SINGAPORE — Mas Azura Abdul Rahman, 32, works as a clinic manager for a gynaecologist. The trained nurse knows the importance of screening for cervical cancer, which is done through regular pap smears or testing for the human papillomavirus (HPV).

Still, the married mum of three children aged five to 13 has been hesitant to go for regular pap smears, citing discomfort and embarrassment over the test.

In early 2022, she was diagnosed with a pre-cancerous condition and had to have the affected cells of the cervix removed.

Subsequent testing has shown that she is out of danger, and she is now looking forward to her pap smear later in 2024 to reinforce her clean bill of health.

Her advice to other women now is to prioritise routine testing for cervical cancer. “Don’t be scared, don’t be stubborn,” says Azura.

Cervical cancer is preventable and easily screened for, doctors say, yet it remains one of the most common cancers in women in Singapore.

According to the Singapore Cancer Registry Annual Report 2021, which was released in 2023, cervical cancer is the 10th most common cancer in women in the country, and the 10th leading cause of cancer death for women.

The report found that from 2017 to 2021, cervical cancer accounted for 2.6 per cent of cancers in women and 2.8 per cent of cancer deaths in women. The top killer was breast cancer, accounting for 29.7 per cent of cancers in women and 17.2 per cent of cancer deaths in women.

About four Singapore women are diagnosed with cervical cancer every week, says Dr Ida Ismail-Pratt, who practises at Astra Women’s Specialists clinic and The Obstetrics & Gynaecology Centre, Mount Elizabeth Novena Specialist Centre.

She adds: “Cervical cancer has a devastating impact on a woman’s life.”

Her patients are often starting families, have young children or are reaching the peak of their careers, when the disease hits.

Treatment may be painful, expensive and affect the patient’s fertility.

“It’s heartrending because we know that this can be prevented,” says the obstetrician and gynaecologist, who is president of the Society for Colposcopy & Cervical Pathology of Singapore.

As a member of the Women’s Gynaecological Cancer Awareness Month Committee of the Singapore Cancer Society, Dr Ida wants more people to be aware that cervical cancer is preventable and can be identified years before it reaches an advanced stage.

It can also be eliminated through vaccination. Nearly all cases of cervical cancer are related to HPV infection.

A vaccine against HPV infection has been offered to female students in Secondary 1 since 2019, as part of the school health vaccination programme. In 2022, the Ministry of Health (MOH) said that more than 90 per cent of the female Secondary 1 cohort has received the HPV vaccine.

Lifestyle Low screening rates

Women in Singapore are aware of cervical cancer screening tests, yet most of them do not opt in for such screenings, according to MOH’s National Population Health Survey 2022.

The survey found that most Singapore women aged 25 to 74 were aware of the pap smear test (89.9 per cent) and more than half were aware of the HPV test (54.6 per cent).

Yet only 43.1 per cent of these women reported having gone for cervical cancer screening.

Screening participation rates had also dropped significantly from the 57.9 per cent reported in 2007.

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Doctors tell The Straits Times that women might opt out of screening for a number of reasons.

Dr Wang says: “Patients may be hesitant due to fear, embarrassment, lack of awareness or concerns about discomfort. Access barriers, such as time constraints or financial considerations, can also impact screening rates. It is crucial to address these factors to encourage regular cervical screenings.”

Misconceptions also abound regarding HPV. Dr Ida says that many think of HPV as a sexually transmitted disease (STD), leading to stigma around those who are found to be infected by it.

Azura, too, was worried at first that her technician husband might misunderstand her positive HPV test results. “A lot of people think that HPV is an STD.”

He did not misunderstand and was supportive throughout the treatment process, but this is not always the case.

Dr Quek says: “What people don’t understand is that HPV infection should be considered a marker of sexual activity rather than being labelled as a sexually transmitted disease. It is well recognised that the vast majority of both men and women, 80 per cent or more, will be exposed to HPV at some stage in their lives, and that cervical cancer is a very rare outcome of this very common infection.”

He adds that more should be done to increase HPV vaccination for both females and males. In men, HPV can lead to anal cancers, cancer of the penis and certain throat and oral cancers.

The incidence of HPV infection and HPV-linked cancers in men is less well studied. The World Health Organisation estimates that globally in 2019, there were 70,000 new cancers in men linked to HPV, compared with 620,000 new cancers in women.

Dr Ida says that outreach efforts to reduce cervical cancer incidence should go beyond educating women and also target family members who can encourage their female relatives to go for cervical cancer screening.

“Cervical cancer is not a woman’s problem. Cervical cancer is everybody’s problem,” she says.

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This article was first published in The Straits Times. Permission required for reproduction.