SINGAPORE: Cervical cancer is one of the most commonly diagnosed cancer among women in Singapore. A worrying upward trend can be seen from the Singapore Cancer Registry report from 2011 to 2015.
While cervical cancer screening remains a pivotal player in the prevention of this disease, it has to work together with an effective Human Papillomavirus vaccination programme.In May 2018, the World Health Organisation’s Director General Dr Tedros Adhanom Ghebreyesu called for the world to commit to a total eradication of cervical cancer., the launch of the free HPV vaccination programme for Secondary 1 girls.
A HPV DNA test which needs to be carried out every five years will replace the pap smear test, which must be done every three years, as the new national cervical cancer screening protocol for women aged 30 and above.The HPV is a group of double-stranded DNA viruses extremely common worldwide and can be transmitted through skin contact including genital contact.
Acute infection including cancer-causing HPV infection does not increase the risk of developing cervical cancer. The issue lies in the persistence of the HPV infection.The HPV vaccine is a prophylactic vaccine. It protects the host against future cancer-causing HPV infections. It is a viral-like particle, and allows the vaccine to confer immunity without infecting the host.There are three HPV vaccines available worldwide; the bivalent, quadrivalent and nanovalent.
HPV vaccines are extremely effective in preventing the development of cervical cancer precursors, offering over 90 per cent protection. But none of these HPV vaccines will provide 100 per cent coverage. Women up to the age of 45, who are already sexually active, with previous history of abnormal pap smear results or have been treated for pre-cancerous cervical lesions, may also benefit from the vaccine. In October 2018, the US Food and Drug Association approved Gardasil 9 to be given to women up to 45.There is also emerging evidence of a causal relationship between a tumour-causing HPV infection and the development of cancer in the anus, vulva, vagina, penis and oropharynx.