When symptoms start to show, it could be too late ...

WHEN news of former actress Yang Lina's death from cervical cancer broke two weeks ago, Amy could not help but recall her brush with the disease early this year.

Last September, her annual pap smear showed that there were mild cell changes in her cervix. A repeat test and a more detailed examination conducted four months later revealed that Amy had already progressed on to CIN 3, medical lingo for severe cell changes in the cervix.

"I was a little surprised because I did not experience any symptoms," said the 38-year-old logistics and purchasing executive, who has two children.

According to Dr Joseph Ng, consultant gynecologic oncologist at the National University Cancer Institute Singapore (NCIS), there are typically three grades of CIN - one to three. "Only CIN 3 is considered to be a true cancer precursor. If left untreated, CIN 3 has the tendency to progress to actual cancer of the cervix," he said.

Dr Christopher Chong, an obstetrician and gynaecologist who runs his own practice at Gleneagles Medical Centre, said that cervical cancer typically goes through the pre-cancerous stage, which usually does not show symptoms. A common tell-tale sign is abnormal vaginal bleeding.

He added that pre-cancerous changes in the cervix may take months, or even years, to develop into full-blown cancer. "Once the patient is treated at the pre-cancer stage, progression to cancer will not occur. Hence, it is important to catch the pre-cancer stage with regular screening."

Cervical cancer is the sixth most common cancer among women here. According to statistics from the National Registry of Diseases, 200 women are diagnosed with the disease each year, and half will die from it.

Cervical cancer is linked to the Human Papilloma Virus (HPV), which is often transmitted through sexual intercourse. However, not every HPV infection ends up as cancer. In fact, at the CIN 1 (mild cell changes) stage, treatment may not even be necessary as "most of these changes may repair or return to normal with time", said Dr Ng.

However, Dr Chong said that most of his patients will opt for treatment to remove the affected areas of the cervix, even at this early stage.

"In general, patients will not wait for the possibility of CIN progressing to a worse stage. When the condition progresses on to CIN 2 or 3, the surgery will be more extensive; most of my patients who are at CIN 1 stage undergo surgery without any anaesthesia," Dr Chong said.

Said Dr Ng: "The extent of the treatment depends on the size and shape of the area to be removed. This should be determined in consultation with a gynecologist experienced in performing these procedures and who is a colposcopist registered with the Society for Colposcopy and Cervical Pathology of Singapore."

He added that patients ought to be aware that the greater the amount of cervical tissue removed, the greater the risk of weakening the cervix, which is associated with pregnancy complications such as preterm delivery.

Amy underwent surgery to remove the abnormal portions of her cervix and has now been given the all-clear from her doctor.

The Health Promotion Board encourages women aged 25 to 69 who have had sexual intercourse to go for Pap smear screening at least once every three years.

Pap smear

Dr Joseph Ng from NCIS on what to expect during the screening:

1 A slim instrument is placed in the vagina to allow the cervix - the neck of the womb - to be seen clearly.

2 A small broom-like brush is then moved lightly over the cervix's surface to collect cells for laboratory analysis.