PETALING JAYA, Jan 11 — Etiqa has pledged RM1.22 million for the third phase of a nationwide cervical cancer screening programme co-organised with ROSE Foundation.
The insurance company and ROSE Foundation target to screen 5,500 eligible women aged 30 to 65 from identified bottom 40 per cent (B40) communities and to procure two sets of mobile colposcopy equipment.
First launched in July 2019 in partnership with ROSE Foundation, a foundation that launched self-sampling for cervical cancer screening, the cervical cancer screening programme officially entered its third phase yesterday.
“I’m very pleased to hear that the Etiqa and ROSE Foundation collaboration has also extended to the frontliners. Sometimes we forget, we take frontliners for granted,” Bandar Tun Razak MP Dr Wan Azizah Wan Ismail said at the launch of Phase Three of the nationwide cervical cancer screening programme at University of Malaya Medical Centre (UMMC) yesterday.
“As part of this frontliners’ campaign, the ROSE programme’s free cervical cancer screening was offered to the police, the army. We have some women in the army, health care professionals. You have to be healthy to be a health care professional. This is important.
“So we have to look after them first and other frontliners who serve the country and people tirelessly during these trying times,” added the patron of Puspanita (Wives of Civil Servants and Women Civil Servants Association).
To date, the Program ROSE cervical cancer screening programme has screened over 1,000 policewomen, close to 300 army personnel, 100 immigration frontliners, over 7,500 health care providers from the Ministry of Health, and 300 education providers from the Ministry of Higher Education.
At the end of December 2022, Program ROSE has screened over 21,000 women nationwide, with 1,210 positive cases detected. Over 90 per cent have been linked to care.
In the span of three years, the programme has been implemented in over 150 communities, 12 health clinics across 12 states, and 28 government hospitals. More than 90 health care professionals were engaged to provide follow-up treatment for women who test positive for HPV infection through Program ROSE.
Whilst headway has been made in the screening of women from various sectors, Dr Wan Azizah underscored the benefits that the screening programme provides to women living in urban poverty.
“I think if this continues, it’s very good. We also want to ensure that underprivileged and under-screened women in Malaysia receive access to cervical screening. Because now that I’m MP of Bandar Tun Razak, there is a lot of urban poverty.
“Urban poverty. I never thought that in sprawling Kuala Lumpur, the capital of Malaysia, there are so many of these flats. One generation, two generations. They live in this enclosed space. Not many things to do. So these are people that contribute to our country, the economy of the country. We must take care of them.
“So these are people that we want to reach out to and also Orang Asli, Orang Asal. People like this.”
Prof Dr Adeeba Kamarulzaman, chair of ROSE Foundation and former Dean of the Faculty of Medicine at the University of Malaya, stated that the self-screening method employed by the ROSE Foundation will also reduce the number of women walking into hospitals, thereby reducing hospital congestion.
“Of course, there’s all been this news about the state of our health care system. I think this is a tool that a woman doesn’t even have to go anywhere near a hospital or a klinik kesihatan (public health clinic) to know that she has potentially cancer-causing infection, the HPV, and be linked to care,” Dr Adeeba said in her speech.
“I think only 6 per cent of women actually, of those women screened, we have found that actually need care. So, when I meet the Minister of Health this afternoon, God willing, I think with this will be one example that we can really expand to minimise the congestion because the alternative is women have to go twice, every two years for the pap smear.
“And when we meet women in the community, they say, ‘Takut lah doctor, sejuk lah doctor, sakit lah doctor, malu lah doctor.’ And then when we show them the stick we swab, they go, ‘Ah, how come we haven’t done this earlier?’
“And when we put them in the context of Covid-19, where everyone’s now familiar with self-testing, they go, ‘Ah, this is something that’s doable’.”
The method of testing employed by the ROSE Foundation is a novel self-swab approach to cervical screening. Unlike a conventional pap smear test which involves the insertion of a speculum into the vagina to widen it so that a small brush can be inserted into the vagina to collect cells from the cervix, the cervical screening test employed by ROSE does not need a speculum and can be done independently.
Like a nasal covid test, the cervical test requires women to insert the test kit swab into their vagina, rotate, remove the swab, and return it to the tube without cleaning or dropping the swab.
The samples are then sent to the ROSE laboratory for human papillomavirus (HPV) polymerase chain reaction (PCR) testing. Results will be sent to women via SMS within three weeks. For women who test positive for HPV infection, the ROSE Contact Centre will refer them to government hospitals for further follow-up.
According to Dr Adeeba, one of the issues with Malaysian patients is the absence of a bridge to care post-screening.
“This programme is into its third year and has benefited many thousand women in Malaysia from the B40 community, prompts a new method of screening for the virus that causes cervical cancer, and importantly, links them to care, because that’s one of the issues with Malaysian patients is that they screen, but they don’t get linked to care.
“And one of the issues with cervical cancer is many women, I think a third of women, present at the late stages of the disease.”
Whilst access to treatment is not a significant concern in urban areas, the same can’t be said for women living in rural areas.
Based on a press statement released by Etiqa, women living in interior areas of Malaysia may decline treatment, citing concerns such as the cost of treatment, distance to the nearest government hospital, and travel expenses.
Etiqa and the ROSE Foundation have purchased two mobile colposcopy devices and introduced on-site colposcopy treatment that can be performed in the community.
A colposcopy is a test to take a closer look at the cervix and is performed if the cervical screening finds changes to the cells. These changes are caused by certain types of HPV. These changed cells can turn into cervical cancer cells. If the doctor finds abnormal cells in the cervix, they may recommend removing them, reducing the risk of cervical cancer.
During the event, Dr Woo Yin Ling, medical technical advisor and trustee of ROSE Foundation and a professor at the University Malaya’s Department of Obstetric and Gynaecology, gave an explanation and a demonstration of how the mobile colposcopy works.
“What we’ve done now is, with the help of Etiqa, bought two units of mobile colposcopy, whereby the patients can be treated in the comfort of the community. During the course that I’ve spoken here, the mobile colposcopy unit has been set up in real-time. So this is the mobile colposcope. They’re all run on battery, and so you don’t need an electrical source.
“The mobile gynocular allows the doctor to inspect the cervix under magnification. If he’s unsure whether there’s any lesions — because it can only treat pre-cancer but not cancer — he can take a photo in real-time, send the image to an expert for a second opinion, and through telecommunication, he will then know whether or not he can continue with the treatment because treatment of cancer should be done at a tertiary centre. All pre-cancer can be treated in the community,” said Dr Woo.
If there is known cancer, Dr Woo said that a battery-operated thermal ablation — a procedure using heat to remove tissue or a part of the body or destroy its function — will be used to treat all pre-cancer effectively without the need for any general anaesthesia.
“It only takes two minutes. Two minutes. So you don’t need to spend half a day for travel to the hospital. We will go there.
“So now, we have two units, which means that two volunteer doctors can go to the kampung or can go to any communities where women have poor access, and we can use volunteer doctors who are well trained in the procedure to treat women.”