Despite cervical cancer being potentially preventable, it is the third most common cancer among women in Malaysia – accounted for 6.0% of all female cancers (an age standardised incidence rate of 6.2 per 100,000), according to the National Cancer Registry Report 2012 - 2016. Cervical cancer develops in a woman’s cervix, i.e. the bottom part of the uterus that opens into the vagina.
(Anatomy time!)
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Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are abnormal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.
Sure, everyone fears cancers because if there’s anything the soap opera TV shows (or korean drama in the early days) teach us is that cancers are usually incurable.
This is not entirely true as far as cervical cancer is concerned. Screening tests can find cervical dysplasia and cervical cancer in the early stages when it can be treated, thus raising your chances of survival.
What can increase your risk of developing cervical cancer?
Before we discuss the details of cervical cancer screening, let’s understand who are at higher risks of cervical cancer and therefore are encouraged to go for screening.
Simply put, all women are at risk of cervical cancer, especially women who aged 30 years old and above. The major risk factor for cervical cancer, however, is the human papillomavirus (HPV) infection, an extremely common virus transmitted through sexual contact. In fact, almost all cervical cancers (99%) are linked to HPV infections.
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Weird huh? A virus that can cause cancer?!
HPV is so common that most people get it at some time in their lives, especially women with a sexually active lifestyle. HPV usually causes no symptoms so a woman can’t tell that she has it. Regarding how HPV causes cervical cancer, we discussed at length in this article previously.
To summarise, not all HPV viruses can lead to cancer, and not all women who are infected with cancer-causing HPV go on to develop cervical cancer (in fact, about 10% of them do). But when a woman indeed is infected by cancer-causing HPV, and her immune system somehow fails to get rid of the virus, it can linger over time and turn normal cells at the cervix into cervical dysplasia , and then potentially cervical cancer.
Besides HPV infection, other things that can increase your risk of cervical cancer are:
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Exposed to diethylstilbestrol (DES) – DES is a synthetic form of female estrogen prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor and pregnancy complications. However, its use has been banned as more studies found out that not only DES is not effective at preventing those problems, it also increases lower genital tract cancers in the users’ daughters. If you are a daughter of women who took DES during pregnancy, you should have more frequent screening for vaginal and cervical cancers.
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Using birth control pills over five or more years – Good news is, the meta-analysis also found out that cervical cancer risk declined after stopping the birth control pill, and by 10 or more years the risk of cervical cancer returned to that of someone who has never used a birth control pill.
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Early age at first birth (younger than 20 years old) and having given birth to three or more children – these are likely due to exposure to HPV through sexual intercourse
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Early onset of sexual activity and having several sexual partners – Compared with one partner, the risk is approximately twofold with two partners and threefold with six or more partners.
Screening for cervical cancer
There are two screening tests can help prevent cervical cancer or find it early:
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The Pap test (or Pap smear)
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The HPV test looks for the virus’s DNA or RNA
Pap smear
Pap smear is a procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. If the cells are abnormal, it will alarm your doctor and a biopsy may be carried out subsequently to further confirm the diagnosis.
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HPV test
The sample that is used for pap smear can be used for HPV test as well – the cells collected are checked to find out if there is any presence of the HPV’s genetic materials inside (present as DNA or RNA). This tells your doctor whether you are infected by HPV and therefore at risk for cervical cancer.
The National Cancer Society Malaysia provides cervical cancer screenings for the pricing below. Nonetheless, you can get any of those tests in your nearby clinics or hospitals.
If you are aged 30 years old and above, doing both pap smear and HPV test every 5 years finds more cervical changes that can lead to cancer than screening with the pap smear alone.
In healthy people, screening before age 21 is not recommended regardless of sexual activity; there is a high risk of "false positive" results since many HPV infections in this age group are only temporary and do not lead to cancer. In some cases, false-positive results could lead to unnecessary procedures which could cause problems with future pregnancies.
After you turn 20, you are recommended to get yourself vaccinated before you are sexually active and a pap smear test once every 3 years after you turn 20.
Preventing cervical cancer
The most cost-effective public health measure against cervical cancer is HPV vaccination targets at young girls before they become sexually active. HPV vaccines work best if administered prior to exposure to HPV.
In 2019, HPV vaccination is FREE to Malaysian citizens or Permanent Resident (PR), female born in 1992-1996, single/not yet married, not pregnant and have not suffered from severe allergies that require treatment at a hospital. You may get the vaccination at any nearby Nur Sejahtera Clinics, LPPKN. LPPKN also goes to secondary schools to offer onsite vaccination for eligible females.
While the offering of HPV vaccination by LPPKN in 2020 is unclear (perhaps due to COVID-19 pandemic), you can still approach your nearby clinics to get a HPV vaccination.
Meanwhile, beware of the possible signs and symptoms of advanced cervical cancer (early cervical cancer may not have signs and symptoms):
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Blood spots or light bleeding between or following periods
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Menstrual bleeding that is heavier than usual
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Bleeding after menopause
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Bleeding after sexual intercourse
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Increased vaginal discharge
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Pain during sexual intercourse
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Unexplained, persistent pelvic and/or back pain
We are not saying that if you experience any of these you definitely have cervical cancer. Nevertheless these are not normal things to put up either. You should see a doctor for physical examination if you experience these issues.
References
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NIH National Cancer Institute - Cervical Cancer Screening (PDQ®)–Patient Version
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UpToDate - Patient education: Cervical cancer screening (Beyond the Basics)
