MARCH, 2019 | Th e HEALTH
ISSUE: CERVICAL CANCER
Cervical cancer and HPV
HPV, or Human Papillomavirus (HPV) is quite
a common type of virus we might have in us.
In a fairly recent breakthrough, we now know
that HPV is the cause of cervical cancer in
women. However, actually having HPV in our
bodies does not automatically means we
have cancer.
There are over 200 different types of
HPV, however only 15 types specifi cally are
identifi ed by the World Health Organization
(WHO) as ‘high-risk subtypes’. These high-
risk subtypes are the ones most likely to
cause cancer.
Other than having these specifi c HPV
types, other factors have been found to also
contribute to the risk of having cervical cancer.
“We do know that stress and smoking are
one of the contributing factors. There was a
study in Sweden that found that the women
who suffered a loss in the family had abnormal
pap smears after a year of screening,” notes
Dr Woo Yin Ling, Consultant Obstetrician and
Gynaecologist at Universiti Malaya.
How to take your own HPV test
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Symptoms to look out for
In many women with early-stage cervical
cancer, these symptoms are typically seen:
• Blood spots or light bleeding between or
following periods
• Menstrual bleeding that is longer and
heavier than usual
• Bleeding after intercourse, or any pelvic
examination
• Increased vaginal discharge
• Pain during sexual intercourse
• Bleeding after menopause
• Unexplained, persistent pelvic and/or
back pain
• Prevention is better than cure, so get
yourself checked today!
Education
is still
important
Dr Woo explaining how to use the swab.
D
R Eeson Sinthamoney, President of the Obstetri-
cal and Gynaecology Society of Malaysia lends
his thoughts on the prevalence of cervical cancer
and Project ROSE.
“It can be considered as a breakthrough, as far as
cervical cancer screening eff orts is concerned.”
Th is was what Dr Eeson Sinthamoney, President of
the Obstetrical and Gynaecology Society of Malaysia said
when Th e Health asked about his thoughts on Project
ROSE. “Th e eff orts made by UM with Project ROSE may
lead to a signifi cant change in the detection of cervical
cancer in the country.”
Cervical cancer, despite being one of the most pre-
ventable cancer, still reigns as the third most common
cancer in Malaysia. And although screening is made
widely available nationwide, there are still ‘barriers’
among women to go for cervical cancer screening.
The test
“Th e idea of a cervical cancer test is to identify whether
there are changes in the cells around the area of the
cervix. A test was developed to look for certain changes
of the cell, and if found, would indicate a risk of cervical
cancer in later years of a woman’s life. Th at test is called
pap smear, or pap test,” Dr Eeson explains.
“In recent times, there was another breakthrough in
cervical screening, where researchers have found the
cause of cervical cancer. It turned out that a particular
virus is the cause, the Human Papillomavirus (HPV).”
“A test is then developed to identify the specifi c type
of HPV that poses the most threat in developing into the
cancer, called the HPV test.”
The problem
“Now that we know the cause of the cancer, and the
screening has been put in place, it would seem that is
quite illogical that we still cannot completely eliminate
cervical cancer,” says Dr Eeson.
Therefore the question arises; Why?
KNOWLEDGE IS POWER: Dr Eeson says that
education is still very important if we want to
completely eliminate cervical cancer in Malaysia.
15
According to Dr Eeson, the main reason on why cervical
cancer is still prevalent is because women are simply not
going for regular screening.
“Th eir reasons may vary. Some are not going because
they are uncomfortable with the screening procedure,
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Cervical screening every fi ve years applies more to
high resource settings. In lower resource settings, WHO
have set more achievable targets which is a HPV test
for 70 percent of the 35-45 year old female population.
However, all screened positive women MUST be appro-
priately followed up.
“HPV infection is very common. A positive result
does not mean cancer. A negative HPV test is a good
predictor of a woman not being at risk of developing
cervical cancer in the next 10 years,” she adds.
“WHO has stated that HPV testing should be replac-
ing pap smears as the primary screening and many
countries are already moving towards it. We are trying
to look for social initiatives, CSR initiatives to make
this a reality.”
“We have also collaborated with LPPKN and off ered
free cervical screening test in Johor recently. In March,
we will be heading to Penang as part of World Cancer
Day. Everyone has a role in eliminating cervical cancer
in Malaysia. And I believe we all have the means to do
it,” she states hopefully. — Th e Health
some may be too ashamed, and others might not even
hold it of much importance.”
Although, whatever the reason is, he says the bottom
line, the problem still yet to be tackled, is that many
women are not going for screening tests in Malaysia.
“Because they do not get screened, they do not dis-
cover pre-cancer stages, leading to them not fi nding out
that they have cancer, ultimately not eliminating the
cancer,” he laments.
What can be done?
Dr Eeson applause the efforts taken by University
Malaya in coming up with Project ROSE. “Th is project is
to be made a game-changer because of the way the test
is to be done,” he states. Project ROSE will implement a
self-sampling approach, whereby women can perform
the fi rst part of the test (swabbing) on their own. Th en
the swabs are taken into participating clinics to be tested
for HPV.
“Th is approach may be able to eliminate the ‘fear’, or
‘shame’ some women have with screening. It would make
them more comfortable to do regular screening, which
would tremendously help one aspect of the problem in
cervical cancer screening.”
To compare, a pap smear or pap test can only be done
by a doctor or nurse, and it can be rather uncomfortable,
even painful to some. And women will have to make an
appointment to go to see their doctors and so on for
screening. Th is could possibly be one of the main reason
as to why many are still opting out for regular screening.
However the idea of doing the test yourself, sending
the sample to the clinic, and having your test result
sent to you via sms, is quintessentially better than the
former.
Education is key
Although Project ROSE are here to tackle a signifi cant
portion of the problem, Dr Eeson also says that educat-
ing the public about cervical cancer, and how regular
screening can prevent them is still very important.
“I believe that there are still room for improvement in
regards to the knowledge we have about cervical cancer.
With ample knowledge and the means to prevent it,
there is real possibility that we can actually eliminate
cervical cancer altogether.” — Th e Health