Cervical cancer can be prevented with vaccination and early detection through screening tests to detect abnormal changes in the cervix, advises Prof Tay Sun Kuie, a Senior Consultant with Singapore General Hospital (SGH).
Can cervical cancer be prevented? Yes!
Most cases of cervical cancer can be prevented, says Prof Tay Sun Kuie, from the
Department of Obstetrics and Gynaecology,
Singapore General Hospital (SGH), a member of the
SingHealth Group.
Cervical cancer (cervix cancer) has a unique natural history in its development. There are abnormal cellular changes in the cervix before a cancer develops. These abnormal changes are known as cervical pre-cancer or cervical intraepithelial neoplasia (CIN). Successful treatment of CIN removes a woman’s risk of developing cervical cancer.
Infection by certain strains of human papillomavirus (HPV) is necessary for development of CIN or cervical cancer. The most important cancer-inducing HPV strains are HPV-16 and HPV-18. HPV infection is common in young women after sexual debut. Vaccination during adolescence against these HPV infections is an effective method in reducing a woman’s risk of cervical cancer in later years of life.
Cervical cancer facts in Singapore
Cervical cancer is the 8th highest cause of cancer deaths among women.
Between 2010 and 2014, 998 women were diagnosed with cervical cancer
357 deaths from cervical cancer were reported with majority of cases diagnosed at stage I and II.
Chinese women were at the highest risk with 817 cases as against their Malay (119) and Indian (33) counterparts.
Nearly 48% of the new cases diagnosed were women aged 54 years and younger.
What should I do to prevent cervical cancer?
Your life is in your hands. Depending on your age, you may take the following strategies to protect yourself against cervical cancer:
HPV vaccination
In Singapore, HPV vaccines can be administered to females between 9 and 26 years old. A full vaccination includes three vaccine doses spread over a 6-month period. Vaccine efficacy is extremely high for women who have never been exposed to HPV-16 and HPV-18 infection and the protection is long-lasting.
More than two hundred million doses of vaccines have been administered to girls and women worldwide since 2006. Records have shown that the safety profile of these vaccines is very good. Development of vaccine-related severe medical adverse events is rare.
Cervical cancer/CIN screening
The role of screening is to detect CIN and/or cervical cancer before they become an obvious disease.
In 2013, SGH spearheaded a new screening program incorporating the Pap smear and HPV DNA testing for HPV-16, HPV-18 and 12 other cancer-inducing HPV strains. This new screening method combines the advantages of a Pap test and a HPV test in the same setting, and allows CIN to be detected early. It thus reduces the incidence of cervical cancer.
If a woman has a negative test, her risk for cervical cancer is extremely low in the next decade. She can confidently lengthen her screening interval to five years. This has been shown to be more cost-effective than conventional Pap smear screening alone.
There are three possible outcomes of screening:
No abnormality detected. Go for the next screening test in five years.
Mild abnormality is present. Requires a follow-up test in one year.
Abnormal results. This warrants further investigation with colposcopy.
Who should go for cervical cancer screening?
Screening targets women, 25 years or older, who have had sexual intercourse.
Screening is recommended regardless of previous HPV vaccination.
Screening is for all women, regardless of family history of cancer, history of pregnancy and childbirth, number of sexual partners, method of contraception, and smoking habits.
Screening is repeated every five years if the woman remains well, has no abnormal changes in vaginal bleeding or discharge, and has no abnormal cervical findings on routine medical examination.
Screening should continue after menopause regardless of cessation of sexual intercourse.
Screening can cease if a woman has an operation to remove her uterus.
Timely eradication of CIN
Cancer development can be prevented only if CIN is treated early.
In 75 per cent of cases, grade-2 or grade-3 CIN can be effectively treated with a simple surgery known as LEEP or Loop Electro-Excision Procedure.
This is an office procedure done with local anaesthetic.
Approximately 25 per cent of cases of grade-3 CIN are treated with a surgery known as cone biopsy. In this procedure, a central portion of the cervix is removed. In most instances, the surgery is done with laser surgery in an operation suite.
More than 90 per cent of cases have successful cure of CIN with one treatment only. The remaining cases are cleared of CIN in subsequent treatments.
If I do a cervical screening test at 5-year intervals, should I continue with my yearly gynaecological check-ups?
You should not change your routine visit to your gynaecologist. Although your cervical cancer screening is done at 5-year interval, you still need to see your gynaecologist for a number of reasons, for example:
Screening of other diseases;
Managing menstrual problems, contraception, or fertility issues;
Treatment of genital infections; and
Managing menopausal issues.
What is cervical cancer?
Cervical cancer is a malignant tumour or growth arising from the cervix.
The cervix or “neck of the womb” is the lower portion of the uterus that opens into the vagina.
Early cervical cancer is silent
Advanced cervical cancer may show the following symptoms:
Irregular vaginal bleeding
Foul-smelling or blood-stained vaginal discharge
Bleeding during or after sexual intercourse
Global cancer statistics showed that, in 2012, cervical cancer was the third most common cancer among women. In Singapore, the incidence of cervical cancer has been declining over the last three decades but the disease still remain one of the most common cancers in women.
Every year, more than 200 Singaporean women are diagnosed with cervical cancer and 100 women die from it.
How can cervical cancer be detected early?
On inspection and palpation of the cervix during examination of the pelvis, a doctor may detect a lump in the cervix and raise a suspicion of an early cancer. A very early cancer - before it is visible to the naked eyes - can be detected with a screening Pap smear test and the diagnosis confirmed with a special examination known as colposcopy.
Early cervical cancer carries a very good cure rate. In young women, treatment can be tailored to preserve fertility.
Ref: I23 (edit)
