Prevention is better than cure By Dr Li Hie Ing
Consultant Obstetrician and Gynaecologist, MBBS (UM), MRCOG (UK), Special interest in minimally invasive surgery (MIS)
Cervical Cancer is the second most common type of cancer affecting women worldwide and is the third most common type of cancer among Malaysian women.
Factors leading towards cervical cancer include early onset of sexual activities and multiple sexual partners that lead to HPV (human papillomavirus) infection, low socioeconomic status, cigarette smoking, oral contraceptive pills and when a person is immunocompromised (having an impaired immune system).
HPV infections are very common, especially in the absence of vaccination when the majority of sexually active individuals are susceptible to HPV infection during their lifetime. High risk HPV may later lead to cervical cancer. In fact, it has been identified as a leading cause of cervical cancer (over 95%).
HPV is sexually transmitted in both homosexual or heterosexual relationships and can infect both men and women, putting them at risk of cancer in the vagina, vuiva, anus, penis, throat and particularly cancer of the cervix. The area affected depends on a person’s sexual habits. For instance, anal sex may lead to anal cancer and oral sex may lead to throat cancer.
In Malaysia, the most common types of HPV causing cervical cancer are HPV 16,18,58, 52 and 33, with HPV 16 and 18 accounting for 62.1% of the cases while HPV 58, 52 and 33 accounts for the other 18% cases.
Malaysia has taken precautionary steps, by implementing HPV vaccination in schoolgoers.
How to prevent cervical cancer:
- hPv vaccination – There are three types of vaccine available, namely; a. Cervarix – to protect against HPV 16, 18 b. Gardasil – to protect against HPV 16, 18, 6, 11 c. Gardasil 9 – to protect against HPV 16, 18, 31, 33, 45, 52, 58, 6, 11Cervarix and Gardasil (against 16,18) can help to reduce the incidence of cervical cancer by 70%, while Gardasil 9 can potentially offer an overall prevention of cervical cancer up to 90%.HPV vaccination is most effective in those who have never been sexually active and can be administered to both males and females as early as 9 years old. Each person should receive three doses in total (those between the ages of 9 and 14 only need two doses).
- Regular cervical screening – Cervical screening (pap smear or LBC – Liquid based cytology) is used to detect precancerous and cancerous processes in the cervix. Females who are sexually active should start undergoing cervical screening at the age of 25. Cervical screening is done annually. If 3 consecutive results are normal, it is recommended that cervical screening is repeated every two to three years.Cervical screening is important as it helps to pick up pre-malignant conditions which are much easier to treat as compared to cancer and it is important to remember that the HPV vaccine does not replace routine cervical screening.