Cervical Cancer Screening

Cervical cancer develops in the cells of the cervix, which is the lower part of the uterus that connects to the vagina. It is usually caused by the human papillomavirus (HPV), a common sexually transmitted infection. In Singapore, cervical cancer ranks as the tenth most prevalent cancer among women, with over 200 new cases diagnosed annually.

Fortunately, cervical cancer is highly preventable through early detection of precancerous changes via cervical cancer screening tests like Pap smears and HPV tests. HPV vaccines also offer protection against certain strains of the virus, further reducing the risk of developing cervical cancer.

Why Cervical Cancer Screening is Important?

Cervical cancer screening aims to detect pre-cancer cells (cells that have the potential to become cancerous in future) and prevent invasive cervical cancer from developing. It is traditionally done with a pap smear only, though recent developments have shown that combining a pap smear with an HPV DNA test (i.e. co-testing) can more accurately predict the chances of having pre-cancer cells or cervical cancer than a pap smear alone. HPV vaccines and regular screenings, such as Pap smears and HPV tests, are essential for early detection and prevention of cervical cancer.

Symptoms Of Cervical Cancer

Abnormal Vaginal Bleeding: Unusual bleeding between periods, during sexual intercourse, or after menopause.
Pelvic Pain: Persistent pain in the pelvis or lower back that is not related to menstruation or usual menstrual cramps.
Unusual Vaginal Discharge: Increased or unusual vaginal discharge that may be watery, bloody, or foul-smelling.
Painful Urination: Discomfort or pain during urination, which can indicate advanced stages of cervical cancer.
Pain During Sexual Intercourse: Pain or discomfort during sexual intercourse, known as dyspareunia, may be a symptom of cervical cancer in some cases.

A group of women walking together on a sidewalk.

Causes Of Cervical Cancer

Cervical cancer can develop due to various risk factors and conditions that affect the cervix. Here are some key causes to be aware of:

Sexual Intercourse at an Early Age: Engaging in sexual activity before the age of 20 increases the risk of contracting human papillomavirus (HPV), a major cause of cervical cancer.
Multiple Sexual Partners: Increased exposure to HPV and other sexually transmitted infections (STIs) raises the risk of developing cervical cancer.
Sexually Transmitted Infections (STIs): Infections such as chlamydia, gonorrhoea, syphilis, and HIV/AIDS can weaken the immune system, contributing to cervical cancer risk.
Medical Conditions and Treatments: Conditions like autoimmune diseases or long-term use of steroids or immunosuppressant drugs can increase susceptibility to HPV infection and cervical cancer.
Solid Organ Transplant: Those who have undergone a solid organ transplant are often prescribed immunosuppressant medications, which can increase the risk of cervical cancer due to reduced immune function.
History of Pre-cancerous Cervical Lesions (CIN): Previous diagnosis of cervical intraepithelial neoplasia (CIN) indicates an elevated risk of developing cervical cancer.
Smoking: Smoking tobacco weakens the immune system and may increase the likelihood of HPV infection progressing to cervical cancer.

How Often Should Cervical Cancer Screening Be Done?

Under the National Cervical Cancer Screening Programme, the frequency of screening should be:

Age 25 – 29: Pap smear once every three years
Age 30- 69: HPV DNA test every five years for a previous negative HPV test

What To Expect During A Cervical Cancer Screening Test

During cervical cancer screening, typically done as part of a pelvic exam, you’ll lie on your back on an exam table with your knees bent and feet in support at the table’s end. The doctor or nurse will gently insert a speculum into your vagina to view the cervix and collect cells for testing using a small brush or spatula. Alternatively, you may also have the option of collecting the sample yourself, which you can discuss with your healthcare provider about.

The sample is then sent to a lab for analysis. There, the cells are checked for HPV infection types linked to cancer (HPV test) and screened for abnormal cells (Pap test). When both tests are done on the same sample, it’s called an HPV/Pap cotest.

In addition to sample collection, the pelvic exam may include further checks. Your healthcare provider might assess the size, shape, and position of your uterus and ovaries, and feel for any lumps or cysts. They may also examine the rectum for any abnormalities and discuss testing for sexually transmitted infections if needed.

Why is HPV DNA not recommended for women below 30?

HPV DNA tests are not usually recommended for women below 30 years old as women in this age group are known to have a high incidence of transient HPV infection (the body clears the infection on its own). Women aged 25 to 29 should, however, continue with a pap smear once every three years, as recommended by the Cervical Screen Singapore Advisory.

Do I Need to Do Any Preparation Before Screening?

The tests for cervical cancer screening can be done anytime, but preferably not when you are menstruating.

Cervical Cancer Screening

Cervical Cancer Screening

Pap Smear
HPV DNA Test
HPV Vaccine
Colposcopy
Punch or Cone Biopsy

Frequently Asked Questions About Cervical Cancer Screening:

Is cervical cancer screening painful?

Cervical cancer screening is generally more uncomfortable than painful for most women. While the procedure is brief and typically involves minimal discomfort, it’s beneficial to try to stay relaxed. Should you experience any discomfort, promptly inform your doctor or nurse so they can make adjustments.

Can I have a Pap smear during my menstrual period?

Pap smears should not be performed during your menstrual period as blood cells can affect the accuracy of the test. Schedule your appointment for 14 days after your period starts.

Do I need a Pap smear if I have no family history of cancer?

Yes, it’s still important to undergo regular Pap smears even if you have no family history of cancer. Many cases of cervical cancer occur in women without a family history, so regular screening is recommended to detect any potential abnormalities early.

Do I still need cervical cancer screenings after menopause?

Yes, the risk of cervical cancer increases with age, so regular Pap smears are recommended even after menopause. However, if you have been regularly screened and have negative results, you may discuss with your doctor the possibility of stopping screening after age 69.