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Anthea Rowan

In the final instalment of a six-part Health Matters wellness series on cancer in Hong Kong, Anthea Rowan explores how genetics, lifestyle and chance intersect in cancer risk and why early detection matters.
Tom Hutchins did not find a lump. What he noticed instead – a tiny, almost imperceptible dot – was enough to change his life.
The Hong Kong-based business director, who has lived in the city for a decade, was just 30 when he was diagnosed with testicular cancer. He first spotted something unusual during a routine check in the shower.
“Not even a lump, really. More like a dot,” Hutchins recalled, saying it was his girlfriend who urged him to see a doctor immediately.
At his first appointment, the doctor outlined the possible next steps if the speck proved to be malignant. That early clarity helped later: when the diagnosis came, Hutchins already knew what to expect, softening the shock.

While testicular cancer is relatively rare overall, it is the most common cancer affecting men aged 15 to 35. Early warning signs often include a painless lump, swelling, or a feeling of heaviness in one testicle. Some men experience a dull ache in the lower abdomen, groin or scrotum.
Hutchins’ experience is a reminder that no one is entirely immune to cancer and that the disease rarely stems from a single cause, according to medical experts.
Many cancers, however, are highly treatable when detected early and a significant proportion are preventable. In Hong Kong and globally, researchers increasingly point to simple lifestyle changes that can radically reduce risk.
Hutchins underwent surgery to remove the affected testicle to prevent the cancer from spreading to the other one or nearby lymph nodes.
He then received preventive chemotherapy to eliminate any remaining cancer cells. The treatment was grim, he said, leaving him tired, achy and largely confined to his home for weeks.
Family history can increase the likelihood of developing testicular cancer. Certain inherited conditions, such as Klinefelter syndrome, where a male is born with an extra X chromosome, also raise risk. But Hutchins had no known genetic predisposition.
Some people carried gene mutations that increased cancer risk, said Professor Anne Lee Wing-mui of the University of Hong Kong-Shenzhen Hospital, vice-chairman of the Hong Kong Anti-Cancer Society and Hong Kong ambassador of the World Cancer Research Fund.
“It is estimated that less than 10 per cent of all cancers are linked to the genes that we inherit,” Lee said.
These include familial cancer syndromes such as BRCA1/2, Lynch syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and von Hippel-Lindau disease.
Since about 90 per cent of cancers are sporadic, anyone can develop the disease, regardless of DNA.
This did not mean fully formed cancer cells were constantly circulating in the body, said Dr Min-Han Tan, founding CEO and medical director at Lucence, a company specialising in non-invasive blood tests for early cancer detection.




Each day, the body produced damaged or mutated cells that were usually eliminated by immune defences and cellular repair mechanisms, Tan said.
“Cancer only occurs if these protective barriers fail and mutated cells begin to divide uncontrollably,” he added.
Dr Danny So, a senior scientist at Pangenia, a Hong Kong-based biotechnology firm specialising in molecular diagnostics, said a single genetic error was rarely enough to trigger cancer.
“When the DNA code is wrong, the cell produces a faulty protein,” So said. “The cell may not function properly, but it typically dies.”
Problems arise when abnormal cells evade destruction and begin to multiply. Even then, the immune system provides another layer of defence through a process known as immune surveillance, in which cells identify and destroy rogue cells.
“When our immune system fails to recognise abnormal cells and they keep dividing, they grow and spread. This is cancer. It takes more than one mistake in the system,” he said.
As people grow older, accumulated cellular mutations and declining immune function make age the single most significant risk factor for cancer.
Yet, inheriting a high-risk mutation does not guarantee disease.
“Even with a BRCA1 or BRCA2 mutation, you may never develop cancer,” So noted.
Cancer typically arises from a complex interplay of genetic predisposition, environmental exposure and everyday biological processes. Chronic infections can also play a role.
Hepatitis B and C viruses can lead to liver cancer, while the human papillomavirus (HPV) is the primary cause of cervical cancer.
This interplay is particularly relevant in southern China. While the Epstein-Barr virus (EBV) is widespread globally, it rarely causes cancer on its own.
But people of southern Chinese descent are more susceptible to developing nasopharyngeal carcinoma (NPC) when exposed to it.
Environmental and lifestyle factors can further compound risk. Radiation from naturally occurring radon gas can contribute to lung cancer, while ultraviolet exposure damages skin cells. Even prolonged exposure to poorly ventilated cooking fumes has been linked to elevated lung cancer risk.
Alcohol consumption also played a role, So said, adding that it acted as a solvent, increasing the body’s absorption of other carcinogens.
“Alcohol affects hormonal levels that may fuel cancerous cells, but its intermediate metabolite, acetaldehyde, is definitely cancer-causing as it binds to DNA and is likely to cause more errors during DNA replication,” he said.
He also said that more than 40 per cent of cancers were preventable.
Aside from quitting smoking, Lee emphasised basic lifestyle measures: regular exercise, limiting alcohol, avoiding excessive sun exposure, maintaining a healthy weight and eating a diet rich in fibre, fruits, vegetables and legumes while reducing processed meat intake.




Preventing infections is another key strategy. Vaccines for HPV and hepatitis B are highly effective; more than 99 per cent of cervical cancers are linked to HPV, while hepatitis B accounts for roughly half of liver cancer cases globally.
Combined with regular screenings, such as mammograms, Pap smears and colonoscopies, these measures formed a critical safety net, Tan added.
“The best shield against cancer is to just stay healthy,” So said with a laugh. “That is the most rubbish thing I have ever said. But it’s true.”
Cancer is common and everyone carries some level of risk. While “it’s virtually impossible to reduce risk to zero”, even small, consistent lifestyle changes can make a meaningful difference, according to So.
In Hutchins’ case, no single cause can be identified, though his age and Caucasian ethnicity placed him in a higher-risk group.
Most testicular cancers originate from germ cell neoplasia in situ (GCNIS), abnormal cells that develop in the testicles. Previously known as carcinoma in situ, these cells are not initially malignant, but if left untreated, about half of men with GCNIS will develop testicular cancer within five years.
What likely made the difference for Hutchins was early detection. He performed regular self-examinations, noticed the subtle abnormality and sought medical attention quickly.
Now 32, he is healthy, active and more attuned to his body.
“I try and rest if I need it,” said Hutchins, a keen dragon boater, golfer and gym-goer. “Before, I would be swept up in the craziness of Hong Kong and all there is to do here.”
He said he now advocated for early diagnosis, noting that men in particular often ignored minor symptoms.
“Testicular cancer is not great, but it is highly treatable if it is caught early,” he said.
The problem, he added, was that men “do not talk about their health as much as they should”.
For others facing cancer, his message is: “You’re not alone. It’s not uncommon.
“There’s a big community of people with stories similar to yours who are happy to talk about it.”


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Although about 90 per cent of cancers are sporadic and can affect anyone regardless of genetics, experts say small, sustained lifestyle changes can still significantly reduce risk


Although about 90 per cent of cancers are sporadic and can affect anyone regardless of genetics, experts say small, sustained lifestyle changes can still significantly reduce risk.
