Cervical Cancer

The newly available global cancer statistics show that, in 2012, cervical cancer was the third commonest cancer among women. In Singapore, cervical cancer has shown a declining incidence over the last three decades but remains one of the 10 most common cancers in women.

Every year, more than 200 Singaporean women are diagnosed with cervical cancer and 100 women die from it.

What is cervical cancer?

• Cervical cancer is a malignant tumour or growth arising from the cervix.
• The cervix or ’neck of the womb’ is the lower portion of the uterus that opens into the vagina.
• Early cancer is silent.
• Advanced cancer may show the following symptoms:
• Irregular vaginal bleeding
• Foul smelling or blood-stained vaginal discharge
• Bleeding during or after sexual intercourse

Can cervical cancer be prevented?

Yes! Most cases of cervical cancer can be prevented.

• Cervical cancer has a unique natural history in its development. There are abnormal cellular changes in the cervix before a cancer develops. These abnormal changes are known as cervical pre-cancer or cervical intraepithelial neoplasia (CIN). Successful treatment of CIN removes a woman’s risk of developing cervical cancer.
• Infection by certain strains of human papillomavirus (HPV) is necessary for the development of CIN or cervical cancer. The most important cancerinducing HPV strains are HPV-16 and HPV-18. HPV infection is common in young women after sexual debut.

Vaccination during adolescence against these HPV infections is an effective method in reducing a woman’s risk of cervical cancer in the later years of life.

What should I do to prevent cervical cancer?

Your life is in your hands. Depending on your age, you may take the following strategies to protect yourself against cervical cancer:

HPV vaccination:

• In Singapore, HPV vaccines are licensed for females between 9 and 26 years old. A full vaccination includes three vaccine doses spread over a six-month period. Vaccine efficacy is extremely high for women who have never been exposed to HPV-16 and HPV-18 infection and the protection period is long-lasting. More than two hundred million doses of vaccines have been administered to girls and women worldwide since 2006. Records have shown that the safety profile of these vaccines is very good Development of vaccine related severe medical adverse events is rare.
• HPV vaccination is currently available at restructured hospitals, polyclinics and private clinics.
• HPV vaccination is Medisave claimable.

Cervical cancer/CIN screening:

• The role of screening is to detect CIN and/or cervical cancer before they become an obvious disease.
• SGH spearheaded a new screening program incorporating the Pap smear and HPV DNA testing for HPV-16, HPV-18 and 12 other cancer inducing HPV strains in 2013. This new screening method combines the advantages of Pap test and HPV test in the same setting, and allows CIN to be detected early and thus reduces the incidence of cervical cancer.

If a woman has a negative test, her risk for cervical cancer is extremely unlikely in the next decade. She can confidently lengthen her screening interval to five years. This has been shown to be more cost-effective than conventional Pap smear screening alone.

• There are three possible outcomes of screening:

• No abnormality detected. Go for the next screening test in five years.
• Mild abnormality is present. Requires a follow-up test in one year.
• Abnormal results. This warrants further investigation with colposcopy.

Who should go for screening?

• Screening targets women, 25 years or older, who have experienced sexual intercourse.
• Screening is recommended regardless of previous HPV vaccination.
• Screening is for all women, regardless of family history of cancer, history of pregnancy and childbirth, number of sexual partners, method of contraception, and habits of cigarette smoking.
• Screening is repeated five-yearly if she remains well, has no abnormal changes in vaginal bleeding or discharge, and has no abnormal findings of the cervix on routine medical examination.
• Screening should continue after menopause regardless of cessation of sexual intercourse.
• Screening can cease if a woman has an operation to remove her uterus.

Timely eradication of CIN:

• Cancer development can be prevented only if CIN is treated early.
• In 75 percent of cases, CIN of grade-2 or grade-3 severity can be effectively treated with a simple surgery known as LEEP or Loop Electro-Excision Procedure.
• This is an office procedure done with local anaesthetic.
• Approximately 25 percent of cases of grade-3 CIN are treated with a surgery known as cone biopsy. In this procedure, a central portion of the cervix is removed. In most instances, the surgery is done with laser surgery in an operation suite.
• In more than 90 percent of cases CIN is successfully cured with one treatment only. The remaining cases are cleared of CIN in subsequent treatments.

If I have screening tests at fiveyear intervals, should I continue with my yearly gynaecological check-ups?

You should not change your routine visit to your gynaecologist. Although your cervical cancer screening is done at five-yearly intervals, you still need to see your gynaecologist for a number of reasons, for example:

• Screening of other diseases
• Managing menstrual problems, contraception, or fertility issues
• Treatment of genital infection
• Managing menopausal issues

How can cervical cancer be detected early?

• On inspection and palpation of the cervix during an examination of the pelvis, a doctor may detect a lump in the cervix and raise a suspicion of an early cancer.
• A very early cancer before it is visible to the naked eyes can be detected on a screening Pap smear test and the diagnosis confirmed on a special examination known as colposcopy.
• Early cervical cancer carries a very good cure rate. In young women, treatment can be tailored to preserve fertility.