What You Need to Know About Cervical Cancer

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No.3 most common cancer among Malaysian women but may be prevented through regular screening test

Cervical cancer is the third (3) most common cancers among Malaysian women. Every year 2000-3000 women were admitted in hospital due to cervical cancer in Malaysia. It’s estimated at least 6.8 new cases of cervical cancer per 100,000 women annually. Cervical cancer is among the few cancers that can be prevented. By doing regular cervical cancer screening test, the risk of getting cervical cancer can be reduced by up to 70%. Cervical Screening (Pap smear) is able to detect abnormal cells before it turns into cancer. By detecting the pre-cancerous cell, it can be treated before it manifests into cancerous cells.

Johor has the lowest rate of Pap smear screening in the country at 39.9%. According to the Fifth Malaysian Population and Family Survey (MPFS-5) 2014, the main reasons are:

1. Do not require check up
2. Time constraint
3. No information
4. Afraid/Shy

Cervical cancer is an abnormal cell growth in the cervix (neck of the womb). Cervical cancer can be reduced by getting HPV vaccination and regular Pap smear. Pap smear should be offered to sexually active women age 20-65-year-old. HPV vaccination can reduce the risk of getting cervical cancer but it’s not 100%. You will still need to go for regular Pap Test.
The most important risk factor for cervical cancer is infection by human papilloma virus (HPV). HPV can spread from one person to another by skin to skin contact. HPV can infect the cervix during sexual activity. Most women will be able to clear HPV infection with their own immune response. However, if HPV infection persists for long duration, cervical cancer may develop. Risk of HPV infection can be reduced by getting HPV vaccination, avoid sexual promiscuity and avoid smoking.

The following should clear your basic doubts on Pap smear procedure and Cervical Intraepithelial Neoplasia (CIN):

Is Pap smear painful?
It is not a painful procedure but is mildly discomforting.

When is the most suitable time (menstrual calendar) for a Pap smear?
There are no restrictions as such as long as the woman is not having her menses during the test.

Is it normal to have minimal bleeding after Pap smear?
Yes, but it will stop in a day or two.

How frequent should a woman go for a Pap test?
Yearly for two years if the results are normal, then every 3 years once.

Should I test for HPV?
Test for HPV is more expensive and are not available at most community clinics. Primary cervical screening with HPV Test is however, currently being tried in a Pilot Study in Malaysia. As for now, HPV test can be used for those with abnormal Pap smear result to determine whether these women need to go for further tests.

What if I have abnormal Pap smear result?
Pap smear is a screening test hence its not 100% accurate. Depending on the severity of the abnormal Pap smear (Low Grade or High Grade), you may need further tests such as Colposcopy and Biopsy.

Does abnormal Pap smear mean I am having cancer?
No. Most women with abnormal Pap test don’t have cervical cancer. They just need further tests to make sure they don’t have Cervical Intraepithelial Neoplasia (CIN).

What is Colposcopy and Biopsy?
Colposcopy is the examination of a woman cervix with magnification to identify any abnormality that can turn into cancer in the future. The cervical abnormality that can manifest into cancer in the future is called CIN.

How do I get CIN?
If our immune system is not able to clear HPV infection of the cervix, after a few years the cervix may develop CIN which can become cervical cancer after 5-15 years.

What is the treatment for CIN?
CIN of the cervix can be removed by performing minor surgical procedure on the cervix. The procedure can be done under local analgesia.

Do I need hysterectomy if I am having CIN?
No. Minor procedure on the cervix will clear the CIN in most cases.

Will I get cervical cancer after my CIN is treated?
The risk of getting cervical cancer will be markedly reduced. But you will still need long term follow up as there are chances for CIN to come back.
Best not to wait long and go for a Cervical Cancer Screening now.