SINGAPORE: Doctors are hoping that the incidence of cervical cancer among women, which has reached a plateau after years of decline, will go down even further.
On the back of cervical cancer awareness month in January, they hope that this can happen with regular health screening, vaccination, and help from men. The cancer is preventable.
Dr Lim Li Min, a consultant in the Division of Gynaecologic Oncology at the National University Cancer Institute in Singapore, said that the improvement in numbers has been attributed to pap smear screening being made available in Singapore since 1964.
However, that decline has stagnated since 2010.
“That is likely related to non-compliance to cervical cancer screening among Singaporean women,” Dr Lim said, citing a study that showed that only half of the participants were up to date with their cervical cancer screening.
Breaking down numbers specific to Singapore, there is one woman getting a cervical cancer diagnosis every two days, and at least one woman dying of the disease every week, she said.
“This is more common than we would like it to be, which is why we hope to spread the message about screening and vaccination for cervical cancer,” she said.
HOW COMMON IS CERVICAL CANCER?
Cervical cancer is the 10th most common female cancer in Singapore. A large majority of cervical cancer globally – more than 95 per cent – is due to the human papillomavirus (HPV), according to the World Health Organization (WHO).
Most sexually active women and men will be infected with the virus at some point in their lives, and some may be repeatedly infected. More than 90 per cent of the infected population eventually clear the infection, WHO said.
“HPV is transmitted via skin-to-skin contact, such as during sexual intercourse. It is the persistence of HPV infections which lead to the development of cervical cancer,” said Dr Lim.
She added that most HPV infections clear spontaneously in one to two years among women and transient infections generally do not have long term health repercussions.
She noted that while HPV transmission via sexual activity is most prevalent among the younger age group below 30 years old, most cases of cervical cancer appear in the middle age group due to the manifestations of persistent HPV infections.
GUARDING AGAINST CERVICAL CANCER
Cervical cancer risk can be reduced with a vaccination against HPV, which Dr Lim said could provide up to 90 per cent protection. That coverage should extend to males as well, she said.
“Men who are vaccinated would have the added advantage of preventing the transmission of HPV infection to their partners as well,” Dr Lim said.
Doctors said that some men may be hesitant to get the vaccine because of misconceptions that HPV infections only affect females.
“They could be asymptomatic, they don’t realise they’re carrying these viruses and they can actually go on to infect their partners,” said Dr Joella Ang, associate consultant in the Department of Obstetrics and Gynaecology at Singapore General Hospital.
She added that HPV can cause penile cancer and anal cancer in men.
There is a long period when cervical cancer is precancerous, said Dr Ang.
“That’s when a pap smear screening picks up these patients and we’re able to actually stop it from progressing to cancer through different forms of treatment,” she said.
NEED FOR AWARENESS
It was through such a regular pap smear screening in 2019 that one woman who wanted to be known only as Lydia realised she had cervical cancer.
She needed to undergo a hysterectomy as her cancer was considered aggressive. Following the procedure, Lydia has remained cancer-free for about a year now.
“I was married when I was 18 and I only had one partner my whole life until I got divorced. So lately, I’ve been walking around and I was asking myself – ‘why was it me?’ Men can be the one to bring the virus back home,” she told CNA.
Lydia said there should be more awareness that cervical cancer is not just a woman’s problem – men have a role to play too.
“We shouldn’t be afraid to say we have cervical cancer just because there’s a social stigma,” she added.
A school-based HPV vaccination programme was introduced to all Secondary One female students in 2019. Since then, more than 90 per cent in each year’s cohort have received their jabs.
As for HPV vaccination for males, the Health Ministry (MOH) said it is unlikely to be cost-effective due to low incidence of the disease.
Nonetheless, MOH said it is monitoring the trend of HPV infections and will review its policies as and when new evidence emerges.
