A routine pap smear is the most common screening method for detecting cervical cancer. It is a painless procedure that accurately detects over 90% of cervical cancers, even before symptoms develop. A speculum is first inserted into the vagina to properly visualize the cervix. Cells from the cervix and vagina are taken using a small brush to be examined for any abnormalities. Early pre-cancerous changes in the cervix can be detected in this way and treated, thereby preventing cancer from developing. All women who are sexually active or had sexual intercourse in the past should have regular Pap smears.
Colposcopy and biopsy is another method for diagnosing cervical cancer and is usually performed following an abnormal pap smear. This provides a magnified view of the abnormal cervix. In this minor procedure, acetic acid and iodine is applied to the cervix to highlight the abnormal areas and biopsies of the abnormal areas are then taken for further evaluation.
Appropriate treatment can be performed based on these results. Treatment of pre-cancerous changes of the cervix includes laser vaporization, LEEP and cone biopsy with laser or knife.
Electrosurgical Excision Procedure) and Cone Biopsy
LEEP or cone biopsies are minor surgical procedures performed to remove a cone or cylindrical-shaped piece of abnormal cervical tissue. This is achieved using an electrically heated wire loop in LEEP and with a knife or laser in the case of a cone biopsy. This can be performed using local anaesthetic or with sedation.
Gardasil® Human Papilloma Virus (HPV) vaccination
Cervical cancer is the 2nd most common cancer affecting women worldwide with 500,000 women diagnosed per year. On average 270,000 women die per year which means a woman dies of cervical cancer every 2 minutes worldwide.
Sexual activity increases the risk of cervical cancer and pre-cancer, irrespective of age and lifestyle.
Cervical cancer is the 2nd most common female cancer in Asia and the 7th most common cause of cancer deaths among Singaporean women.
There are 100 types of human papilloma viruses (HPV) but only 15 of them are categorised as "high risk type" which cause cervical cancer. The two most commonly found types are HPV type 16 and 18 which are responsible for 70% of cervical cancers. HPV infection is mainly spread through sexual intercourse and can be asymptomatic.
Cervarix® vaccine protects against HPV types 16 and 18 associated cervical pre-cancerous disease and cancer. The ASO4 adjuvant incorporated into Cervarix® induces a sustained immune response. Cervarix® also provides cross protection against HPV 45 & 31 infections, which are the 3rd and 4th most common causes of cervical cancer globally.
The vaccination regime comprises of three doses, given at 0, 1 and 6 months. Women should still continue with their regular pap smear screening after vaccination.
Gardasil® vaccine offers protection against cervical, vaginal, vulva and anal cancer, in addition to pre-cancerous changes of the cervix and vulva, and genital warts caused by HPV types 6, 11, 16 and 18. The majority of infected individuals are asymptomatic and can unknowingly transmit the infection which is why the HPV infection affect up to 50% of sexually active couples.
Both women and men can receive Gardasil®. It is best administered to persons with no previous HPV infection although those with previous HPV exposure can still benefit. It consists of three doses given at 0, 2 and 6 months.
Vaccination is designed to prevent infections and not treat it. Routine Pap smears screening is recommended post-vaccination as it is not meant to be a substitute.