Younger women now more at risk

CERVICAL cancer can strike the young. This is something that Ms Jenny Chua has experienced first-hand.

Her sister-in-law was diagnosed with the disease after suffering a miscarriage in her fifth month of pregnancy. She had just turned 21. She had multiple sexual partners and started having sex at a young age.

When she had the miscarriage, she went to the Singapore General Hospital to remove the foetus, said Ms Chua, 33, a clinic manager.

"A few days later, she experienced abdominal cramps. Then a few weeks later, we noticed that her abdomen was getting bigger," said Ms Chua.

A check showed that there was a 16cm tumour in her sister-in-law's womb.

"She was advised to do a removal of the womb, which she did," said Ms Chua. The tumour was found to be an aggressive form of cervical cancer.
 
Ms Chua's sister-in-law then underwent chemo and radiotherapy.

It didn't work. Her condition worsened and she died in October 2005, a year after she was diagnosed.

The National Cancer Centre Singapore's website keeps figures on all the different types of cancers it sees.

In one table, it showed that between 1998 and 2002, a girl aged 15 was diagnosed with cervical cancer. Doctors believe this is the youngest recorded case of cervical cancer.

Dr Christopher Chong, a consultant obstetrician and gynaecologist at Gleneagles Medical Centre, said that over the past five years, he has been seeing more younger patients, aged 35 and below, who show abnormal changes in their cervical cells on routine screening using the Pap smear test.

"Age is not a good indicator of whether you are more likely to get cervical cancer. Women should get regularly screened for cervical changes once they are sexually active," said Dr Chong.

This is because a woman is more likely to develop cervical cancer if she has multiple sexual partners or if she becomes sexually active at an early age.

"Early sexual activity is believed to increase the risk because during puberty, cervical tissue undergoes many changes that might make the area more vulnerable to damage," said Dr Chong.

There have been no studies done here, but a South Korean study published in 2008 showed that over the last 20 years, the incidence of cervical cancer in women aged below 35 years has increased.

More patients were also found to have an aggressive form of the disease.

Social behaviour, including sexual habits, has changed in Korean women, with sexual activity starting at a younger age.

More women in Korea are also taking up smoking, which makes them twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect organs other than the lungs.

Such trends are also showing up here.

A recent report said that more girls under the age of 14 are having sex.

According to annual crime statistics released by police last month, there were 83 reported cases of statutory rape last year - a 36 per cent jump from the 61 cases in 2008. The youngest victim was 12.

There have also been cases where girls first had sex when they were only 9 or 10 years old.

Changing trends
Said Dr Chong: "Such changing trends and risk factors suggest a need for more active education of young women about cervical cancer prevention strategies."

Infection with human papillomavirus (HPV) increases a woman's risk of getting cervical cancer by 20 to 100 times, he said.

HPV is a sexually transmitted virus that is quite common, especially amongyounger women.

However, there are more than 100 types of HPV and only a few are high-risk types.

The good news is that there are two approved HPV vaccines available here which protects against four types of HPV that cause 70 per cent of all cervical cancers.

The Health Sciences Authority has approved two vaccines here for girls and women. One vaccine, Gardasil, is approved for those aged between 9 and 26, and the other, Cervarix, for those between 10 and 25.

But Dr Chong recommends that even those in the older age group can benefit from vaccination.

"It is still effective protection for older women," said Dr Chong.

This is something that Ms Chua is considering on top of her regular screening tests.

"Seeing my sister-in-law's case has made me aware that it can hit anyone at any age," she said.