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Oncology

Early Prevention and Detection of Cervical Cancer

Dr Sue Lo
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Human papilloma virus (HPV) is the major cause of the main types of cervical cancer – squamous cell cancer and adenocarcinoma. There are over 100 different types of human papilloma virus (HPV).

HPV is common. Most sexually active women will come into contact with at least one type of HPV during their lifetime. But for most the virus causes no harm and goes away on its own. So other factors must be needed for cancer to develop.

There are now vaccines to prevent HPV infection. All girls aged 12 or 13 in Singapore are routinely offered the HPV vaccine at school. These vaccines protect against the strains of HPV that are most likely to cause cervical cancer. But they do not protect against all strains. As it takes between 10 and 20 years for a cervical cancer to develop after HPV infection, it is still important for women to carry on with cervical cancer screening. It will take some years before the introduction of the vaccine has a major effect on reducing the number of cases of cervical cancer.

The purpose of screening

Cervical screening is very important because we can stop cervical cancer from developing in the first place. This is one of the few cancers that is preventable because abnormal cell changes can be picked up before they have a chance to develop into a cancer.

Who should be screened?

All sexually active women who are above the age of 21. 

How is a screening test done and what are the screening tests available?

The screening test involves a doctor taking a small sample of cells from the surface of your cervix. They do this by putting an instrument called a speculum inside your vagina and then scraping the cervix with a small soft brush. The doctor either rinses the brush in a pot of liquid, or removes the head of the brush and leaves it in the liquid. They then send the sample to the laboratory. This is called liquid based cytology. In the lab, a pathologist puts your sample under a microscope. They examine the cells and report any abnormal ones.

A Pap test will be done if you are 25 to 29 years old. A Pap test can detect the precancerous stage of cervical cancer when the abnormal cells (dysplasia) are in the outer layer of the cervix and have not spread to the deeper tissues. At this age, you will be able to clear HPV infections at a faster rate, thus, you do not need a HPV test.

A HPV test will be done if you are 30 years and above. Your cells will be sent for a HPV test to detect high-risk cancer-causing strains. At this age, a HPV test is more effective in determining your risk of developing cervical cancer.

Prevention

Risk of cervical cancer can be reduced by:

  • Going for regular cervical cancer screening (Pap or HPV test) at the recommended intervals as it is the most effective way to detect cervical cancer.
  • Speaking to your doctor about HPV vaccination.
  • Delaying first sexual intercourse, having fewer sexual partners and avoiding smoking.


What happens if cervical cancer is identified?

If cervical cancer is detected, an oncologist will discuss the best treatment options with you.

This article was written by Dr Sue Lo, Senior Consultant, Specialist in Medical Oncology at The Cancer Centre, a Singapore Medical Group clinic.

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