Cervical Cancer Screening

Are you aware of the need for cervical screening?

According  to  the National Health and Morbidity Survey (NHMS), the percentage of women who  underwent  cervical  screening  has  increased  from  26 per cent  in  1996  to  43.7 per cent  in  2006. However, as of 2011, this percentage has dropped to 12.8 per cent.

The   World   Health   Organization   (WHO)   advocates   that   interventions   such   as   HPV vaccination,  cervical  screening  and  proper  treatment  are  imperative  for  the  elimination  of cervical cancer.

The 90-70-90 target outlined by WHO states that each country should target HPV vaccination in 90 per cent of girls by 15 years old, screening in 70 per cent of women by 35 years old and again at age 45, as well as treatment of 90 per cent of women identified with cervical disease by 2030.

Hence, this article will provide concise information about cervical screening in Malaysia, with emphasis on tests involved and where to access them.

What Is Cervical Cancer?

Cervical cancer is a disease where cells of the cervix grow uncontrollably. The cervix connects the birth canal to the womb as illustrated above.

In  Malaysia,  cervical  cancer  is among the top 10 cancers and ranked the third most common cancer among  Malaysian  women.  Notably,  the lifetime risk of acquiring cervical cancer is 1 in 144 and is greatest among the Chinese population.

How Is Cervical Cancer Preventable?

Almost all cases of cervical cancers are caused by a sexually acquired virus called the human papillomavirus (HPV), particularly, the high risk types 16 and 18. That said, HPV infections are extremely common and many of the other HPV types do not lead to cervical cancer. 90 per cent of HPV infections are cleared by our immune system within two years.

Persistent infection with high risk HPV can result in precancerous and cancerous changes in the cervix. There are some other factors associated with increased risk of persistent infection, namely,   high   risk  types  of  HPV  (types  16  and  18),  weakened  immune  system  (HIV, transplant  patients  and  immunosuppressants),  smoking,  coinfections,  number  of  babies born  and  young  age at first birth.

However, the biggest risk factor for cervical cancer is not having had cervical screening.

Typically,  it  takes  15  to  20  years  for  cervical  cancer  to  develop  in  a  woman  with a normal immune   system.  This  allows  time  for  early  lesions  to  be  detected  through  screening.

Imperatively,  early  lesions and HPV infections detected are often treatable.

In other words, cervical  screening  allows  for  early  detection  and  treatment  to  prevent  the  development  of cervical cancer.

Cervical Screening In Malaysia

Currently, the screening tests utilised in Malaysia are mainly pap smear or/and HPV test.

Pap smearHPV test
What is it?A test that detects abnormal cells in the cervixA test that detects presence of HPV
Sensitivity in detecting cervical cancer riskLess sensitiveMore sensitive
How is it done?A sample is collected by a health care provider using a speculum and a sampling tool.
The sample is analysed under a
Self-sampling by women themselves or by health care professionals using a self-sampling kit

Who?Sexually active women 30-65 years old
*Sexually active women <30 years old are encouraged to screen
Sexually active women 30-49 years old (Ministry of Health Guidelines)
*Women 21-29 and 50-65 are advised for pap smear screening
Screening intervalYearly for two years. Continue three yearly if results were normalEvery five years
Where?Government clinics & hospitals
Private clinics & hospitals
National population and family development board (LPPKN)
ROSE Foundation
National Cancer Society of Malaysia

A  negative  result  would  warrant  routine  screenings  according  to  the  schedule  given.  A positive  result  would  require  further  confirmatory  testing  and  referral  for  appropriate treatment if necessary.

How Can We Play Our Part?

In  conjunction  with WHO’s Global Strategy to accelerate the elimination of cervical cancer, all  countries  must  reach  an  incidence  rate  of  less  than  four  cases  per  100,000  women.  As previously mentioned, every country must reach this 90-70-90 global goal by 2030.

This   involves   collective   efforts   from   various   stakeholders.   Medical   students   and organisations  can  raise  awareness  regarding  cervical  cancer  by building knowledge around the  disease,  key  prevention  methods  and  early  detection  services. 

For  instance,  Malaysian Medics   International   (MMI)   has   recently   released   a  press  statement  on  their  call  to accelerate the elimination of cervical cancer in November 2020.

Nonetheless,  the  road  to  the  successful  elimination  of  cervical  cancer  starts  with  women themselves.  It  is  absolutely  crucial  for  women  of  Malaysia  to  take  matters  into  your  own hands. Empower yourselves and others and prioritise your wellbeing. No woman should die from cervical cancer.

While many turn to doctors for screening and treatment, the difficulty is in taking the first step.

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