What is cervical cancer?

• A cancer of the cervix
  • Cervix is the lower end of a woman’s uterus / womb, just above the vagina
• It is the 3rd most common cancer among women after breast cancer and colorectal cancer
• Link : http://myhealth.moh.gov.my/en/cervical-cancer/

Who is at high risk of getting cervical cancer?

1. Women infected with certain types of Human Papilloma Virus (HPV)
2. Women with any of the following is at high risk of getting cervical cancer
   • Early sexual activity (<17 year old)
   • More than3 sexual partners
   • 7 Pregnancies or more
   • First elivery before the age of 17
   • Smoking
   • Lower socioeconomic status
   • Use of oral contraceptives for more than 10 years

How to prevent cervical cancer?

Prevention is better than cure! Practice healthy life style.

• Be faithful to your partner
• Remember to do pap smear every 3 years
• HPV Vaccination

Screening test

• All sexually active women between age 30 to 65 years old should be screened for cervical cancer, once every 3 years
• Women who are sexually active but less than 30 years old are encouraged for screening test
• The tests include pap smear and HPV testing. If the result is abnormal, you may need to go for colposcopy

Pap smear

What is pap smear test?

• Pap smear or papanicolaou test was developed by Dr George Papanicolaou in 1940s
• A test to identify abnormality in cervical cells
• It is a screening tool to detect precancerous conditions i.e. abnormalities of the cervix that may lead to cancer.
• A simple procedure in which a small number of cells are collected from the cervix and sent to a laboratory for test.
• No drugs or anesthetics are required.
• It only takes a few minutes.

Does the test hurt?

• You might experience discomfort during the procedure, so try to relax and take slow and deep breaths

Who will carry out the test?

A qualified doctor or trained nurse will carry out the test.

What exactly happens during the test?

• You will be asked to undress from waist down.
• You will be asked to lie down on a couch in a closed area
• Then the doctor or the nurse will gently insert a small instrument called a speculum into your vagina to hold it open.
• Then, a smooth wooden spatula or a small brush ( cytobrush ) will be lightly wiped over the cervix to pick up a few cells (360 degrees)
• The sample will be smeared on to a glass slide and will be sent to the laboratory to be stained and examined under microscope and interpreted.
• The procedure itself takes just a few minutes.

Advice for women

• You cannot be tested while you are having your period.
• You should avoid sex for 24 hours before the test
• Do not douche or use a spermicidal (a barrier method for contraception) or lubricant jelly or insert any form of medication into the vagina 24 hours prior to the test
• Pap smear can be done during pregnancy

When do I get the results?

• When you have the test you will be told where and approximately when you will get the results.
• Usually 3 weeks -3 months depending on the workload of the laboratories and clinics.

How often should I have a Pap Smear test?

• If you are aged between 20 and 65, are sexually active or had been active sexually, we recommend for the first two consecutive years, yearly.
• If both results are negative, we advice every 3 yearly.

Where can I have the test done?

• In all government health clinics and hospitals
• private clinics / hospitals
• Federation Of Family Planning Association Of Malaysia (FFPAM)
• National Population And Family Development Board, Ministry Of Women And Family Development (NPFDB) clinics.

What do the results mean?

• A normal smear means there is no detectable abnormalities or problems.
• If the result is abnormal, your health care provider will dicuss with you regarding follow-up treatment
• Some abnormal results are :
  • The effects of microorganisms or viruses (Sexually Transmitted Infections) may be seen on the smear
  • The cells may be changed in reaction to an infection or similar type of injury (these reactive changes are temporary and localized / benign – they do not indicate cancer)
  • The cervical cells may exhibit changes that could be identified as precancerous conditions.
• In abnormal result, you may need to :
  • Repeat smear in 3 – 6 months time
  • Undergo Colposcopy

What is colposcopy?

• It is a diagnostic tool to allow doctors to see the size and area of the abnormality on your cervix
• It is really just a large magnifying glass which lets the doctors look more closely at the changes on your cervix
• It does not go inside you
• It is a painless examination
• But some may find it a bit uncomfortable
• A biopsy of tissue i.e. sample may be taken for an additional examination
• The area may be treated with electro coagulation, laser or cryosurgery to destroy the affected tissues.

2. HPV Testing

• Human Papilloma Virus (HPV) is a virus that is transmitted through skin to skin contact, and it affects both men and women
• It is the most common sexually transmitted infection
• There are over 100 types of HPV viruses and it is divided into high risk and low risk virus
• There are 14 types of high risk HPV virus and it may cause cervical cancer and other cancers such as anal cancer and throat cancer.
• The low risk virus causes genital wart

What is HPV testing?

• This test will detect the type of virus

Who should get the test?

• All sexually active women aged 30 to 49 years old should be screened with HPV test. Women less than 30 years old and between 50 to 65 years old are advised for pap smear

How is the test done?

• Self-sampling by the women herself, or
• Sampling by health care provider
• The sample is sent to laboratory to test for HPV

Picture of self-sampling technique (picture from the Guideline for Primary HPV testing for cervical cancer Screening Malaysia 2019)

What do the results mean?

• If the result is negative, you shall repeat the test every 5 years
• If the result is positive, you need further assessment in a clinic or hospital.
• This further assessment is either liquid based cytology or colposcopy to look for pre-cancerous conditions or cervical cancer

References

• Malaysian National Cancer Registry Report 2007-2011
• Clinical Practice Guidelines – Management of Cervical Cancer 2nd Edition 2015, Malaysia
• Guidelines for Primary HPV Testing in Cervical Cancer Screening in Malaysia 2019