We talk to a top gynaecologist in Singapore about cervical cancer, and related issues like HPV. DR IDA ISMAIL-PRATT is part of Astra Women’s Specialists Tampines and The Obstetrics and Gynaecology Centre at Novena. Here, she answers our questions on the topic and discusses why you should put that pap smear on your priority list.
What is cervical cancer?
Cervical cancer is a type of cancer that grows on your cervix (the entrance to the uterus from the vagina), the same way cancer can grow on other parts of the body. It is the fourth most common cancer in women worldwide.
Cervical cancer is a slow growing cancer. It can take 10 to 15 years or more for abnormal cells to turn into cervical cancer, says Dr Ismail-Pratt.
“This characteristic is an advantage because it means we have time to detect and effectively treat the abnormal cells well before it becomes cancer. We cannot do this with other female cancers.”
Symptoms of cervical cancer, she says, can include irregular vaginal bleeding, discharge or pain. However, in many cases, there are no symptoms.
Unfortunately, most women who do present symptoms will already have cervical cancer, she says. Symptoms usually present in the late stages, when the cancer has most likely spread.
Which is why it’s crucial to take the necessary preventative steps to reduce your risk.
What causes cervical cancer?
According to the WHO, almost all cervical cancer cases are linked to persistent infection with a common virus called Human Papillomavirus (HPV). This virus can cause normal cells on your cervix to turn abnormal. Over many years, these abnormal cells, if not detected, can turn into cancer without the woman knowing.
You cannot see or feel HPV, or these cell changes on your cervix. That’s why it’s important to proactively prevent changes in your cervix that can lead to cervical cancer, says Dr Ismail-Pratt.
What is HPV and how do you get it?
HPV is a common virus that is transmitted by skin-to-skin contact including sexual intercourse. Most HPV infections are often cleared up by the immune system without treatment, and without increasing a woman’s risk of cervical cancer in the future.
In fact, the prevalence of HPV is equivalent to the flu virus; most of us will get an HPV infection at some point in our lives but may not know it.
There are many strains of HPV; they can be categorised as “non-cancer-causing” and “cancer-causing”. Some non-cancer-causing types may cause genital warts. The cancer-causing types, if persist and not cleared by the body over time, can cause abnormal or pre-cancerous changes that can lead to cancer.
Currently, there are 14 cancer-causing types that are associated with cervical cancer. An HPV test can check whether or not you have been infected with any of these 14 HPV types.
HPV infections have no symptoms and it is normal for someone to have the infection for years without knowing it, says Dr Ismail-Pratt. It’s also very possible that a partner may have had the infection years earlier, and was not aware of it.
How to prevent cervical cancer
So, how can you prevent cervical cancer? There are two main ways you can prevent cervical cancer. “The key is to detect the abnormal cell changes or the cancer-causing HPV before cancer has formed,” says Dr Ismail-Pratt. “You can do this by going for your regular cervical cancer screening using the Pap test or the HPV DNA test. A second way is to prevent future cancer-causing HPV from infecting you by taking the HPV vaccine.”
What is regular cervical cancer screening?
Regular cervical cancer screening can be done either by doing the Pap test (pap smear) or the HPV DNA test, depending on your age.
What is a pap smear test?
A pap smear test is to detect abnormal cell changes (precancerous or cancerous lesions) on the cervix. Your doctor will collect cell samples from your cervix to test for any abnormalities.
It’s recommended that all sexually active women aged 25 to 29 years old get a pap smear test done once every three years.
What is HPV DNA test?
An HPV DNA test is done like a Pap test, but it is to detect the presence of the cancer-causing HPV, and usually before any abnormal cell changes have happened. Dr Ismail-Pratt recommends that all sexually active women aged 30 to 69 years old get the HPV DNA test once every five years.
What about the HPV vaccine?
In addition to regular cervical cancer screening, Dr Ismail-Pratt says you may want to consider the HPV vaccine as another preventative option.
There are three types of the HPV vaccine: Cervarix, Gardasil and Gardasil 9. As they are slightly different, it’s best to talk to your doctor or gynaecologist about which one is the most appropriate for you.
Other ways to reduce your risk of cervical cancer
There are other ways to reduce your risk, says Dr Ismail-Pratt. These include:
- Avoidance of cigarette smoking
- Leading a healthy lifestyle so that you have a strong immune system
- Limiting the number of sexual partners
- Using condoms
For more information, or to schedule an appointment, visit smg.sg.
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