PETALING JAYA, Feb 17 — A Malaysian cervical cancer screening programme, the first globally to use self-administered HPV tests as the primary exam, today launched its laboratory at Universiti Malaya.
The ROSE Foundation and Laboratory, located at UMXcelerate complex at the public university’s campus, are a partnership between Universiti Malaya (UM) and Australia’s VCS Foundation, a cancer prevention non-profit.
“Programme ROSE is a solution that is the first of its kind in the world that addresses the social and the health barriers to ensure that women come forward to have their screening tests,” ROSE Foundation medical technical advisor Dr Woo Yin Ling said at the launch of the ROSE Foundation and Laboratory here today.
“Sitting in a busy clinic takes time off from our work and children, so we used disruptive innovation using the revolutionary approach of a self-swab, of the mobile technology, and of molecular testing to ensure that women get screened and get their results rapidly.”
ROSE uses a self-sampling swab inserted into the vagina, which is more comfortable than pap smears, to test for cervical cancer. It says its HPV tests are not only more effective and accurate than pap smears, but only need to be done two to three times throughout a woman’s life, as opposed to 15 times for the traditional pap test. HPV tests check for HPV viruses that can cause cervical cancer, whereas pap smears look for abnormal cells in the cervix.
Test results are sent to women’s mobile numbers in three weeks. If results are abnormal, ROSE will link the women up to a government hospital for follow-up.
“Those women need not worry about ‘getting lost in the system’,” said Dr Woo, who is also a consultant obstetrician and gynaecologist at University of Malaya Medical Centre (UMMC).
The ROSE programme, which has screened 8,000 low-income women throughout Malaysia after its launch in January 2019, previously sent those samples to the VCS laboratory in Australia for testing. But with the launch of the ROSE lab in UM, testing can now be done locally.
Dr Woo said over the past year, the ROSE programme has engaged over 60 health care professionals, trained 13 ROSE nurses at government health clinics, and 140 community volunteers to screen those 8,000 women from the bottom 40 per cent (B40) across the country, including Perak, Klang Valley, Johor, Sarawak, Sabah and Penang. Out of the total, 7 per cent tested positive and received follow-ups.
When asked how many of the 560 women who tested positive for cervical cancer were linked to hospitals for treatment, Dr Woo told the press that women with positive test results had six weeks to make an appointment with a hospital.
“More than 80 per cent of women covered by UMMC got follow-up care,” she said.
She acknowledged that in certain remote areas like Lawas, Sarawak, transport costs discouraged women from seeking follow-up at hospitals when they tested positive for cervical cancer. ROSE linked women there to a nearer Sabah hospital instead of Sarawak, as the latter required passage through Brunei.
“We’re looking forward to working closely not just with health agencies, but also transport.”
Dr Woo said the ROSE programme piloted at five Ministry of Health (MOH) clinics, while the foundation provided the HPV tests to three government clinics, all in Selangor. Events with mobile clinics were also run in six to seven states.
“We plan to move forward to more Klinik Kesihatan as part of ROSE Foundation.”
When asked about ROSE’s registry on women who took its HPV tests, Dr Woo said the foundation recorded such data to identify those who take repeat tests, as women only need to take it twice or thrice in their lifetime.
MOH and the Women, Family, and Community Development Ministry, however, have their own databases on women who screen for cervical cancer at their clinics respectively.
ROSE provides the HPV tests, which are more expensive than pap smears, for free to government clinics, but other women can buy the kit for RM250. When asked if ROSE would make its cervical cancer self-testing kits available in Malaysian homes, instead of just providing them to clinics, Dr Woo said the HPV self-administered tests should be made available in pharmacies and convenience outlets.
VCS Foundation executive director Dr Marion Saville, however, said in Australia’s experience, sending the tests to homes did not yield high uptake rates compared to doing the tests in health settings like clinics.
ROSE Foundation programme executive Rachel Tan told CodeBlue at the sidelines of the event that some women in Port Klang declined to do the HPV self-sampling tests, as they preferred to get screened by doctors or nurses.
“The main rejection is that it’s too simple and not reliable,” Tan said, noting that those women had greater confidence in traditional pap smears done by health care professionals than in innovative technology like the ROSE kits.
However, if nurses instruct the women to take ROSE’s HPV self-administered tests, they will do so unquestioningly.
“We have to get health care professionals on board,” Tan said.
She added that ROSE will still concentrate on mobile clinics to provide the HPV tests, as government health clinics are a permanent alternative for women who somehow miss the mobile clinics because of their period or busyness.
According to the latest Malaysia National Cancer Registry Report (MNCRR) 2012-2016, cervical cancer is the third most common cancer among women. Malaysia, however, reported a decrease in new cervical cancer cases, from close to eight of every 100,000 women contracting cervical cancer from 2007 to 2011, down to roughly six of every 100,000 women for the 2012 to 2016 period.