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Cervical Cancer Singapore
Prevention is Better than Cure—Get Screened Regularly
Why is Cervical Cancer Known as One of the Most Preventable Cancers?

Once a leading cancer among women and a leading cause of cancer death around the world, cervical cancer rates have fortunately since plummeted; though much more can be reasonably done to bring the numbers even lower.

Prevention is Better than Cure—Get Screened Regularly

Cervical cancer is now recognized as a highly preventable and treatable (in the early stages) cancer, partly because of the slow-progressing nature of the development from a HPV infection to cervical cancer (often up to 10 years or more); and partly because of the plethora of simple and effective screening options widely available:

  • HPV Vaccine: If administered before any sexual exposure, it can prevent up to 70% of cervical cancer cases.
  • Pap Smear: When done in a timely fashion, it can detect pre-cancerous cells on the cervix.
  • HPV Test: This is used to detect the presence of high-risk (cancer-causing) HPV on the cervix.
  • Colposcopy & Biopsy: Usually recommended after an abnormal Pap smear and/or HPV test result, this will give your gynaecologist a much clearer indication of your condition and how best to treat it.

Other lifestyle choices to reduce the risk of cervical cancer include limiting the number of sexual partners you have, using a condom and not smoking.

The Pap Smear:

Ability to Detect Cell Changes

One of the most useful things about the Pap smear is how it can detect cell changes and abnormal cells in the cervix before they turn cancerous; allowing your doctor to either engage in watchful waiting (since most cases clear up on their own within two years, thanks to our immune systems), or perhaps opt to remove these cells pre-emptively before they possibly progress into cancer.

  • How is a Pap smear done?
    • A quick and relatively painless procedure, the Pap smear essentially involves the collection of cells from the cervix, which will be sent to a lab for examination.
    • To do this, the doctor will gently insert a speculum into the vagina and obtain some cells from the cervix using a soft plastic brush.
  • How often should I have a Pap smear?
    • Women who have been sexually active before should undergo a Pap smear around once every three years, past the age of 25.
    • Should any abnormalities be found, your gynaecologist may recommend that you come back more often for closer monitoring.
  • What if my Pap smear results are abnormal?
    • This does not necessarily mean that you have cancer.
    • Often, it may be pre-cancerous cells which may require further testing to verify (coloposcopy and/or biopsy), and which can be effectively treated at that stage.
    • Mild abnormalities may also be caused by other infections, hormone changes, or menopause. These can be easily confirmed by colposcopy.

The HPV Test

: Ability to Detect Presence of High-Risk HPV

Though the HPV test does not indicate whether a woman has cervical cancer or not, it does indicate whether HPV is present or not; which can prompt the gynaecologist to conduct further testing, closer monitoring or treatment of any abnormal cells.

  • When might the HPV test be recommended?
    • Women aged 30 and above are recommended to have the HPV test instead of the pap smear for screening. In some cases, your doctor may recommend doing both the pap smear and HPV test together (co-testing).
    • If a woman has mildly abnormal Pap results, sometimes a HPV test is added to provide more information about whether additional investigation is needed.
    • In women of any age who have had treatment for pre-cancerous cells, a HPV test is recommended after the treatment.
  • Why only women aged 30 and above?
    • Because HPV is so common among sexually active women in their teens and 20s, it is not helpful to test for it, since most cases of HPV infections resolve on their own within two years.
    • However, when women aged 30 and above have a positive HPV result, it more accurately predicts the presence of pre-cancerous cells.
  • How is the HPV test done?
    • The HPV test is done in the same way a pap smear is taken. A swab sample is taken from the cervix and surrounding vagina.
  • What is co-testing?
    • Co-testing is when a Pap smear and HPV test are conducted at the same time. Some doctors may recommend this method of testing.
    • Women with both normal Pap and HPV test results have a negligible chance of developing cervical cancer within 5 years.

Colposcopy & Biopsy

: Verifying the Nature of Abnormal Cervical Cells

A colposcopy is a procedure used to examine the cervix in greater detail through a special magnifying instrument known as a colposcope; and it may be recommended if a Pap smear, HPV test or pelvic exam uncovers any abnormalities. If abnormal areas are identified, a small sample of tissue (a biopsy) may be removed for closer examination. The procedure generally takes no more than 10 minutes, and is performed in the clinic without the need for any anaesthesia.

  • How is a colposcopy done?
    • Similar to a Pap smear and HPV test, you will be asked to lie down with your legs propped up on supports. A speculum will be inserted into your vagina to gently open it, allowing the colposcopist to examine your cervix in detail.
    • A magnifying device (colposcope) with a strong beam of light will be used to look at your cervix, though the colposcope is positioned outside the vagina and will remain outside your body.
    • A weak vinegar solution (acetic acid) will be applied to the cervix to highlight the abnormal areas—you may feel a slight tingling sensation.
    • In some cases, it may be necessary to conduct a biopsy, in which case a small sample of tissue will be gently removed from the cervix for further testing.
  • Does a colposcopy hurt?
    • While the insertion of the speculum may cause you to feel some pressure, it shouldn’t hurt.
  • Does a biopsy hurt?
    • It may feel like a small pinch or scratch, but it shouldn’t be painful.

Try Not to Worry

If any of your tests uncovered abnormal cervical cells, particularly after a colposcopy, don’t worry—most women don’t uncover cancer at this point (if timely screenings have been adhered to), plus mild abnormalities don’t always need to be treated immediately.

Cervical cancer screening is generally successful because abnormal cell changes can happen many years before progressing into cancer, making early detection and intervention all the more effective.

If, however, treatment is needed, the goal will be to remove the abnormal cells while preserving as much normal tissue as possible. There are many well-established ways to do this.

What Causes Cervical Cancer?
Dr Quek Swee Chong
Dr Quek is an experienced gynaecologist of over 20 years with a specialized interest in the prevention and treatment of cervical cancer.

To that end, he serves on the board of the International Federation of Colposcopy & Cervical Pathology, and his extensive research and humanitarian work centre around HPV and cervical cancer as well.