02 May 2010
Madam Lynsey Yap had always prided herself on being in control of her health. In 2004, at the age of 46, she went for a routine full body checkup. Little did she expect her Pap smear results would indicate early signs of cervical cancer.
She was referred to Associate Professor Tay Sun Kuie, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH), for a second opinion. Further examination and a biopsy confirmed that Mdm Yap had adenocarcinoma of the cervix, a type of cervical cancer with a risk of spreading to the ovaries. Assoc Prof Tay performed a radical hysterectomy on Mdm Yap, which involved the surgical removal ofher uterus, ovaries and the lymph nodes surrounding the area.
A silent but deadly killer Cervical cancer is the sixth most common cancer affecting Singaporean women, claiming 200 lives a year. It has a reputation as a silent killer with little or no symptoms in its early stages. In the later stages, symptoms may include pain during intercourse, bleeding between periods or pelvic pain. One out of every six women diagnosed with early-stage cervical cancer will die from it, half of them within five years.
Nearly all cases of cervical cancer are linked to 15 out of more than 100 – mostly harmless and common – strains of the human papillomavirus (HPV). In Singapore, about 35 per cent of women in their early 20s and 10-to-12 per cent of women in their late 30s to early 40s test positive for genital HPV. Most infections clear up on their own but a small proportion of the cases will progress to cervical cancer, sometimes up to 15 years after the person has been infected.
“The virus can infect a girl during adolescence and gradually induce changes in the cells on the cervix until a pre-cancer develops in young adulthood and cancer during middle age or later in life,” said Assoc Prof Tay.
Most infections that lead to cervical cancer occur during sexual activity.
Condom use cannot completely protect against HPV as the virus may be presenton the parts of the genital area that are not covered by a condom.
“HPV can also be contracted through non-sexual skin contact, sharing wet towels or walking on wet floors in gym shower rooms,” said Assoc Prof Tay.
However, the virus has to be introduced internally for it to cause cervical cancer.
So, women who have never had sexual intercourse have a “very low risk of getting cervical cancer,” he said.Prevention is possible Although it can be deadly, cervical cancer is easily prevented, said Assoc Prof Tay.
“Delaying the onset of sexual intercourse, quitting smoking, avoiding multiple sexual partners and adopting healthy dietary habits can have a significant impact on minimising risk. A Pap smear every threeyears will help to catch the disease in its early stages and allow patients to get treatment.”
Assoc Prof Tay also recommended vaccination to provide women with lifelong immunity against HPV.
Most importantly, more needs to be done to raise awareness about HPV and its link to cervical cancer. A recent study found that 75 per cent of Singaporean women had never heard of HPV.
Several misconceptions also need to be cleared up. For example, some women think they can’t get HPV because they are no longer sexually active or are faithful to their partners. Many older women also wrongly assume that they won’t get cervical cancer after they reach menopause or stop having sex.
“Since HPV infections are so common, it’s likely that the seed has been planted and cervical cancer can occur at any time,” said Assoc Prof Tay. “So it’s important to remain vigilant.”
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