WHY talk about cervical cancer in the first month of the new year? Because January is the official month for raising cervical cancer awareness.
In the United States, the American Cancer Society, National Cancer Centre and a few other influential bodies will rally to highlight the importance of knowing about and combating this cancer.
In the United Kingdom, there is a charity called Jo’s Cervical Cancer Trust, which is dedicated to patients with cervical cancer or other cervical abnormalities.
It is heartening to read that with increased awareness, fewer women are afflicted by this cancer and fewer deaths occur. What about Malaysia? Are we seeing a similar positive change in the figures?
Between 2003 and 2006, cervical cancer was the second most common cancer in Malaysians. The first was breast cancer. The latest data released by the Health Ministry in 2016 (covering figures from 2007 to 2011) showed a positive change. The cancer has dropped to third place, behind breast cancer and colorectal cancer (malignancy involving the large bowels).
However, research showed that every year, 2,145 new cases are discovered and 621 patients die from it. The main reason for the significant number of deaths is that only 24 per cent will be diagnosed in time, during the early stage. More than three-quarters of those affected only turn up at an advanced stage. Many diagnosed were aged over 35 and the highest number were among those aged 54 to 70 years.
For my colleagues and I, this is a sad scenario. Why is that so?
CERVICAL cancer has a pre-cancer stage that can last for five to 10 years before there is actual cancer;
THIS pre-cancer stage called “CIN” (cervical Intra-epithelial Neoplasia) can be detected by a simple and non-expensive test called the Pap smear;
TREATMENT at the pre-cancer stage usually promises total cure;
EARLY stage cancers (Stage 1) are usually good responders to treatment and have a high cure rate (above 85 per cent);
NOW , there are also vaccines that can help prevent virus infections in young women. The virus called Human Papilloma virus (HPV) has been identified to be the cause behind 90 per cent of cervical cancers. Vaccination before a woman starts having intimate relationship with a male partner can give her almost 100 per cent protection from the virus and, subsequently, from cervical cancer; and,
THERE are also tests that can be used to detect the presence of HPV DNA in cervical fluids. The HPV DNA test can be used as complementary, or in certain situations, a substitute for Pap smear.
Because of these reasons, it does not make sense that we still see more than 2, 000 new cases every year. Nor does it explain why women as young as 35 die because of cervical cancer.
A study by Datuk Dr Zaridah Shafie (the head of obstetrics and gynaecology at Tuanku Fauziah Hospital, Perlis, and a fellow gynae-oncologist) that was published in 2014 helped shed some light.
One of the obstacles faced in Malaysia is the poor response to Pap smear campaigns. While most developed countries see 75 to 90 per cent of the target population going for regular cervical smears, in Malaysia, we are only seeing 50 per cent or less women coming for check-ups. The figure was 47.6 per cent in 2006, but much higher than the two per cent recorded in 1992.
Most women cite lack of knowledge in terms of why they need to do Pap smears, and where it can be done. Others are not keen to be seen by male doctors. Some worry about the cost; not realising it can be done for free at any government clinic.
We, doctors, lose the golden opportunity, the five to 10-year period when the pre-cancer changes are just starting to occur and can be treated. Once, it has become cancer, the challenges in treating them are more.
The possibility of cure also gets lower. Some women will not see doctors even when they have vaginal discharges, post-sex bleeds or bleeding in-between menstrual flows.
Again, there are various reasons: shyness and discomfort in discussing such a problem, giving priority to family matters and, sometimes, avoidance of unpleasant news. It may be due to the belief that “as long as I do not know it is cancer I can happily pretend nothing is wrong inside my body”.
I am writing this article to generate more awareness among the readers regarding cervical cancer. In the 21st century, no woman should get cervical cancer or die because of it. There is so much that can be done to prevent or cure it. Share this with friends, ask a sibling or colleague if she has had her Pap smear done, talk about cervical cancer in your Facebook page or blog, take your mother, aunt or grandmother for a Pap test, do something. You can, we can.
Dr Zamzida Yusoff is a gynaecologist and obstetrician, and a committee member of the Malaysian Gynaecology Cancer Society