Renowned Pathologist K. Shanmugaratnam Dies At 97 (In Memoriam) – By Sim Shuzhen

AsianScientist (Jul. 30, 2018) – Professor Kanagaratnam Shanmugaratnam, a renowned pathologist best known for establishing the Singapore Cancer Registry (SCR), died on July 28, 2018 at his home in Singapore. He was 97.

Shanmugaratnam was emeritus consultant at the National University Hospital (NUH) and emeritus professor of pathology at the National University of Singapore (NUS). Widely regarded as Singapore’s ‘father of pathology,’ he reported daily to work well into his nineties, holding fortnightly seminars for trainee doctors and consulting on difficult cases referred to him by colleagues.

In addition to establishing the SCR, a repository of data valued by clinicians, researchers and public health administrators alike, Shanmugaratnam was also a world-leading expert on nasopharyngeal carcinoma (NPC), a cancer of the upper respiratory tract which disproportionately affects ethnic Chinese.

“[Shanmugaratnam] was a much-respected and revered luminary in the NUS community. His keen intellect and dedication to his work and research in pathology were legendary… the university mourns the loss of a giant in Singapore medicine,” said NUS president Professor Tan Eng Chye in a statement.

The early years

Shanmugaratnam was born on April 2, 1921 at the Lanka Dispensary, Singapore. The eldest of five children, he enrolled at Singapore’s King Edward VII College of Medicine in 1938, but the Japanese occupation of Singapore during World War II put his studies on hold.

To avoid being taken away for manual labor, Shanmugaratnam found work at the bacteriology and serology laboratories established by the Japanese Army Medical Corps at the College of Medicine building. He also worked at the Chuo Byoin or Central Hospital (later the KK Women’s and Children’s Hospital), which served as a general hospital for local and Japanese civilians.

Despite the hardships and deprivations of the war, it was also during this period that Shanmugaratnam developed an interest in pathology, he told Asian Scientist Magazine in a 2015 interview. Resuming his classes after the war, Shanmugaratnam graduated from the College of Medicine in 1947, and joined the Government Medical Service as an assistant pathologist. Later, he went on to complete a PhD in pathology at the University of London in 1957.

From punch cards to a nation-wide registry

In 1950, histology services—the use of microscopy to study diseased tissues—for the whole island were provided by the government’s department of pathology, where Shanmugaratnam was based. Keen on studying local disease patterns, Shanmugaratnam began keeping a simple card index of all histologically diagnosed cancers in Singapore. This later evolved into the SCR, a nation-wide registry he founded in 1967 to catalog all cancers, whether they were diagnosed with histology, radiology or other methods.

Based at NUS, the SCR was the first comprehensive, population-based cancer registry in Southeast Asia. It was at first funded by the International Agency for Research on Cancer (IARC), a World Health Organization (WHO) agency in Lyon, France, and later by donations from the Singapore Cancer Society and research grants from NUS.

With no computers at the initial stages of operation, registering cancers was a tedious, time-consuming process. The SCR’s two secretaries and one record searcher would manually collate data—including cancer notification forms submitted by doctors, hospital discharge forms and pathology reports—and transfer it to 80-column punch cards, which were then shipped to Lyon to be read by IARC computers.

Since 1983, the SCR—which by then had acquired its own computing equipment—has published detailed reports on the incidence and patterns of various cancers in Singapore, allowing researchers to pick out interesting or unusual trends among different ethnicities, age groups, occupations, or other demographic groups.

Today, the SCR is part of the National Registry of Diseases Office, which also comprises registries for acute myocardial infarction, chronic kidney failure, stroke and trauma injuries. Shanmugaratnam served as the SCR’s director from 1968 to 2002.

“As a pathologist my main concern was diagnostic work,” he said in 2015. “But I felt that this was important data to collect. Such information is essential for the development and evaluation of cancer control programmes.”

Evolving with the times

In addition to building the SCR, Shanmugaratnam also led the development of the WHO’s detailed classification guidelines for NPC, a cancer that is rare in most countries but prevalent in southern China and Southeast Asia. Not simply an academic exercise, the accurate classification of cancers helps doctors make prognoses and determine the best course of treatment for each patient.

Shanmugaratnam mentored countless medical students over the course of his seven-decade career. He also saw the field of pathology advance from simple tissue sections and stains in the 1950s to the wide range of techniques on offer today, including electron microscopy, immunohistochemistry (the use of antibodies to label molecules in cells) and molecular diagnostics (the detection of genetic mutations in cancerous cells, for instance). Over the years, the internet-savvy Shanmugaratnam made it a priority to keep abreast of these new developments, he told Asian Scientist Magazine.

While Shanmugaratnam enjoyed reading about local history and listening to Indian classical music in his spare time, being able to continue working after his official retirement at the age of 94 gave him the most satisfaction, he said in 2015. He is survived by his wife, three children and four grandchildren.