalities

The most common types of cancer in Brunei are colorectal, lung and bronchus, prostate, liver, and non-Hodgkin lymphoma for men, and breast, colorectal, lung and bronchus, corpus uteri, and cervix uteri for women. Lung cancer is the leading cause of cancer-related death in Brunei, with 94 deaths recorded in 2020. The next most frequent causes of cancer-related death are colorectal cancer, liver cancer, stomach cancer, and breast cancer.

The burden of cancer in Brunei is expected to rise significantly in the coming years. Without effective intervention, the number of cancer cases is predicted to more than double within the next 2 decades, and cancer deaths are predicted to rise by almost 160%. Risk factors for cancer in Brunei include both modifiable factors, such as smoking and obesity, and non-modifiable factors, such as genetic predispositions.

To curb the rising rates of cancer incidence and death, several cancer prevention and control initiatives have been implemented in Brunei. For example, a one-time screening program for colorectal cancer was conducted in 2009, and a national cervical cancer screening program was initiated in 2011-2012. In 2019, Brunei began implementing national cancer screening guidelines for breast cancer, cervical cancer, and colorectal cancer, as part of a larger national health screening program.

Colorectal cancer has the highest incidence of all cancer types in Brunei, with about 150 new cases recorded in 2020

Colorectal cancer is the second leading cause of cancer death in Brunei Darussalam, posing a major burden on society. It has the highest incidence of all cancer types in Brunei, with about 150 new cases recorded in 2020. The highest incidence of colorectal cancer is seen among men and women between the ages of 55 and 59 years. According to the National Cancer Registry in Brunei Darussalam, cases of advanced disease account for more than 70% of colorectal cancers in the country.

The overall survival rates of colorectal cancer patients at 1-, 3- and 5-year intervals in Brunei Darussalam were analysed and compared between two study periods: 2002–2009 and 2010–2017. The 1-, 3-, and 5-year survival rates of CRC patients for 2002–2009 are 82.2%, 69.6%, and 64.7%; 77.0%, 59.1%, and 51.3% for 2010–2017, respectively. A significant difference in CRC patients’ survival rate was observed between the two study periods, age groups, ethnic groups, cancer stages, and sites of cancer.

The 1-, 3-, and 5-year survival rates of CRC patients from the period 2002–2017 are 78.6%, 62.5%, and 56.0%, respectively. The overall Kaplan-Meier survival curve is presented in the attached image. Comparing the two study periods, patients diagnosed in 2002–2009 have higher 1-, 3-, and 5-year survival rates than patients diagnosed between 2010 and 2017.

A national screening programme with screening guidelines for CRC was launched in 2019. Screening is recommended for those between the ages of 50–75 years with FIT or/and colonoscopy. Individuals < 50 years with risk factors for CRC will be offered colonoscopy.

Lung cancer has the highest mortality, with 94 deaths recorded in 2020

Lung cancer is the second most common cancer in Brunei Darussalam, and the leading cause of cancer death for men in the country. In 2020, 94 deaths were recorded, making it the cancer with the highest mortality rate.

Lung cancer is the leading cause of cancer death worldwide, and is responsible for 19.4% of all cancer-related deaths. The five-year survival rate for lung cancer is only about 13% globally, and 15.6% in the US.

In Brunei Darussalam, the five most common cancers for men are colorectal, lung and bronchus, prostate, liver, and non-Hodgkin lymphoma. For women, the five most common cancers are breast, colorectal, lung and bronchus, corpus uteri, and cervix uteri.

The Brunei Darussalam Cancer Registry (BDCR) was established in 2001 to provide a population-based cancer database. In 2013, the country implemented the Brunei Healthcare Information Management System (BruHIMS), a national electronic patient record system, to streamline data extraction and verification of malignant cancer cases. This has enhanced the accuracy, timeliness, and completeness of the cancer registry.

The high mortality rate of lung cancer in Brunei Darussalam may be attributed to tobacco smoking, which is the overwhelming cause of lung cancer worldwide. Despite the adoption of significant tobacco control measures, smoking prevalence remains relatively high among men in the country.

The adoption of universal health coverage, as well as the availability of preventive services, early detection, referral, and treatment of cancer, have likely contributed to the reduction in lung cancer mortality observed in Brunei Darussalam.

The burden of cancer in Brunei is expected to rise significantly in the coming years due to population growth, increased life expectancy, and an ageing population

Brunei Darussalam, a small equatorial nation in Southeast Asia with a population of under half a million people, has seen cancer as the leading cause of death for over a decade. The lifetime risk of being diagnosed with cancer is about one in four for men and one in three for women, which is much higher compared to neighbouring countries. The average age in Brunei is 31.1 years, with a life expectancy at birth of 78 years, and a population growth rate of 1.48%.

The burden of cancer in Brunei is expected to rise significantly in the coming years due to several factors:

• Population Growth: As the population increases, there will be more individuals at risk of developing cancer. The population growth rate of 1.48% contributes to this factor.
• Increased Life Expectancy: With advancements in healthcare and improvements in overall health, people are living longer. This extended lifespan provides more opportunities for cancer to develop and progress.
• Ageing Population: Cancer risk increases with age. As the population ages, the number of individuals in older age groups, who are more susceptible to cancer, will also increase.

Without effective intervention, the cancer incidence in Brunei is predicted to surge. It is estimated that cancer cases will more than double from about 1,000 in 2020 to over 2,000 in 2040. During the same period, cancer-related deaths are expected to rise by almost 160%, from 434 in 2020 to 1,123 in 2040.

To address this growing burden of cancer, implementation of effective interventions is crucial. This includes strategies to reduce behavioural risk factors, such as smoking and obesity, as well as increasing early detection through cancer screening programs.

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