Regular screening is the single most effective way to prevent cervical cancer, one of the most treatable cancers for women

When pre-cancerous changes in the cervix are detected early, it is much easier for a woman to beat the odds of getting cervical cancer later.

“Cervical cancer is the tenth most common cancer affecting women in Singapore,” says Associate Professor Tan Hak Koon, Senior Consultant and Head, Department of Obstetrics & Gynaecology, Singapore General Hospital (SGH), a member of the SingHealth group.

“Pre-cancerous changes usually show no symptoms. The only way to detect any abnormality is through regular cervical cancer screening. Screening also checks for HPV (human papillomavirus) infection which must be treated early to prevent it from progressing to cervical cancer,” adds A/Prof Tan.

What is the cervix?

The cervix is located at the neck of the uterus; it widens during childbirth and is the passageway for menstrual fluid to flow out of the uterus, or for sperm to travel up into the uterus.

Being the passageway, the cervix is susceptible to virus infections such as the sexually-transmitted HPV. The body’s immune system will normally prevent the HPV from doing any harm. But what if the virus survives and stays in the body for years? A pre-cancerous condition called cervical dysplasia may develop if the virus is one of the 13 types of HPV known to cause cervical cancer.

What to do when a Pap smear shows pre-cancerous changes…

First, do not panic. Pre-cancerous cells are not cervical cancer. They are simply abnormal-looking cervical cells. Your doctor may recommend a repeat Pap smear or any of these procedures:

Colposcopy examination

A colposcopy scrutinises the cervix through an instrument with a magnifying lens. If pre-cancerous changes are confirmed, the doctor may recommend a cone biopsy or loop electrosurgical excision procedure (LEEP).

Cone biopsy

A cone biopsy removes a cone-shaped piece of the abnormal cervical tissue to be examined for any malignancy. It can also be used to remove the entire abnormality, thereby clearing away any pre-cancerous cells.


LEEP uses an electric wire loop to cut away abnormal tissues from the mouth of the cervix. These tissues are then examined for any malignancy.


This involves freezing and killing both pre-cancerous and cancerous cells.

Laser surgery

A narrow, intense beam of light is used to kill pre-cancerous and cancerous cells.

Which treatment method will depend on the location and severity of the abnormal cervical cells, and whether a biopsy is needed.

Signs and symptoms of cervical cancer

While pre-cancerous changes in the cervix are not visible to the naked eye, symptoms of cervical cancer are more obvious. Watch out for the following symptoms of cervical cancer:

  • Vaginal bleeding between menstrual periods, after menopause or after sex
  • Bloody discharge from the vagina
  • Pelvic pain or abnormal bleeding after sex
  • Dull backache

Make cervical cancer screening a habit

Though Singapore’s cervical cancer rates have fallen in the past 30 years, the decline is slower than in the US and Europe.

If you are sexually active, aged 25 to 65, go for cervical cancer screening (Pap smear and HPV test) once every three years.

“Even if you have been vaccinated against HPV, it is still advisable to go for regular Pap smear tests,” says A/Prof Tan. “The vaccine is only effective against two types of HPV that cause 70 per cent of cervical cancer cases. Most new cervical cancer cases are found in women who have never been for a Pap smear,” A/Prof Tan cautions.

Ref: O17