18 May 2014

Cervical cancer: Myths debunked and prevention

My guest-blogger, Ling and I have been invited to the Cervical Cancer Event at Lady M @ One Fullerton. Below is her blog post.

Cervical cancer: Myths debunked and prevention – by Ling

It’s been a month since Carol and I have gone to this event held at Lady M at One Fullerton.


I would like to apologise for taking such a long time with this post due to a hectic schedule (new job, appointments, responsibilities… you get the drift). As much as I can make “excuses” and procrastinate, we should never procrastinate when it comes to health. As clich├ęd as it gets, prevention is really better than cure. It is way better to protect yourself and live healthily than to be infirmed and suffering.

Cancer is a topic that I am very much concerned with, having lost a couple of relatives to it. As we age, most of us will probably know someone who is battling cancer, or succumbed to it. As much as we do not want to believe it, cancer is the leading cause of death in Singapore. 1 in every 3 Singaporean dies of cancer. Cancer can strike no matter what age we are. No one has zero risk of it, but we can do our best to try to prevent ourselves from getting such a terrible disease. I am always thankful that a good friend of mine is able to overcome it twice, and living a happy and healthy life now. That being said, non-profit organisations always need more donations to make lives better for our fellow human beings, so please donate if you can afford it and volunteer if you have the time!

This event brought to all present knowledge about cervical cancer, clearing confusion and also shared prevention methods. I am very grateful to the speakers (A/Prof. Anne Goh, Prof. Tay Sun Kuie and Dr. Chia Yin Nin), GSK and the Singapore Cancer Society (SCS) for holding this event so that awareness can be spread to more people through the media. (I’ve “temp-ed” at SCS for a couple of weeks before while I was looking for a new job after my sabbatical, so here’s a big wave to my ex-colleagues at SCS if you’re reading! Jiayou!)


What is cervical cancer?

The cervix is the neck of the womb and made up of tiny cells. Changes to these cells, if left untreated, could become abnormal cells called intraepithelial neoplasia (CIN) which can cause cervical cancer. This cancer is spread mainly by HPV (Human Papilloma Virus) infection, which is not commonly associated with any symptoms. The scary part about this is that the virus can spread without some women knowing it. Studies have shown that previous infection with cancer-causing HPV types does not provide protection from future infections. Cancer of the cervix is very serious, and can even be life-threatening for some. 

Signs and symptoms:

If there are symptoms, the most common are:
1. Vaginal bleeding after sexual intercourse
2. Foul-smelling vaginal discharge that may be watery, bloody or heavy
3. Irregular bleeding between periods or after menopause
4. Lower abdominal pain or pain during intercourse

Diagnosis and prevention

Cervical cancer can be diagnosed with tests – Pap Smear, Colposcopy, Endocervical Curettage and Cone Biopsy. 

The most common test for women is the pap smear. Pap smears should be done once a woman is sexually active, especially above 25 years of age. An initial smear is performed once a woman is sexually active and repeated after one year. Following that, pap smears can be done once in one to three years as advised by one’s doctor. 

The accessibility of the cervix allows a pap smear to be performed easily and quickly. A specimen of cells is obtained with a spatula from the cervical lining and examined under the microscope. This test can detect pre-cancerous changes or early cancer, which are easier to treat and have better survival outcome. If there are indications that there are changes in the cervix, further tests will need to be done to confirm the findings. 
It is comforting to know that cervical cancer rate has dropped since the introduction of CervicalScreen, Singapore’s pap smear screening programme.

Another method of prevention is HPV vaccination. HPV vaccination was also made Medisave-payable since 2010 for young girls. 






Treatment

At the pre-cancerous stage, the abnormal area of the cervix can be destroyed using laser, heat treatment or freezing of the cells. Larger areas can be surgically removed using a thin wire loop. When the CIN has spread into the cervical canal, a cone biopsy is required to remove the abnormal area.

At the early cervical cancer stage, removal of the womb may be used to treat women who have completed their families. Women who want to retain their wombs may opt for cone biopsy or laser treatment.
At the invasive cancer stage, surgery is usually used to treat cancer that has not invaded beyond the cervix. The womb, fallopian tubes, ovaries, nearby tissue and lymph glands are also removed to ensure clearance of the cancer. 

If the cancer has invaded beyond the cervix, the main treatment is radiotherapy. Radiation is given in two stages: external radiation and internal close range radiation by inserting radioactive rods into the womb. Chemotherapy is given to women with widespread or recurrent cancer that cannot be cured. 

Debunking myths about cervical cancer

1. “Cervical Cancer is not common, it can never happen to me.”

The number of cases in Singapore has been decreasing in the last 20 years because women take part in prevention programmes. If these programmes did not exist, cervical cancer is the second-most common cancer affecting women. Globally, 500,000 women are diagnosed each year.

2. “I am not at risk of cervical cancer as there is no such history in my family.”

Almost all cases of cervical cancer occur in women with no family history of it, as it is caused by the common HPV. There are 130 different types of HPV, but only 15 cause cancer. The most frequent HPV types that cause cervical cancer are HPV 16, 18, 45 and 31.

3. “Getting cervical cancer is linked to being sexually promiscuous.”

Women can still be infected from having only one partner. HPV is transmitted through sexual intercourse, genital contact, or even during delivery from mother to infant. Every sexually active woman is at risk of being infected by HPV.

4. “I am feeling well; I do not have HPV infection.”

The infection is silent. Many individuals do not know they are infected and unknowingly spread the virus. Early cervical cancer has no sign or symptom, which is why regular screening and prevention are of utmost importance. Genital warts, on the other hand, are also caused by HPV but do not cause cancer (Types 6 and 11).

5. “If I have a normal pap smear, it means I will not have cervical cancer.”

Going for pap smears is a lifetime commitment (until 69 years of age). One pap smear is not sufficient to “protect” you from cervical cancer. In Singapore, all women aged 25-69 who are no longer virgins are advised to have a pap smear done once every 3 years. 

6. “Pap smear programme is effective; HPV vaccination is unnecessary.”

Pap smears and HPV vaccination play different roles: pap smears detect changes in cervix cells, and vaccinations prevent certain HPV infection and reduce the risk of developing cervical pre-cancers and cervical cancer.

7. “I am already sexually active, so the vaccine will not work for me.”

The best time for vaccination is prior losing virginity, however, HPV vaccines have been proven to protect thousands of women in the clinical trials who were already sexually active. Vaccinations do not cover all types of cancer-causing HPV, but it does give protection for the more common types.

8. “My daughter is too young to be vaccinated. She won’t be at risk of cervical cancer at the age of 10.”

The immune response is stronger when vaccinating young. Best responses are received from girls 9-11 years old. Singapore’s recommendation is that the decision to go for HPV vaccination is based on informed choice. We have also included HPV vaccination into our National Childhood Immunisation Programme from age 9-26 years.

9. “Vaccinating adolescents will encourage sexual promiscuity.”

The goal of vaccination is to reduce the risk of cervical cancer. Vaccination does not (and should not!) encourage promiscuity.

10. “I must wait for my daughter’s menses before vaccination.”

Vaccination will not impact the onset of the menstrual cycle, and the antibodies generated does not interfere with adolescent development. There might be side effects however from the vaccination, which are commonly low grade fever, fatigue, and injection site pain/redness.

Conclusion

If there are two things that should be taken away from reading the post, they are: Go for regular screenings and get preventive vaccination!

SCS provides free pap smear screening. It doesn’t take much for us to make an appointment! Visit the website to learn more!





Like the SCS page: https://www.facebook.com/sgcancersociety on Facebook for more information on cancer and how you can play a part. 
The kind folks at GSK have also provided an informative poster which you, dear reader, can refer to (if you have no patience to read the very lengthy walls of text above).

The location

The event was held at Lady M at One Fullerton. It’s a lovely place with fantastic cakes. I especially like the Vanilla/Green Tea Mille Crepes and strawberry shortcake! Service is also excellent. Thanks for the hospitality! Take a look at their website. Like their facebook page:
https://www.facebook.com/ladymsingapore for promotions.

Disclaimer: Protect to Tell – Cervical Cancer Awareness” on 12th April 2014 Sat (the “Event”) was held as a lunch session, organised and sponsored by GlaxoSmithKline Pte Ltd. I was not paid for participating in the Event. All personal views expressed here are entirely my own.





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