Cervical Cancer Screening in Singapore
- MBBS, National University of Singapore
- M Med (Obstetrics and Gynaecology) (National University of Singapore)
- Fellow of the Royal College of Obstetricians and Gynaecologists (FRCOG) United Kingdom
- Fellow of the Academy of Medicine Singapore (FAMS)
Cervical Cancer
The human papillomavirus (HPV) is considered to be the primary factor leading to cervical cancer. More than 100 HPV types exist, but only 15 of them are categorised as “high-risk types” for cervical cancer. The two most commonly found types are HPV 16 and HPV 18, which are responsible for 70% of cervical cancers. HPV infection is mainly spread through sexual intercourse and can be asymptomatic.
Cervical Cancer Screening
Pap Smear
The most common screening method used to detect cervical cancer is a Pap smear. It is a quick and painless procedure that accurately detects over 90% of cervical cancers even before symptoms develop.
During the procedure, a speculum is inserted into the vagina to get a clear view of and access to the cervix. A small brush is used to collect cervical and vaginal cell samples, which will be analyzed in a lab for cancer and other abnormalities. Pre-cancerous changes can be detected at this stage and promptly treated, thereby preventing cancer from developing.
All women who are sexually active or have had sexual intercourse before should have Pap smears regularly.
Colposcopy
Colposcopy with biopsy is another method for diagnosing cervical cancer and is usually performed following an abnormal pap smear. It provides a magnified view of the abnormal cervix for a more thorough inspection. During this minor procedure, acetic acid and iodine are applied to the cervix to highlight the abnormal areas, and a biopsy will be taken to evaluate the cervical cells better.
Treatment will depend on the results of the colposcopy and biopsy. Treatments for pre-cancerous changes in the cervix include laser vaporization, loop electrosurgical excision procedure (LEEP), and cone biopsy with laser or knife.
Cervarix® & Gardasil®9 Vaccination
Over 80% of cervical cancer cases in Asia Pacific are caused by HPV 16, 18, 31 and 45. HPV 33, 52 and 58, meanwhile, are linked to anal, cervical, vaginal and vulvar cancer. HPV 6 and 11 can result in genital warts. HPV 16 and 18, which make up 70% of all cervical cases, can be prevented with the Cervarix® vaccine.
On the other hand, Gardasil®9 provides protection for all HPV types mentioned above, giving it 90% immunity against cancers of the cervix, vulva, and anus, as well as precancerous changes and genital warts.
Gardasil®9 is suitable for men and women, and works best for those who’ve never had sexual intercourse or possible HPV exposure before. However, the vaccine is still beneficial to those who may have been exposed to HPV before, as they may not have been exposed to all the types of HPV before that the vaccine protects against.
Cervarix® and Gardasil®9 are given in 3 doses over a duration of 6 months.
Do note that HPV vaccines are not meant to be substitutes for routine Pap smears, which should still be diligently undertaken.
LEEP (Loop Electrosurgical Excision Procedure) and Cone Biopsy
LEEP and cone biopsy are procedures that help remove abnormal cervical tissues, typically in a conical or cylindrical shape. In LEEP, this is achieved using an electrically-heated wire loop; and in a cone biopsy, this done using a knife or laser. Both procedures are performed under local anaesthetic or sedation.
Dr Regina Zuzarte-Ng
Every Step of the Way.