From The Straits Times    |

Image: Aleksej Zhagunov / 123rf

Cervical cancer is the 10th most common cancer among Singaporean women. According to the Singapore Cancer Society, almost 200 new cases are diagnosed and 70 deaths from the disease occur each year. Yet, The Singapore HPV Survey, conducted between August and September 2015, found that most women in Singapore have no idea what causes it. A substantial number of women are also not aware of the tests that can help prevent them from developing the disease. 

The Pap test, also known as the Pap smear, is the current method used to screen for cervical cancer. Unfortunately it is not the best way to detect the disease. In fact, a study, published in May 2005 in the Journal of the National Cancer Institute revealed that nearly one-third of the women who were diagnosed with cervical cancer had one or more negative Pap tests within the three years prior to their diagnosis. As the Pap test might have a risk of false negative results, there is a need for a more accurate screening test to prevent the disease.

How does cervical cancer develop?

Cervical cancer is cancer that arises from the tissues of the cervix, which is the neck of the womb. It is normal for cells lining the surface of the cervix to undergo changes over the years. However in rare instances these changed cells can become cancerous. 

The cells in our body grow in an orderly fashion, but genetic damage can cause them to multiply out of control, leading to a tumour or an abnormal growth. If the tumour is not cancerous, it is diagnosed as “benign”. A cancerous tumour, on the other hand is “malignant”.

Polyps, cysts and genital warts are examples of benign tumours in the cervix. A malignant tumour is a growth that is made up of cancer cells that continue to multiply. These tumours invade surrounding tissues and organs, where they cause damage. If some cells break off from the tumour they can travel through the bloodstream or lymph channels to other parts of the body, where they then invade these tissues. When this happens, the cancer is said to have metastasised.

The link between cervical cancer and HPV

According to World Health Organisation, HPV (the Human Papillomavirus) is the leading cause of cervical cancer, causing more than 99 per cent of cases. HPVs are a group of more than 100 related viruses. These viruses live in the body’s epithelial cells and they are common, affecting at least four out of five women at some stage in their lives. About 40 HPVs are transmitted through direct sexual contact, including vaginal, anal and oral sex. Generally, there are no symptoms of HPV infection or cervical pre-cancer, so most women do not know if they have it.

In the majority of the HPV infection cases, the virus clears by itself and the cervical cells return to normal. But in some cases, the infection can persist and cause the cells to grow in an abnormal way, developing into cervical cancer. 

Not all of the 40 sexually transmitted HPV viruses cause serious health problems. The highest-risk strains of the virus include types 16 and 18, which are responsible for about 70 per cent of cervical cancer cases worldwide. 

Cervical cancer types and symptoms

There are two types of cervical cancer: The most common is squamous cell cervical cancer, which develops from a skin-like cell (a squamous cell) that covers the cervix and becomes cancerous. The other type, called adenocarcinoma cervical cancer, is not as common. This develops from a glandular cell in the cervical canal, which becomes cancerous. 

In the early stages of cervical cancer, symptoms aren’t usually present. However, as the disease progresses, it may display a few signs, such as vaginal bleeding following sexual intercourse or in-between periods or after menopause; watery, bloody vaginal discharge that may be heavy and have a foul smell; and lower abdominal pain or pain during sex. 

That Pap smear is not enough

If you’ve had a Pap smear before, you’ll know that this quick and simple test is used to check for changes to the cells of the cervix that may lead to cervical cancer. But alarmingly, The Singapore HPV Survey found that two in five women between the ages of 25 and 55 have never undergone a Pap test. 

Regular Pap tests are definitely important, but unfortunately they are not able to detect HPV. Now, doctors in Singapore are also recommending that their patients undergo HPV screening. The high-risk HPV test helps to identify the 14 most prevalent high-risk HPV genotypes, providing specific genotyping information for HPV types 16 and 18.

You can have HPV – even if you’re in a monogamous relationship

Dr Chia Yin Nin, a gynaecologist, and President of the Society for Colposcopy and Cervical Pathology of Singapore urges all women to take the time to understand HPV and cervical cancer. “Any woman who is sexually active, even with just one partner, could be exposed to HPV,” she explains. “Therefore, women cannot assume that they will not have HPV, even if they are in a monogamous relationship. It is imperative for women to talk to their doctors about screening options so that they can live life to the fullest during their prime years.”

Dr Chia adds that she highly recommends that women go for cervical cancer screening, using both the Pap smear and high-risk HPV test for more accurate results. “Prior to the development of the high-risk HPV test, the Pap smear was the default option,” she says. “The advent of technological advancements has enabled us to precisely detect the presence of HPV directly with the high-risk HPV test. This means that the high-risk HPV test can be used as a primary screening method or co-tested with the Pap smear. Screening is an essential first step in cervical cancer prevention. It is time for women to take health matters into their own hands.”

Do you have a high risk of developing cervical cancer?

According to the Health Promotion Board, you are considered high-risk if you: 

  • Have a HPV infection
  • Are Human Immunodeficiency Virus (HIV)-positive
  • Have a weakened immune system, also known as immunosuppression, which may result from certain diseases such as HIV/AIDS, or from immune-system suppressing drugs such as steroids, which are often given to organ transplant patients
  • Have multiple sexual partners
  • Had sexual intercourse at an early age
  • Have a history of sexually transmitted infections such as genital warts or genital herpes
  • Have been taking combined oral contraceptive pills (birth control pills) for a long period of time
  • Smoke cigarettes

Cervical cancer can be effectively treated, which is why early detection is so important. In addition to screening, the most recommended ways to reduce your risk is to speak to your doctor about HPV vaccination, delaying your first sexual intercourse, having fewer sexual partners, and avoiding or stopping smoking.

 

For more tips, check out these 5 ways to keep your cervix healthy