Cover Story: Cervical cancer can be prevented

2009/11/12

Kasmiah Mustapha

THE good news is cervical cancer can be prevented. The bad news is that most women are unaware of how to prevent it. Doctors have long advised women who are sexually active to undergo pap smear tests at least once a year.

With the introduction of the cervical cancer vaccine, a prevention method has become available for women.

Finally, there seems to be hope in reducing the number of deaths from the deadly disease.

Consultant obstetrician and gynaecological oncologist Datuk Dr Abdul Aziz Yahya said the majority of patients are already at an advanced stage of their illness when they are diagnosed by doctors.

Unfortunately, most of them will die within a year after being diagnosed.

Sexually active women should go for a pap smear test at least once a year, says Dr Abdul Aziz.

“Cervical cancer usually peaks when a woman is between the age of 40 and 49. These women are wives and mothers and when something happens to them, their families will have to bear the brunt of the consequences.

“That is why we have always encouraged women to go for pap smear tests. Those who are in high-risk categories should do it every year while others should do it once every three years.”

Women who are at high risk of being infected with HPV (the human papilloma virus that is the most frequent cause of cervical cancer) are smokers, those who’ve had more than five pregnancies and those with multiple partners.

Dr Abdul Aziz said a pap smear test, which is key in the prevention of cervical cancer, would be able to identify abnormal and pre-cancerous cells in the cervix.

However, less than 30 per cent of women in Malaysia do the test.

A study by the National Population and Family Planning Board in 2003 revealed that 90 per cent of women have heard of pap smears, 55.2 per cent have done it at least once and 32.1 per cent did it regularly.

However, for those who have never done it, 23 per cent said it was not necessary as they were not ill, 20.3 per cent said they’ve never heard of it, 18.3 per cent said they were too busy, 9.6 per cent said they were shy and 9.2 per cent said they were afraid of the pain.

In Malaysia, cervical cancer is the second most common cancer in women. More than 70 per cent of cervical cancer is due to HPV, a common virus which is transmitted sexually.

There are two main types of cervical cancer — squamous cell carcinoma (SCC) and adenocarcinoma. SCC is the most common and less aggressive and accounts for about 80 per cent of all cervical cancers.

The remaining 20 per cent is adenocarcinoma, which is more aggressive and difficult to treat.

Cervical cancer vaccination helps reduce the number of new cases, says Dr Syed Mohamed.

“In other parts of the world, adenocarcinoma accounts for 50 per cent of cervical cancer. This is because the women have been sexually active since they were 10 years old,” said Dr Abdul Aziz.

A study done by researchers from UKM Medical Centre found that vaccination also helps in reducing the number of new cervical cancer cases in the country.

It is estimated that there are 4,969 new and old cases of cervical cancer in the country. Of this figure, there are between 1,000 and 1,500 new cases every year.

According to Professor Datuk Dr Syed Mohamed Aljunid, one of the researchers of the study, if 13-year-old girls are vaccinated, the probability of them contracting cervical cancer can be averted.

Also, the cost of treating cervical cancer patients can be reduced.

The study found that the cost of detecting and treating all stages of cervical cancer, including cases potentially detected through pap smears, is RM389.8 million annually.

For in-patient and out-patient treatment of the more than 4,000 cases, the cost is RM78.6 million.

“The cost is a conservative figure as the study only looked at government hospitals. It is probably higher than that. It is estimated that the cost will increase each year.

Last year, the Health Ministry budget for healthcare was RM13 billion of which three per cent went to the management of cervical cancer,” said Dr Syed Mohamed.

The Health Ministry has announced that beginning next year, all schoolgirls in Form One will get vaccinated against cervical cancer, a move which will cost the government RM150 million annually.

About 300,000 girls will receive the three doses of the vaccine, which they’re encouraged to get although they will not be forced to.

The safety of the vaccine was questioned recently when a 14-year-old British girl died immediately after getting vaccinated. An autopsy revealed that she had died of a malignant chest tumour and not because of the vaccine itself.

Dr Abdul Aziz said as with new drugs, the vaccine has gone through vigorous testing and is found to be safe. Some people do experience side-effects such as pain, swelling and redness.

“We have to move forward and vaccinate these young girls to give them the immunity against the deadly disease.

“A pap smear is a secondary prevention procedure. It can detect abnormal cells. But vaccination is the primary prevention test and is key in preventing cervical cancer.”

The vaccine protects against HPV strains 16 and 18, which are responsible for 70 per cent of cervical cancer cases.