Boost screening habits, systems for cancer treatment: SMU leads study for a Healthier SG

By Vince Chong

SMU Office of Research Governance & Administration – Developed cities like Singapore are increasingly facing similar healthcare pressures like ageing populations and limited resources. To lessen the burden on healthcare resources, the city-state has embarked on Healthier SG, a national preventive health initiative to build lifestyles that staves off chronic maladies.

SMU Associate Professor Gao Yini aims to reinforce this policy by spearheading a project to explore the short- and long-term effects of cancer screenings – which the project proposal aptly calls “a vital component of preventive care” – and recommend ways to improve and tackle challenges. As of January 16, 2026, cancer is the leading cause of death in Singapore. 

Enhancing Preventive Healthcare in Singapore: Evaluating the Effectiveness of Healthier SG Initiative in Cancer Screening has been awarded a distinguished Population Health Research Grant (PHRG), under the auspices of the Singapore Ministry of Health’s (MOH) National Medical Research Council.

Professor Gao’s interest in the research was piqued by an earlier study where she uncovered a low screening rate of 12 percent for colorectal cancer under a MOH free or subsidised screening scheme. That study in 2019 surveyed nearly 4,000 respondents who were eligible for the scheme. The trend tallied with separate government data in 2019 that showed a low screening rate of 38.7 percent for breast cancer. 

In the prior project, the academic told the Office of Research Governance & Administration (ORGA), her team studied not just if people went for screenings, but also what happened after that, particularly if individuals with positive faecal immunochemical test (FIT) results followed up with appropriate care. While positive FIT results do not necessarily mean cancer, it implies that further assessment is necessary, often with colonoscopy.

An important insight that she gleaned from that earlier research was that “screening is not just a one-off individual decision (but) an end-to-end care pathway.” 

“A person has to be identified, invited, screened, informed of the result, referred for follow-up if needed, and eventually connected to diagnosis and treatment,” she explained. 

“At every stage, there can be behavioural barriers, operational bottlenecks, and capacity constraints.”

This is especially important under Healthier SG, Professor Gao continued, as Singapore is making “a major shift toward preventive healthcare.” But while the ambition to detect and manage disease earlier has to be applauded, it is not enough to just aim for raising screening uptake, she said.

“If follow-up diagnostic capacity is limited, or if patients do not complete the care pathway, the full benefit of screening may not be realised,” Professor Gao noted.

“That is the motivation behind this grant.” 

Through it, the research will help develop data-driven models and decision-support tools to help decision-makers “evaluate how different screening strategies affect patient outcomes, waiting times, diagnostic workload, and long-term healthcare resource use.”

The PHRG project is part of a long-term collaboration between SMU, MOH, Singapore Health Services – the country’s largest public healthcare group – and the National University of Singapore. Professor Gao is the project’s principal investigator (PI), alongside co-PIs Zhichao Zheng from SMU, Shao Wei Lam from SingHealth, and Ang Tiing Leong from Changi General Hospital.

Knowledge gaps

A key aim of Enhancing Preventive Healthcare, which builds on Professor Gao’s earlier research with colorectal cancer screening, is to fill up key knowledge gaps that “hinder evidence-based planning for Singapore’s preventive care agenda.” For example, the proposal sets out, there is insufficient data on the resources available to tackle any short-term rise in preventive screening demand. Also, while current research focuses on barriers to screening, it overlooks how they co-evolve with patient behaviour: while improved access and shorter queues can restore confidence, reduce financial fears and encourage screening, it could also “sow the seeds of future congestion.”

Indeed, even with low cancer screening rates, there are still long queues for scopes or diagnostic follow-ups in Singapore. According to a 2022 MOH parliamentary reply, the median waiting time for colonoscopy in public hospitals was approximately 38 days in 2021, up from about 31 days in 2019, with a small number of subsidised patients waiting more than five months. 

While this seems contradictory at first glance, Professor Gao noted that they are not mutually exclusive. For instance, a small group of screening participants that tested positive may create substantial demand for downstream diagnostic services, particularly since screening tests are designed to be highly sensitive. Highly sensitive tests can also result in more false positives, which adds to follow-up demand. Methodologically, Professor Gao continued, the project will also combine quantifiable real-world healthcare data with simulation modelling and optimisation, alongside behavioural insights. The grant, she added, will move the research from colorectal cancer screening to a broader preventive healthcare setting under Healthier SG.

 “The key policy question is not just ‘How do we get more people to screen?’ but also ‘How do we design screening and follow-up pathways so that limited diagnostic capacity is used where it creates the greatest health benefit?’” she noted.

“We need to understand not only what people know, but also what they believe, whom they trust, what barriers they face.”

A journey, not a test

Enhancing Preventive Healthcare is expected to take three years to complete, with the team building its foundation right now. This includes defining study perimeters and working with healthcare partners on data access and governance. 

What fascinates Professor Gao is how much preventive healthcare depends on what comes after one is invited to screen or test.

Ultimately, health screening is more of a journey than just an exercise to test for illness, she continued. She hopes her latest project can improve earlier detection, patient follow-up, as well as wait times and processes.

This will also, the project proposal states, “reduce the burden of late-stage treatment, improve survivorship, and generate substantial national cost savings” through more efficient resource use. In the long term, it is expected to help lower cancer-related deaths.

“It is tempting to think that the main problem is awareness: if people knew screening is important, they will do it,” Professor Gao said.

“But in reality, the pathway is much more fragile. More screening is not automatically better unless the system is ready.”

Back to Research@SMU August 2026 Issue