Cervical cancer is preventable, yet cases are still on the rise

Parents of girls who turned 13 in 2020 and 2021 are encouraged to get their daughters vaccinated against HPV if they missed it due to the disruption of the NIP during those years. — Photos: Filepic

Cervical cancer is one of the few cancers that is almost totally preventable, yet it is still the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women.

There are an estimated 604,000 new cases and 342,000 deaths worldwide due to this malignancy.

In Malaysia, it ranks as the second most frequent type of cancer among women aged between 15 and 44 years old.

Every year, approximately 1,700 women in our country are diagnosed with cervical cancer, of which, an estimated 990 will die from the disease.

The major cause for cervical cancer is the human papillomavirus (HPV), especially types 16 and 18, which cause 70% of all cervical cancer cases around the world.

HPV is normally transmitted through sexual intercourse, with higher risks for those with multiple sexual partners.

Therefore, the Health Ministry has set in place measures to help the public combat HPV, such as including the HPV vaccine in the National Immunisation Programme (NIP) back in 2010.

Despite the efforts made by the ministry, the figures are still increasing at a concerning rate.

Thus, it begs the question: why?

Reasons for upward trend

Many will assume that the administering of the HPV vaccine should combat these numbers, but unfortunately, Malaysians are still contracting cervical cancer even after being vaccinated against the virus.

This is due to lack of education and understanding, hesitation to go for regular cervical cancer screenings (i.e. pap smears), and the stigma surrounding the topic of cervical cancer in Malaysia.

Firstly, the HPV vaccine – while protecting against the most common cancer-causing strains of the virus – does not protect you from every strain of HPV that might cause cancer.

Additionally, other risk factors such as previously contracting other sexually-transmitted diseases (STDs), smoking, or having a compromised immune system (such as those living with HIV), will predispose a woman towards contracting cervical cancer.

This is the reason that women ages 21 to 65 are encouraged to undergo either HPV screening or a pap smear once every three years.

Meanwhile, women aged 30 and older can consider doing a pap smear just once every five years if it is combined with testing for HPV.

Secondly, there are numerous cultural and religious beliefs in Malaysia that demonise the topic of women’s health, and prevent them from seeking out health screenings.

Many women associate going for cervical cancer screenings as almost an admission of sexual promiscuity.

In a country where premarital sex is still frowned upon, this gets tricky, especially for teenagers or young women who will not feel they are supported enough to get themselves checked once they become sexually active.

There are incidences where women go out of their way to conduct screenings discreetly – sometimes even going to another state to have a pap smear – to prevent their community from finding out that they are sexually active.

In fact, studies have shown that the top barriers for screening are embarrassment, poor knowledge of screenings, as well as lack of support from husbands, families and friends.

The 2019 National Health and Morbidity Survey (NHMS) found that only 36.6% of women in Malaysia have done a pap smear.

Fear is also one of the reasons Malaysian women do not undergo their pap smears.

They are afraid of the diagnosis and the connotations the term “cancer patient” brings.

In the event an individual is diagnosed with cervical cancer, they might be treated differently, have employment opportunities or other opportunities taken away, and/or be shunned by their family, friends, colleagues, and even their partners.

Taking action

As there are no signs and symptoms during the early stages of cervical cancer, a pap smear is useful in helping doctors detect early changes in the cervix.

Education, especially amongst those in the lower socio-economic demographic, is essential to save lives.

Health literacy regarding HPV infection, cervical cancer and preventative methods is relatively low.

As it stands, many Malaysian women are not even aware if they have received the HPV vaccine, or that risk factors for cervical cancer include being sexually active, smoking, eating fatty foods, having experienced previous miscarriages, or having had STDs.

Additionally, a change of mindset is imperative when it comes to combatting the rise of this cancer.

We need to prioritise women’s health, rather than making judgements on morals or social lifestyles.

As such, we must take the appropriate measures to create awareness that this is a cancer that is entirely preventable, even if regular screenings pick up the presence of abnormal cells in the cervix or a HPV infection.

There is a need to inculcate a robust sex education curriculum in schools for girls from as young as nine to 14 years of age.

This is also the age range when the HPV vaccination is the most effective, and an opportune time for education as 13-year-old girls are administered the HPV vaccine via the NIP throughout the country.

In doing so, I believe that we may ingrain the risks and dangers of cervical cancer into their minds while they are still impressionable.

Having certain national programmes and systems in place may help the take-up rate for pap smears and create a level of acceptance.

For example, the National Health Screening Programme in the United Kingdom promotes screenings and vaccinations vigorously, ensuring that women are reminded to conduct follow-up screenings via text messages and calls when their screenings are due.

Early diagnosis, higher survival

Most of the time, the symptoms of cervical cancer are not present until a very late stage.

In fact, a HPV infection does not mean you have cervical cancer, and it can take years, or even decades, for the abnormal changes in the cervix to become invasive cancer cells.

However, knowing what to look for could very well save your life.

Those experiencing unusual vaginal bleeding after intercourse, between periods or after menopause; irregular pelvic pains; watery and bloody vaginal discharge; sudden weight loss; and constant fatigue, should consult a specialist immediately.

It can be extremely terrifying and nerve-wrecking for women to first find out that they have been diagnosed with cervical cancer.

They have to come to terms with and accept the fact that they may never have children, their sex lives with their partners might be affected temporarily, and face the possibility that their life is nearing an end.

Therefore, it is important that they are provided with the utmost care and support for their mental well-being and emotions – not only from healthcare professionals but also their loved ones.

Spousal support becomes very crucial during the treatment and recovery stage, as women will also need to deal with the grief of losing their perceived “womanhood” if they undergo a hysterectomy (surgery to remove the womb).

In any case, if a patient is diagnosed with cervical cancer, it is not the end.

There are several treatment options that provide a chance for a full recovery.

Naturally, early detection is the key in ensuring high survivability.

Assuming the cancer is detected within stage 1, the odds are at a 95% survival rate, as opposed to stage 4 with only a 15% survival rate.

During stage 1, a hysterectomy will be conducted or the cervix will be amputated.

For stage 4 however, only chemoradiation is available as a treatment option.

Prevention via screening

Needless to say, given that waiting for symptoms to appear might be too late, every adult woman should undergo regular screenings and get vaccinated for HPV if they did not get the vaccine under the NIP.

Girls who turned 13 in 2020 and 2021 should also get vaccinated if they missed it due to the disruption in schooling as a result of the Covid-19 pandemic.

The National Cancer Society of Malaysia stated that at least 176,944 and 186,593 13-year-old girls would have missed their HPV shots in 2020 and 2021 respectively, due to this disruption.

Undergoing a pap smear may seem invasive and uncomfortable, and that is not entirely untrue.

However, the screening should not be painful, as a good healthcare practitioner should be able to ensure that the patient is calm and comfortable.

Women should also remember other risk factors that may lead to cervical cancer, including smoking, immunosuppression (e.g. having HIV), chlamydia infection, a poor diet, being on oral contraceptives (birth control pills), intrauterine device (IUD) use and having a family history of cervical cancer.

At the end of the day, know that cervical cancer is almost totally preventable... if you take action early.

Dr Thangesweran Ayakannu is an obstetrician and gynaecologist. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.