Cervical cancer is the cancer of the neck of the womb, or the cervix. It is the 10th most common cancer in Singaporean women and can be effectively treated if detected early. It is commonly caused by an human papilloma virus (HPV) infection, which is generally transmitted sexually. Hence, women who are sexually active are at a higher risk of infection. There are over 100 strains of HPV, but at least 12 strains can lead to cervical cancer. Though an estimated 8 out of 10 people will get an HPV infection at some point in their lifetime, the virus generally clears by itself and the cells return to normal. It is only when the infection persists and the cells develop abnormally that cervical cancer may occur.
Symptoms of Cervical Cancer
As a cervical cancer patient may not exhibit any symptoms in the early stages, it is important to go for regular screening so as to detect early cell changes in the cervix. It can sometimes take up to 15 years with no symptoms until cervical pre-cancer develops and advances. As cervical cancer progresses, it can cause symptoms such as abnormal bleeding (bleeding after intercourse, between menstrual periods or after menopause), unusual or foul-smelling discharge, or lower abdominal pain.
Screening for Cervical Cancer
Pap smear test
This test looks for abnormal changes in the cells of the cervix and is recommended for women between 25 and 29 years old. Most women in this age group are able to clear HPV infections easily, hence there is no need for an HPV test.
This test checks if the cells of the cervix have the DNA of the cancer-causing HPV strains and is recommended for women who are 30 years old and above.
Who should undergo screening?
Women above 25 years old who have ever had sexual activity are recommended to do the above screening.
How often should I undergo screening?
If your test results are normal, Pap smear tests should be repeated every 3 years and HPV tests should be repeated every 5 years.
Where can the tests be done?
Both the Pap smear test and the HPV test can be done at a subsidised rate under the Screen for Life – National Cervical Cancer Screening programme and cost either $2 or $5 for Singaporeans at CHAS GP clinics.
Cervical Cancer Prevention
Currently, there are three types of HPV vaccines available in Singapore – Gardasil, Gardasil 9, and Cervarix. All three vaccines prevent infection with HPV types 16 and 18, which account for about 70% of cervical cancers. Gardasil also prevents infection with HPV types 6 and 11, which causes 90% of genital warts. Gardasil 9 prevents infection with all four of the HPV types above, as well as five additional cancer-causing types which account for a further 10% – 20% of cervical cancers.
Who should be vaccinated?
The vaccines are recommended for use in females aged 9 to 26 years old. They are most effective if given before the first sexual exposure, or in females who have yet to be exposed to the HPV types covered by the vaccine. Sexually active females may still benefit from the vaccine as they may not be exposed to all the HPV types covered by the vaccine.
What is the dose schedule like?
For females aged 9 to 14 years, 2 doses are recommended with an interval of 0 and 6 months. For females aged 15 to 26 years, 3 doses are recommended with an interval of 0, 1 – 2 and 6 months.
Side effects of the vaccines
Common side effects include pain, swelling, redness and itch at the injection site.
Do women who have been vaccinated still need to undergo cervical cancer screening?
Yes. About 10% – 30% of cervical cancers are caused by HPV subtypes which the vaccines do not protect against, hence it is still recommended that women who are vaccinated continue to undergo regular cervical cancer screening.
Can Medisave be used to pay for HPV vaccination in Singapore?
Since June 2018, patients can use up to $500 per Medisave account per year under the Medisave500 scheme to pay for HPV immunisation, if the person receiving the vaccination is a female aged 9 to 26 years old. However, the scheme is only applicable for the Cervarix and Gardasil (4-valent HPV vaccine) vaccines. Patients can use their own Medisave or that of their immediate family members (e.g. parents or spouse) to help pay for the vaccination. The deductible and co-payment rules will not apply for HPV vaccinations.