At the recent Women’s Health Day held by the Singapore Council of Women’s Organisations, we attended a talk given by Dr Lisa Wong, practising gynaecologist and women's cancer specialist at Mount Elizabeth Hospital on cervical cancer.
Here's cervical cancer decoded:
Where is the cervix, anyway?
It’s located at the end of the narrow neck of the womb, the small opening into vagina that allows menstrual blood to pass through. The cervix also dilates during childbirth to allow the fetus to pass from the uterus to the vagina.
What are the symptoms of cervical cancer?
• Bleeding after sexual intercourse
• Bleeding in between periods
• An abnormal PAP smear
• Blood-stained vaginal discharge
When do I need to go for a PAP smear?
According to the Health Promotion Board, ‘all woman aged between 25 and 69 who ever had sex are advised to have a Pap smear done once every 3 years.” Cells are collected from your cervix using a speculum and sent for a laboratory test. A result letter will be posted to you if everything’s normal. If not, you will need to see your doctor for a follow-up.
What happens after I get an abnormal pap smear?
Your doctor will ask you to come back for a colposcopy, where your cervix is examined using a microscope (a colposcope) to see the abnormalities under magnification, like if it’s just a mild infection from the human papillomavirus (HPV) or something more serious.
What’s the treatment for cervical cancer?
If you’re in the early stage where the cancer cells haven’t spread to the upper layers of the cervix then surgery to remove the cancerous cells or radiotherapy and/or chemotherapy. If you’re in the later stage of cancer, then radiotherapy and/or chemotherapy will be recommended.
What are the causes of cervical cancer?
The human papillomavirus (HPV) is detected in 99.7% of cervical cancers - majority of them caused by type 16 and 18 of the virus. The other types of HPV are more low risk ones that cause things like genital warts. HPV enters through breaks in the superficial layers of the cells of the cervix during sex. The viral particles then infect cells at the bottom layer and spread upwards.
How can I prevent cervical cancer?
Condoms can lower your risk but they’re not all effective. The HPV vaccine protects a woman against HPV infection, and thus, cervical cancer. Its efficacy is 98 to 100%. There are 2 types on the market now – Gardasil and Cervarix both cover types 16 and 18 of the virus. Gardasil also protects against types 6 and 11, and thus helps prevent genital warts. However, the vaccine is not fool-proof and you still have to go for regular pap smears after.
Going for your regular PAP smears is also important. As the precancer stage of cervical cancer is long (10-20 years) and can be asymptomatic, PAP smears are the most effective way of picking up abnormalities.
We also asked our resident Sex Q&A expert, Dr Douglas Ong, an Obstetrics and Gynaecology specialist to comment on an important procedure that saves lives - PAP smears.
Q: Women nowadays are still afraid of going for PAP smears – what advice would you give them?
A: Women fear PAP smears for 2 reasons: fear of pain and fear of the result. PAP smears can be painless – it really depends on the person doing it for you to be gentle, patient and skilled. I firmly believe that a woman’s first PAP experience must be a good one. A painless initial PAP makes a woman less tense at her subsequent visits.
Fear of the result is a byproduct of any test. Unlike many other tests that detect cancer after it has occurred, PAP smears are aimed at detecting precancerous lesions and actually prevent cancer from happening. Now that should be good enough incentive.
Q: Should all women go for PAP smears, regardless of whether they've started being sexually active?
A: Women who have not had their first sexual encounter do not need a PAP smear. However women who have already had sex in the past should continue to have PAP smears even if they are not currently sexually active.
Q: We’ve read that PAP smears aren't good if you're intending to conceive, so women should go for one every 2 years. Is this true?
A: PAP smears do not affect your chances of conceiving. This is a myth that must be corrected to protect women’s health.