CERVICAL CANCER
The silent killer

The lack of early stage symptoms makes health checks vaccinations vital

AT 28, radio deejay Rosalyn Lee thought she was in the pink of health. So when she bumped into an old friend who insisted she went for a women's health check, Rosalyn initially waved off the advice.

"I was 28 years old then healthy and normal did not see the immediate need to go for a health check," said Rosalyn who eventually went for a medical check after her friend made an appointment for her.

Her friend's insistence saved her life.

Rosalyn's checkup revealed abnormal cells in her cervix — and she was just one stage away from full blown cervical cancer.

Cervical cancer typically affects women in their 40s and 50s. But what many people don't know is that the disease starts off as pre-cancerous cell changes in the cervix, and they can be present for many years before they become cancerous, said Dr Quek Swee Chong, a senior consultant and head of the pre-invasive disease and screening unit and department of gynaecological oncology at KK Women s Children's Hospital (KKH).

Every two days, one woman in Singapore is diagnosed with cervical cancer. Despite being a highly preventable disease, it is still one of the top cancer killers among women here. Doctors TODAY spoke to felt
that there are many misconceptions surrounding the disease.

To raise awareness several initiatives have been put in place recently. Last month the Obstetrical and Gynaecological Society of Singapore launched The Women's Health Series. These women-related healthcare
workshops are held at more than 17 community clubs islandwide. The initiative done in partnership with the People's Association, aimed to enhance the level of awareness on women's health issues such as cervical cancer prevention in the heartlands. Visit one.pa.gov.sg for details.

In July, Power Over Cervical Cancer (POCC) was launched by MP Halimah Yacob. This campaign aims to get 18,000 women in Singapore aged between 10 and 25 to take a cervical cancer risk test online at the POCC website (www.pocc.sg).

Contrary to common belief, cervical cancer is not a hereditary condition, said Dr Chris Ng, consultant obstetrician and gynaecologist at GynaeMD at Camden Medical Centre. In fact, 99 per cent of cases are caused by the Human Papilloma virus (HPV), a common virus that afflicts up to 80 per cent of women who have been sexually active, he added.

For most people the virus usually clears up on its own without causing any serious consequences. However, for some, these cancer causing viruses persist and may result in pre-cancer cells in the cervix. explained Dr Quek.

NO EARLY WARNING SIGNS
Like many cancers, the disease creeps up on you insidiously. In the early and pre-cancer stages, doctors said there are often no warning signs.

"The most common signs are a bloody or watery vaginal discharge bleeding after sexual intercourse or vaginal bleeding after menopause, said Dr Quek.

Other symptoms such as un pleasant smelling vaginal discharge and pain during sexual intercourse may also sometimes be mistaken for other gynaecological ailments such as vaginal infection or dryness, added Dr Ng.

"But by the time these symptoms occur it is often too late and the cancer would have become quite advanced. Therefore it is important to have regular Pap smears even if you feel completely well," advised Dr Quek.

After undergoing treatment, Rosalyn has recovered.

"I never thought that there was anything wrong with my health. If not for my friend who was persistent to get me to go for the health appointment, I would not have known what was life threateningly wrong with me," she said.

In Rosalyn's case any chances of her contracting full blown cervical cancer were nipped in the bud in time.

"Most abnormal pap smear results are because of some cell changes in the cervix which may be pre-cancerous. Appropriate and timely detection allows doctors to treat the pre-cancer and prevent cancer from ever occurring," said Dr Quek.

CERVICAL CANCER VACCINES

• There are currently two vaccines - Gardasil and Cervarix - that offer up to 70 per cent protection, said KKH's Dr Quek Swee Chong. They are administered in three doses over the course of six months.
  
• In Singapore, vaccines are licensed for women aged nine to 26. " The main target group are adolescents as they're not likely to have been exposed to HPV before (from sexual actitivity) and can expect maximum benefit," said Dr Quek. Older women who has never had sex before should similarly receive the same degree of protection from the vaccine, he added. The vaccines have also been shown to offer significant, but lesser, protection for women who have been sexually active.
  
• Vaccinated women should still go for routine Pap smear tests, which can pick up abnormal changes. Dr Chris Ng of GynaeMD explained that this is because the cervical vaccines do not protect against all cancer-causing types of HPV.
  
• According to Dr Ng, pregnant women and cervical cancer patients should not go for the vaccination.