GYNAECOLOGICAL CANCERS SCREENING AND VACCINATION

The top three gynaecological cancers in Singapore are endometrial cancer, ovarian cancer, and cervical cancer. Cervical cancer is the only gynaecological cancer that can be screened and vaccinated.

Cervical cancer remains the top 10 women’s cancer in Singapore. Globally, cervical cancer is the 4 th most common cancers in women. Cervical cancer is caused by a virus called Human Papilloma Virus (HPV). Almost all (99%) of cervical cancers are caused by HPV. There are many strains of HPV, and it is divided into high-risk strains and low risk strains. Only the high-risk strains are cancer causing. HPV can be acquired through penetrative and non-penetrative sexual activity. Once infected with HPV, most will clear the virus within 2 years. However, if the virus persists in the cervix for an extended period, it may cause changes to the cells of the cervix resulting in precancerous change. After many years typically 15-20 years the precancerous change may turn to cancerous changes.

Since cervical cancer is caused by a virus, it can be vaccinated against to protect oneself. HPV vaccination is currently part of our Singapore national vaccination program. The vaccines work best if administered prior to HPV exposure. From 9 to 14 years of age, only 2 doses of HPV vaccine is sufficient 6 months apart. From 15 to 25 years of age, three doses are required. The protection varies between 70% to 90% depending on the type of vaccine one choses.

HPV vaccination does not replace screening for cervical cancer. The vaccines do not confer a 100% protection against all the high-risk HPV strains. Hence if one is sexually active, she will need to undergo regular screening. Screening for cervical cancer is done either by a PAP smear or HPV test. From the age of 25 to 29 years, a PAP smear every 3 years is recommended. From 30 to 69 years, a HPV test every 5 years is recommended.

Unfortunately for endometrial cancers and ovarian cancers, there are no effective screening techniques available. There are no vaccinations as well. Symptom recognition is therefore very important. Endometrial cancers tend to present early as abnormal menstrual patterns. In menopausal ladies, any bleeding seen after menopause is considered abnormal and will need to seek immediate gynaecological consult.

Ovarian cancers are notoriously difficult to detect. The symptoms are very nonspecific such as abdominal bloatedness, non-specific aches and pains, tiredness, and lethargy. By the time the lady presents to the gynaecologists, most will be an advanced stage of ovarian cancer. Understanding one’s body and seeking medical consult early is the only way to beat ovarian cancers.

In summary, cervical cancer is preventable with vaccination and regular screening.

Written by Dr Wong Wai Loong