According to World Health Organization, cervical cancer is regarded as the most preventable cancer, yet it remains the fourth most frequently diagnosed cancer in women worldwide, with an estimated 604,000 new cases per year. This malignancy is responsible for the deaths of about 311,000 women annually¹.
In Singapore, cervical cancer ranks as the tenth most prevalent cancer among females. More than two hundred Singaporean women are diagnosed with cervical cancer each year. Most cases of cervical cancer can be traced back to exposure to certain human papillomavirus (HPV) strains².
What are the causes of Cervical Cancer?
The cervix (the female reproductive organ that opens into the uterus) is the site of development for cervical cancer³. Today, we know that nearly all cases of this malignancy (96–99%) are caused by infection with high-risk human papillomaviruses (HPV). It is predicted that one in two women will become infected with HPV at some point in their lives. Fortunately, most infections clear up on their own without any symptoms.
However, prolonged infection with the virus may cause cervical cancer in a particular group of women. If detected early, cervical cancer is highly curable. Screening procedures (such as the Pap smear and the human papillomavirus (HPV) test) allow for early detection of cervical cancer, making it one of the most preventable forms of cancer. Vaccines against human papillomavirus (HPV) are also useful for preventing infection⁴.
What is the HPV vaccine and where can I get one?
HPV vaccination can be used as a primary method of preventing cervical cancer. Since 2007, schools and polyclinics in Singapore have been able to access and administer the first generation of HPV vaccinations. This vaccination specifically targets types 16 and 18, which account for up to 70% of all cervical malignancies. Many studies have proved their effectiveness, and they have been linked in many national screening programs worldwide.
The FDA licensed the 9-valent vaccine’s second generation in 2014, and it became widely available in Singapore the following year. It has been stated that this newer vaccination can prevent up to 90% of the diseases that it targets, including 7 high-risk types (16,18,31,33,45,52,58) and 2 low-risk types (6,11). The healthcare and cosmetics industries rely heavily on it. More than 99% of girls and women between the ages of 9 and 26 who received the vaccine developed antibodies against all 9 kinds of HPV, and the vaccine was not worse than the first generation vaccines⁵, according to a big clinical trial. Subsequent research confirmed that vaccinating women up to the age of 45 is safe and effective.
The vaccine is built from proteins that only vaguely resemble the outside of the high-risk HPV viruses and does not really contain the HPV virus. The vaccine causes the body to produce antibodies, which defend against subsequent viral infections. There is no solid evidence linking the vaccine to any serious adverse events or health problems5, and it has been demonstrated to be safe. There is no need for a booster shot because the vaccination is so effective.
Since 2010, the Ministry of Health has encouraged all females between the ages of 9 and 26 to get the HPV vaccine. Vaccination against human papillomavirus (HPV) is covered by MediSave for all women under the age of 26 in all polyclinics and qualified clinics. All female students entering Secondary One in 2019 have the option of participating in a nationwide school-based immunization program in 2019 and receiving a free HPV vaccination to protect against cervical cancer. Two doses are sufficient for young women (ages 9–14), whereas three doses are required for females aged 15 and over.
Which Cervical Screening Test Should I Take?
Cervical cancer screening enables the early diagnosis of cervix abnormalities prior to the onset of cancer. Cervical intraepithelial neoplasia describes these precancerous alterations. In the long run, if CIN isn’t treated, it can develop into an aggressive form of cancer.
1. Pap smear
Many women’s lives have been spared thanks to the development of pap smears for the purpose of detecting these changes. However, clinical research has shown that the pap smear has a low sensitivity (between 48.6% and 57.4%) and a specificity (96.1 to 96.5%)⁶.
2. High-Risk Human Papillomavirus (HPV) Test
Thankfully, the pap smear has been superseded as the gold standard in cervical cancer screening by a new test: the HPV test. A woman’s susceptibility to cervix cancer can now be determined using a simple blood test. Although it is less specific than the pap smear, this test is excellent for early diagnosis and is more sensitive in detecting women with CIN2+ lesions. While a positive HPV test result could indicate precancerous lesions on the cervix, a negative result greatly reduces the likelihood that a woman has any such abnormalities. Compared to women who had negative pap smear results, women whose HPV tests came back negative had a much lower risk of acquiring cervical cancer.
The Health Promotion Board’s National Cervical Cancer Screening Program in Singapore strongly encourages sexually active women between the ages of 30 and 69 to get screened for cervical cancer with the HR HPV test every three years from 2019⁷. Conversely, women between the ages of 25 and 29 are strongly urged to get a pap smear because of the increased likelihood of identifying asymptomatic HPV infections.
The next screening can be performed after 5 years if the HR HPV test is negative, indicating a less-than-1% risk of developing cancer. Screenings can be spaced out every three years if the initial pap test turns up negative. Under Singapore’s Screen for Life National Health Screening Program, locals and PRs can get screened at a reduced rate.
Conclusion
In conclusion, healthy people should get cervical cancer screenings as soon as possible. Vaccination is an essential step toward reducing your risk of developing cervical cancer, so if you haven’t already gotten the HPV vaccination, talk to your doctor about whether or not you’re a good candidate for it. Finally, limiting the number of sexual partners you have, not smoking, and utilizing a barrier method of contraception can all help decrease the spread of this fatal disease.
References:
https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
https://www.singhealth.com.sg/patient-care/conditions-treatments/cervix-cervical-cancer
https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/cervical-cancer.html
https://www.singhealth.com.sg/patient-care/conditions-treatments/cervix-cervical-cancer
A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. Joura et al. N Engl J Med. 2015 Feb 19;372(8):711-23. doi: 10.1056/NEJMoa1405044.
Overview of the European and North American studies on HPV testing in primary cervical cancer screening. J. Cuzick, C. Clavel, K.U. Petry, C.J. Meijer, H. Hoyer, S. Ratnam, et al. Int J Canc, 119 (2006), pp. 1095-1101
https://www.healthhub.sg/programmes/61/Screen_for_Life/screening-journey