In Malaysia, cervical cancer is the third most common and the fourth most deadly cancer among women with a record of 76,800 deaths as of 2019. While the authorities have taken various measures to prevent this deadly disease, such as implementing HPV vaccination programs gradually, only 4 out of 10 women between the ages of 30 to 65 had undergone cervical cancer screening between 2014 -2019.

 

This shows that the awareness of cervical cancer in Malaysia is still very low, and the taboos that surround the topic is still very high, especially in the rural areas and among underserved communities.

 

To understand cervical cancer and the awareness of cervical cancer in Malaysia, we spoke to Dr Thangesweran Ayakannu, Obstetrician & Gynaecologist at Sunway Medical Centre, who gave us an in depth understanding on cervical cancer.

 

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Who are the women most prone to get cervical cancer? Is there a specific group who are at risk?

There are a few risk factors that may cause someone to be more prone to cancer, and includes:

• Smoking: Women who smoke are almost twice as likely as non-smokers to get cervical cancer. Smoking impacts the immune system and makes it less effective in fighting HPV infections.
• Immunosuppression: Human immunodeficiency virus (HIV), which causes AIDS, damages the body’s immune system. Thus, women who are HIV+ are at higher risk for HPV infections.
• Chlamydia infection: Chlamydia is a relatively common bacteria that can infect the reproductive system. It is spread by sexual contact. Some studies have seen women with blood test results showing evidence of past or current chlamydia infection (compared to women with normal test results) at a higher risk of cervical cancer.
• Diet: Women who partake in diets without enough fruits and vegetables may increase the risk for cervical cancer. Overweight women are more likely to develop adenocarcinoma of the cervix.
• Oral contraceptives (birth control pills): Studies have shown that taking oral contraceptives over a prolonged period increases the risk of cervical cancer.

Intrauterine device use: A recent study found that women who have used an intrauterine device (IUD) showed a lower risk of contracting cervical cancer. This effect on risk was seen even in women with an IUD for less than a year, and the protective effect remained even after the IUDs were removed.

 

• Family history of cervical cancer: Due to genetics, cervical cancer might run in some families. Hereditarily, if your mother or sister has a history of this cancer, your chances of developing it are two to three times higher than if no family member had it.

 

2. What causes cervical cancer?

The human papillomavirus (HPV) is a major cause of the main types of cervical cancer. HPV is common, and most sexually active people will come into contact with HPV during their lifetime. Still, for most, the virus causes no harm and goes away.

 

 

3. What are the main warning signs of cervical cancer?

It is often difficult to notice the symptoms of cervical cancer until it has advanced to a severe stage. Symptoms that may indicate cervical cancer include unusual vaginal bleeding – such as intermenstrual bleeding (IMB), postcoital bleeding (PCB), or postmenopausal bleeding (PMB).

 

Additionally, pain or discomfort during sex and unusual vaginal discharge, such as foul-smelling or watery bloody discharge, can indicate cervical cancer. Cancer spreading beyond the cervix may cause pelvic pain, urinary problems, swollen legs, kidney failure, bone pain, weight loss, or fatigue.

 

4. Is cervical cancer preventable?

There are several ways to reduce the risk of developing cervical cancer, including avoiding smoking and protecting yourself from HPV by using condoms. Additionally, the HPV vaccine can offer protection against certain HPV infections that are linked to cancer. Vaccinating at the recommended age can help prevent more cancers than receiving it at older ages. If you are between the ages of 27 and 45, it’s essential to discuss with your doctor whether HPV vaccination might benefit you.

 

There are several ways to reduce the risk of developing cervical cancer, including avoiding smoking and protecting yourself from HPV by using condoms

To further reduce the risk of discovering cervical cancer at a later stage, it’s important to prioritise regular screening. Women should begin getting screened for cervical cancer starting at age 20, and those between the ages of 25 and 65 should aim to get tested every five years.

 

 

5. Is cervical cancer curable? What are some of the treatment options available?

The treatment for cervical cancer depends on various factors. This includes the stage of the cancer, the patient’s general health, and whether the cancer has spread. Typically, a multidisciplinary team will work together to determine the most effective treatment plan for the patient. This team will be made up of gynaecology-oncological surgeons, oncologists (medical/clinical), cancer support nurses and psychosexual care providers.

 

 

6. What are the current perceptions and cultural taboos surrounding screening and cervical cancer?

In Malaysia, cultural taboos and perceptions surrounding cervical cancer screening are influenced by various factors, including awareness, education level, socioeconomic status, and traditional beliefs. In some communities, reproductive health discussions are considered taboo, and screening tests may be seen as embarrassing.

 

Some communities may perceive cervical cancer screening as unnecessary because premarital sex is considered taboo in the religion, and the risk of developing cervical cancer is believed to be low. This perception may lead to a reluctance to undergo screening, particularly for unmarried women.

 

Another cultural taboo is the belief that discussing women’s reproductive health issues is inappropriate. This taboo may prevent women from seeking information about cervical cancer screening and treatment and prevent healthcare providers from discussing these topics with their patients.

 

In addition, there may be a lack of awareness and understanding about the importance of screening, particularly in rural areas where access to healthcare may be limited. Some women may also have misconceptions about the screening process, such as the belief that it is painful or invasive, which can discourage them from seeking care.

 

7. What can the community do about these perceptions and taboos?

To address these barriers, healthcare providers in Malaysia should take a culturally sensitive approach to cervical cancer screening and treatment and tailor their approach to the needs of each patient.

 

Education and awareness campaigns are also essential in breaking down taboos and misconceptions surrounding cervical cancer screening, particularly in rural areas and among underserved communities.

 

By promoting open and honest discussions about reproductive health, we can help to reduce the stigma and improve access to screening and treatment for all women in Malaysia.

 

 

8. In your opinion, who should get themselves screened for cervical cancer? And why is it important?

Regular screening tests are vital in detecting changes in the cervix that could develop into cancer. The two primary tests for cervical cancer screening are:

 

HPV test – The HPV test is designed to detect infections by specific types of HPV that can lead to the development of precancerous or cancerous cells in the cervix.

 

Pap smear test – The Pap smear test involves examining cervical cells to identify any abnormal changes that may indicate the presence of cancer or precancer.

 

Cervical cancer screening should begin at age 20, and individuals aged 25-65 should undergo primary HPV testing every five years. If primary HPV testing is unavailable, a co-test (an HPV test along with a Pap smear test) every five years or just a Pap smear test alone every three years is recommended.

Cervical cancer screening should begin at age 20, and individuals aged 25-65 should undergo primary HPV testing every five years.

 

While screening and vaccination programs have considerably reduced the incidence of cervical cancer, thousands of cases are still diagnosed each year in the UK alone, especially in women who do not undergo regular screening. Therefore, primary care practitioners like us must advocate for these programs and ensure that patients with persistent abnormal bleeding or discharge receive appropriate examinations and referrals.

 

For instance, we recently launched a free cervical cancer screening program in February, fully funded by our Sunway Cancer Support Fund. This programme is part of our ongoing efforts to promote the early detection of cervical cancer, as early diagnosis dramatically increases the chances of successful treatment.

 

By providing these screenings at no cost, we hope to make it easier for individuals who may not otherwise have access to regular screenings due to financial constraints. In addition, we aim to raise awareness about the importance of early screening and provide a tangible solution that will help people stay on top of their health and get the care they need.

 

9. Any last words or statement you would like to inform women about cervical cancer?

I want to stress the importance of regular cervical cancer screening through Pap smears and HPV tests. These tests can detect abnormal cells or HPV infection early when they are easier to treat and before they develop into cancer.

 

Additionally, getting vaccinated against HPV can reduce the risk of cervical cancer. Women must prioritise their health and talk to their healthcare providers about their risk factors, screening options, and vaccination. Remember, early detection is key to successfully treating and surviving cervical cancer.

 

Getting vaccinated against HPV can reduce the risk of cervical cancer.