According to the latest report in 2012, Cervical cancer is now the 2nd commonest cause of female cancer in Malaysia. 2145 new cases of cervical cancer are diagnosed annually and 621 new cervical cancer deaths are recorded in 2012. That translates to about 6 new cases of cervical cancer diagnosed in Malaysian women everyday and nearly 2 women will die from this dreaded and tragic disease everyday. Cervical cancer was the 3rd commonest female cancer in Malaysia in 2007.
Preventive efforts to decrease the incidence of cervical cancer are vital towards maintaining women’s health as well as saving women’s lives and preserving the health of the nation.
Among the preventive steps that can be taken are Human Papilloma Virus immunisation for teenage girls, Pap smears and Human Papilloma virus testing for sexually active women as well as patient education. It is the coordinated and multi pronged efforts that will be effective in the fight against this deadly disease.
The Ministry of Health, Malaysia introduced HPV immunisation for 13 years old on a voluntary basis as a nationwide programme in 2010, making Malaysia one of the very few countries in the Asian Pacific region to offer such a vital life saving programme to its girls and joining many European countries and United States to place the health of its women and girls as the utmost priority. This is indeed one of the boldest and most valiant efforts towards women’s health preservation and must be hailed as one of the greatest achievements of the Government and the Ministry of health in the area of women health.
The reason why the early adolescence age group are chosen is that cervical cancer prevention by vaccination works best before the initiation of sexual activity and that the same age group exhibit the strongest antibody response towards the vaccine, thus by convention, may translate to better as well as longer protection accorded by the vaccine.
Pap smear has a sensitivity of 56% to 83% and taking the midrange, it’s only about 70% sensitive. Translating these figures to the normal implications of the test, a negative Pap smear result is only 70% right that the women do not have any disease related to cervical cancer or pre-cancer. Therefore because of the long time frame for cervical cancer to develop and the relative inaccuracy of the Pap smear results, such test should be repeated at regular intervals, typically 3 yearly.
In order to improve accuracy of Pap smears, the addition of Human Papilloma Virus Co testing is advocated. If both tests results are negative, the possibility of women developing cervical cancer or pre-cancer within the next 5 years is extremely low and thus screening interval can be extended to 5 yearly.
Please note that the women who are suitable for HPV/ Pap smear co testing are those 30 years old and above. Women below 30 years old are not indicated for HPV/ Pap smear co testing as the incidence of HPV infection in the younger age group are relatively higher with most infections being transient without any harmful sequelae . Thus doing those tests for young women below 30 years old may results in more unnecessary potentially harmful procedures without the expected cancer prevention benefits.
The World Health Organisation has recommended that Primary cervical cancer prevention by vaccination be given to girls between the age of 9 to 13 years old before sexual initiation and Secondary prevention by Pap smear alone or HPV co – testing be performed at a minimum in women 30 years and above to the age of 49 at least once in their lifetime.
It is important to realise that most girls will acquire HPV infection shortly after initiation of sexual activity and that most infections are transient or temporary. It is the persistent HPV infection with high risk types that may develop into cervical pre-cancer and ultimately cancer.
HPV infections are mainly transmitted through sexual contact and thus all women who are sexually active are at risk of cervical cancer.
The global efforts to prevent cervical cancer have been, to a significant extent, limited by resources including Malaysia’s; and the realisation that placing women’s health at the forefront of a Nation’s goal is pivotal to a Nation’s economy and health is increasingly gaining traction.
Let me end this by sharing a story of a young British girl who succumbed to this devastating disease at the age of 23 years in 2012. Her name was Mercedes Curnow. Following are the excerpts taken from the Mercedes Curnow Foundation Facebook page reporting about her tragic passing.
“Fighting back her tears, Sandra Cousins gripped her daughter’s hand tightly as she watched her take her final breath, “Mum, I am going now”, Mercedes, 23, whispered as her eyes slowly begin to close.
Weighing just 5 stones and with her hairs cropped short due to the effects of chemotherapy, she finally lost the battle against the cruel disease that have ravished her young body. Just 18 months earlier, Mercedes was a bright and bubbly young woman with her whole future age ahead of her. Now she lay motionless on her brightly coloured bedroom, the walls around her decorated with pink flowers and love hearts.”
No mother, no father, no families, no husbands, no daughters and sons need to suffer such untold tragedy which is totally preventable .
We need to decide, as a society, that women’s lives are worth saving. We have all the knowledge and technology to prevent this devastating disease, but the lack of will to close the gap between what we know and what we do has proven to be deadly for many women and continues to destroy families unless we do what is right for women.
Dr John Teo is an Obsteatrician & Gynaecologist in Sabah. He serves as a Medical Advisor to the state Family Planning Association and is extensively involved in contraceptive and HPV prevention teachings nationwide. He has a deep passion for women’s health and reproductive rights.
References:
- MOH cancer statistics 2007
- Konnon R et al, Vaccine 2008, 265
- US preventive services task force recommendation March 2012
- HPV and related diseases report , Malaysia, December 2014
- WHO guidance note, comprehensive cervical cancer prevention and control: A healthier future for girls and women, 2013
- WHO media center, HPV and cervical cancer, Nov, 2014
- Mercedes Curnow foundation Facebook.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]