Malaysia: A Vanguard In Eliminating Cervical Cancer — Prof Dr Woo Yin Ling

Malaysia’s adaptable strategies highlight its unwavering dedication to reducing the burden of cervical cancer and other HPV-related cancers and diseases.

In Southeast Asia, Malaysia shines as a beacon in her commitment towards the elimination of cervical cancer. The country’s pioneering efforts showcase the power of collective action towards a singular cause.

As the Southeast Asian frontrunner in establishing a national HPV immunisation programme to vaccine types, Malaysia’s adaptable strategies highlight its unwavering dedication to reducing the burden of cervical cancer and other HPV-related cancers and diseases.

The World Health Organization’s (WHO) ’90-70-90′ initiative, urging 90 per cent vaccination coverage for girls by age 15, 70 per cent high-performance screening of women at 35 and 45, and 90 per cent treatment for pre-cancer and invasive cancer, emphasises the imperative for worldwide cooperation, knowledge exchange, and swift research integration.

The Malaysian government has demonstrated exceptional success in implementing the HPV vaccination programme. In 2010, the Ministry of Health initiated a pioneering school-based HPV vaccination programme, targeting 13-year-old girls.

Over the subsequent 10 years (2010 to 2020), meticulous strategies yielded impressive results. The school-based program boasted an impressive 96 to 98 per cent rate of parental consent, with an outstanding 99 per cent uptake of the first dose annually, and a completion rate of 98 to 99 per cent for the full vaccination course.

Beyond the school environment, coverage expanded to a range of 83 to 91 per cent on a yearly basis, demonstrating a broader impact.

As one of the most preventable cancers — both through HPV vaccinations and screening tests, cervical cancer could one day be history for the world. But just how far away are we from that reality?

Annually, a staggering 600,000 new cases of cervical cancer worldwide darken our statistics, tragically claiming over 340,000 lives. Globally, we have seen the effectiveness of organised HPV vaccination programmes leading to a significant reduction of vaccine-targeted HPV infection, pre-cancerous changes of the cervix, and a reduction of new cases of cervical cancers. This is a powerful testimony that HPV vaccines do work.

In Malaysia, our group has demonstrated an impressive 90 per cent reduction in vaccine targeted high-risk (HR) HPV types a decade after the National Immunisation Programme.

On the other hand, we see an increasing trend in the prevalence of the non-vaccine targeted HR HPV types prevalent in Malaysia in the study we carried out. This means more can be done to achieve further reduction of HPV infection. Elimination is on the horizon, but awaits patient-centric screening!

However, it’s not solely about vaccines; it encompasses the entire cascade. From fostering awareness among women and health care professionals to embracing screening and treatment, while sustaining a supportive, consultative dialogue, each step is indispensable.

Within our cultural context, the mere mention of cancer triggers an unsettling fear of the unknown, deterring us from seeking screening. We must understand that our primary ask — of healthy women voluntarily getting screened — is an uphill battle. It is not part of our lifestyle, especially in the emerging economies in Asia.

Therefore, I have come to appreciate more prominently of late the proactive efforts undertaken by numerous hospitals in this regard.

Embracing this crucial paradigm shift is essential. In Malaysia, cervical cancer screening has traditionally hinged on pap smears since 1969, until a revolutionary switch to PCR tests in 2019.

It was this very concern that sparked the inception of ROSE Foundation. In 2017, during a meeting, I encountered Australian experts leading the charge in shifting from pap smears to HPV tests using swabs.

This moment was transformative when a colleague shared, “Did you know, a simple swab can screen?” My initial scepticism gave way to confirmation that a low vaginal swab is as effective as a clinician’s sample.

This revelation planted the seeds for Program ROSE. Designed with Malaysia in mind, the programme strives to provide doorstep screening services for women, driven by convenience. The notion of community service resonated deeply, igniting the genesis of Program ROSE.

While appreciating pap smears’ historical impact, it’s vital to educate women about the superior effectiveness of HPV tests and embrace patient-centred services. Pap smears necessitate frequent screenings (every one to three years), whereas HPV tests can be effective with as few as two screenings, offering greater efficiency.

As health care professionals, we face an urgent call to action, as the landscape of HPV screening has undergone a transformative shift in the past decade. However, despite this progress, the negative social stigmas associated with HPV persist.

The Covid-19 pandemic has yielded a silver lining, which is a remarkable expansion in our molecular testing capabilities. Over a span of three years, our capacity has burgeoned, with the integration of advanced machines capable of swift PCR through streamlined automation.

These very machines, initially procured for Covid-19 testing, can now be ingeniously repurposed for HPV screening. Bolstered by skilled technicians, engaging women in conversations about swabs has become an effortless endeavour.

It is my hope that the Global HPV Convening, which holds a significant mission to unite a dedicated network and streamline decision-making, will enhance customised health care delivery for HPV prevention and cervical cancer elimination.

This event, which fittingly takes place in Malaysia, underscores the shared urgency to expedite global HPV prevention efforts, ensuring equitable access to vaccines and preventive measures.

The Convening’s goals, from establishing the Global HPV Consortium to facilitating impactful dialogues among stakeholders and fostering innovative partnerships, presents a potentially transformative strategy.

By fostering collaboration, this gathering marks the start of a promising endeavour is further serves as a testament to the Malaysian government’s commendable efforts. These efforts bolster support for high-burden countries and catalyse collective action toward a healthier future.

It’s a unique opportunity for Malaysia’s contributions to play a pivotal role in advancing global momentum towards eliminating cervical cancer and empowering communities.

Prof Dr Woo Yin Ling is a consultant gynaecological oncologist at University Malaya Medical Centre. She is also the founder and trustee for ROSE Foundation.

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