A new integrated technology-driven screening approach will enable women to get tested for cervical cancer in the comfort of their own homes – a pioneering effort to detect cervical cancer in its early stages.
ROSE (Removing Obstacles to Cervical Screening), the world’s first cervical screening programme featuring self-sampling by women themselves, is a human papilloma virus (HPV) DNA test – rather than a Pap smear diagnostic test that uses microscopy – and is based on an e-health platform.
Deputy Prime Minister Datuk Seri Dr Wan Azizah Wan Ismail who launched the programme on Jan 14, 2019, says the lifetime risk of a Malaysian woman developing cervical cancer is one in 116, with about two-thirds (76%) only being diagnosed at the later stages of the disease, i.e. stages two, three and four.
The ROSE programme, she says, will help many women overcome the barriers to screening and encourage more to willingly participate in screening in a timely manner.
Healthcare professionals will be able to both register and deliver the results of the screening to women through their mobile phones.
This will translate to less visits to the clinic and will eliminate the embarrassment and fear associated with a Pap smear, which needs to be done by a doctor at a clinic.
Dr Wan Azizah encourages more women to go for early cervical cancer screening as early prevention is the key to stopping the disease.
She notes that despite the country’s National Immunisation Programme – which provides free HPV vaccinations to 13-year-old girls – achieving a coverage of over 90% among this group, cervical screening overall among Malaysian women falls far below the World Health Organization’s (WHO) target of 70%.
“We have only managed to achieve a rate of 12.8%, a far cry from the WHO’s target. The challenge is getting women to come forward to be screened,” she says.
HPV vaccination protects young girls against the main types of HPV that cause cervical cancer.
Dr Wan Azizah, who is also the Women, Family and Community Development Minister, says cervical cancer is the third most common cancer (7.7%), after breast cancer (32.1%) and colorectal cancer (10.7%), among women in Malaysia.
ROSE is an innovation by Universiti Malaya (UM) and VCS Foundation (VCSF) of Australia to accelerate the drive towards cervical cancer elimination in Malaysia.
A memorandum of understanding between UM and VCSF was signed by UM Medical Faculty dean Professor Datuk Dr Adeeba Kamarulzaman and VCSF executive director Associate Professor Marion Saville on the same day, to establish a not-for-profit joint venture to enable the implementation of ROSE as a cervical screening programme in Malaysia.
Also present at the launch was Health Minister Datuk Seri Dr Dzulkefly Ahmad and Deputy Women, Family and Community Development Minister Hannah Yeoh.
Dr Wan Azizah says the HPV DNA test is recommended for women over the age of 30, adding that the test can detect the DNA of high cervical cancer risk HPV.
She also says the implementation of the programme by the National Population and Family Development Board (LPPKN) is expected to benefit 14,000 people in the B40 group.
“Because we have limited funds and facilities at the moment under the LPPKN, I’m being told that the target is for the B40 people first, because the M40 have other avenues for a check-up,” she says.
Adapting the screening programme
Meanwhile, Dr Dzulkefly explains that the Pap smear test was previously the only tool available for the early detection of cervical cancer.
“It was introduced as part of the family planning services package in 1969 and eligible women are encouraged to do the test once every three years, meaning approximately 15 screens in a woman’s lifetime,” he says.
He adds that the ministry’s Pap smear screening target, which was set at 40% of eligible women, only achieved an average of 25% for the past five years.
“The poor coverage is contributed by multiple factors, including the lack of funds and manpower such as cytoscreeners (a clinical laboratory scientist specialising in cytology, the study of cells).
“Many Malaysian women also do not attend screening because of embarrassment, fear or because they do not have adequate information,” he says.
Dr Dzulkefly says the adoption of ROSE as a primary screening programme will require the Health Ministry to reengineer and strengthen its strategies, and reorganise its current programmes in order to achieve elimination goals.
With the success of the national HPV vaccination programme, he says that the ministry recognises the need to review its national cervical screening programme.
“While HPV vaccination will not remove the necessity for cervical screening, there is a need to change to a more effective screening modality that is aligned with current international evidence,” he says.
He adds that recent advances in screening and testing technology led WHO to recommend the use of HPV testing as a screening tool.
“Introducing new technology at a national scale will be a great challenge as the introduction cost will be high.
“The ministry must carefully lay out the execution plan to ensure each and every women will benefit and have access to the new technology,” he says.
He adds that the new technology would be ineffective if women did not come forward to be screened.
Dr Dzulkefly is optimistic that the country will be able to achieve the targets set by WHO to eliminate cervical cancer.
“We have already achieved greater than 90% HPV vaccination rates among adolescent girls.
“We will now work towards screening 70% of eligible woman between 35 and 45 years with the HPV test and offering them the appropriate treatment,” he says.
Women who are above 30 years of age and in the B40 group can register for the screening programme through the 49 LPPKN clinics nationwide.