IPOH: More than 2,000 Malaysian women get cervical cancer every year, with over 600 dying from it annually.
Only one in four (24%) are diagnosed early enough for a total cure to be possible, according to data from the Health Ministry.
Despite efforts to raise awareness about cervical cancer and the importance of screening, it is still the third most common cancer among Malaysian women.
Here, senior consultant obstetrician and gynaecologist and Malaysian Gynaecological Cancer Society vice-secretary Dr Zamzida Yusoff answers some questions on cervical cancer screening.
Why is cervical cancer screening needed?
Screening is done to detect pre-cancer changes that can occur years before the actual cancer develops.
If detected at this stage, the chance of a total cure is very high.
Does every woman need to be screened?
No, you are only at risk of cervical cancer if you are sexually active. If a woman has never had sex, she need not undergo this screening, as it is very rare to get this type of cancer.
If a woman has previously been sexually active and is no longer so, it is advisable to still go for screening.
Those who are sexually active need regular screening tests.
Why is it rare for virgins to get cervical cancer?
Studies show that more than 90% of cervical cancers are due to infections caused by the human papilloma virus (HPV).
These infections are believed to be spread by sexual contact.
HPV has also been implicated in other cancers associated with sex, such as mouth, throat and anal cancers.
When should screening start?
Around one year after becoming sexually active. We advocate doing the screening once a year for the first three years.
If the results are normal, it can then be done once every two to three years until the age of 60.
The cut-off age of 60 is only if the woman has been having regular tests with normal results prior to that.
If, for example, a 70-year-old woman comes along who has never been screened for cervical cancer before, we would still advise her to do a test.
What happens during the screening?
The doctor (or trained nurse) will insert a special tool called a speculum into your vagina in order to take a look at the cervix, which is the entry to the womb.
He or she will take some cells from the cervix using a wooden or plastic spatula or brush, which will be sent to the laboratory for examination.
This test is called a Pap smear.
The doctor (or nurse) will also look for any polyps, bleeding, signs of infection and other abnormalities of the cervix.
For most women, the procedure is not painful, although it might cause a little discomfort.
When will I get the results?
For government hospitals and clinics, it usually takes six to eight weeks.
Sometimes, due to the large number of patients, the staff can only contact those whose results are abnormal.
Those not contacted can be assured that “no news means good news”. If the patient is worried, she can go to the clinic or hospital, and request a copy of the report.
In private hospitals or clinics, the results are usually available within one to two weeks, and will be sent to the patient (if normal) or given to them during their subsequent appointment.
Are there other types of cervical cancer screening?
Yes. The cervical cells taken during a Pap smear can be sent for a DNA test to detect the presence of 13 HPV sub-types.
Another type of test is liquid-based cytology (LBC), where the cells are first suspended in a solution to clean off mucus and other contaminants. They are then placed on a glass slide and examined for any abnormalities.
Are these tests available in Malaysia?
Government hospitals and clinics offer the Pap smear.
Private hospitals and clinics may offer LBC and the HPV DNA test, in addition to the Pap smear.
Is the HPV DNA test the best?
This test is actually not recommended for women aged below 30.
This is because around three in four women (70%-75%) will be infected with HPV in their lifetimes.
Almost all (90%) will have immune systems that are strong enough to eventually destroy the virus without the need for any treatment.
Only 10% will be unable to clear the virus completely, and might go on to develop cervical cancer later in life.
Women aged below 30 might still have the virus in their body, which their immune system will eventually clear out.
Therefore, a positive HPV DNA test at this stage would cause them unnecessary anxiety and might cause them to seek unnecessary treatment.
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