Busting cervical cancer myths

(Credit: iStock.com/SewcreamStudio)

With over 200 new cases diagnosed locally each year, cervical cancer is the 10th most common cancer and the 10th leading cause of cancer death among women in Singapore¹. The good news is that it is one of the most preventable and treatable cancers when detected early through regular screening. Yet, surprisingly cervical cancer screening uptake in Singapore remains relatively low, with the latest statistics from the National Population Health Survey indicating that less than 40% of Singaporean women get regularly screened.

In conjunction with Gynaecological Cancer Awareness Month in September, Dr Joella Ang, Consultant, Department of Obstetrics & Gynaecology, Division of Surgery and Surgical Oncology, Singapore General Hospital (SGH) & National Cancer Centre Singapore (NCCS) busts some common myths about cervical cancer and hopes this will encourage more women to get screened for this very preventable and treatable cancer.

Dr Joella Ang, Consultant, Department of Obstetrics & Gynaecology, Division of Surgery and Surgical Oncology, SGH & NCCS dispels common myths about cervical cancer and highlights the life-saving difference vaccination and regular screenings can make.

What is Cervical Cancer?

Cervical cancer occurs when cells in the cervix mutate and grow abnormally. There are two main types of cervical cancer: the more common squamous cell carcinoma which develops in the thin, flat cells lining the outer part of the cervix and the less common and more difficult to detect adenocarcinoma which forms in the glandular cells of the cervix.

Myth 1: Only women with multiple sexual partners get cervical cancer

Any sexually active woman is at risk of cervical cancer, regardless of how many partners she has had.

Fact: Any woman who has been sexually active, even if they have only had one partner can be at risk. Cervical cancer is primarily caused by persistent Human Papillomavirus (HPV) infection, which is transmitted through intimate skin-to-skin contact. While having multiple sexual partners, smoking or having a weakened immune system can increase the risk, no woman can assume she is safe simply because she has had only one or a few sexual partners.

Myth 2: Cervical cancer cannot be treated

Fact: Cervical cancer is in fact highly treatable, especially when detected early. With regular screening, precancerous lesions can be detected and treated even before it becomes cancer. Treatment options depend on the stage of the disease as well as the patient's overall health and preferences, and may include surgery, radiation therapy, chemotherapy or a combination of these treatments. When detected early, the chances of a full recovery are significantly higher.

Myth 3: I feel well, so I don't need screening

Do not wait for symptoms to appear. Abnormal bleeding, unusual discharge and pain can be signs of advanced cervical cancer.

Fact: Precancerous changes, when cells begin to display abnormal behaviour with the potential to become cancer, and early-stage cervical cancer typically do not cause any symptoms. Many women only seek medical attention when they experience abnormal bleeding, unusual discharge or pain which are symptoms that may only appear at a more advanced stage of the disease. A Pap smear or HPV test is the most effective way to detect abnormal cell changes long before any symptoms develop, making regular screening one of the most effective tools in the fight against cervical cancer.

Myth 4: I don't have a family history, so I'm not at risk

Fact: Unlike some cancers, cervical cancer is not hereditary. It is mainly linked to the HPV infection, which means that women with no family history of cancer can still develop the disease. Do not assume you are at a low risk simply because no one in your family has had cervical cancer. HPV infections are the main risk factor and regular screening is important for all eligible women (see box story below for more details).

Myth 5: Pap smears are painful and screening is expensive

Regular Pap smears can detect pre-cancerous changes early, significantly improving treatment outcomes.

Fact: Fear of discomfort and cost are among the most common reasons women may delay screening but the good news is that a Pap smear or a HPV test is a quick and simple procedure. During a vaginal examination, which typically takes only a few minutes, a sample of cells is gently collected from the surface of the cervix and sent to the laboratory to be tested for precancerous or cancerous changes. While some women may experience mild discomfort, it is generally not painful. Singaporeans also benefit from subsidised screenings at participating CHAS GP clinics or polyclinics

Some clinics also offer vaginal self-sampling, which you can carry out in the privacy of your own home and may help reduce discomfort. The process involves inserting a specially designed cotton swab into the vagina and swabbing for around 10 to 20 seconds. Studies have shown that self-collected samples are just as accurate as those collected by a doctor. Speak to your gynaecologist to find out more or to request for this option.

Screening and vaccination: What you need to know

If you are aged between 25 and 69 years and have ever been sexually active, speak to your doctor about cervical screening, which should be done once every three to five years. The Pap smear and HPV test are used to screen for cervical cancer and both are performed in the same way — a doctor or nurse conducts a speculum examination and collects a sample from the cervix.

The Pap smear detects abnormal cell changes in the cervix, giving an indication of whether precancerous changes are present at the time of testing. The HPV test, on the other hand, detects the virus responsible for causing these cell changes, and can provide a broader picture of your current and future risk of developing precancerous changes.

For females between the ages of 9 and 26, the HPV vaccination offers an additional layer of protection. The vaccination is administered in three doses delivered over six months and is available at polyclinics and GP clinics. Ideally, the vaccination is given before sexual activity begins and is subsidised under the National Childhood Immunisation Schedule (NCIS) for girls. HPV vaccination provides long-lasting protection and is highly effective against HPV-16 and HPV-18. However, as it does not cover all HPV strains regular cervical screening remains important even for vaccinated women of eligible age.

Where to get screened:

• To check your screening eligibility and book a screening appointment at a participating CHAS GP clinic, log into the Health Appointment System at https://book.health.gov.sg/healthiersg-screening or call your nearest polyclinic to make a screening appointment.

• Free Pap smear tests are available for females aged 25 to 29 who have not done a test in the last three years, and free HPV tests are available for females aged 30 to 49 who have not done a test in the last five years. Both are available at the Singapore Cancer Society Clinic @ Bishan, call 1800 727 3333 to find out more.

¹Singapore Cancer Registry Annual Report 2023