Preventing and eliminating cervical cancer in Malaysia

Dr Ganesh Ramachandran 

PETALING JAYA Nov 11 (FMT): Nov 17 marks the first anniversary of the World Health Organisation’s (WHO) declaration of eliminating cervical cancer. This is a laudable goal as there are reliable screening methods and effective vaccination for this cancer.

In 2018, the World Cancer Research Fund reported 18 million new cancer cases around the world, of which 47%, or eight million cases, involved women.

Almost 600,000 were new cases of cervical cancer. In fact, this is the fourth most common cancer among women after breast, colorectal and lung.New FMT App00:00PreviousPauseNext00:11 / 00:23UnmuteFullscreenCopy video urlPlay / PauseMute / UnmuteReport a problemLanguageMox PlayerAlmost all cervical cancer is associated with the Human Papilloma Virus (HPV), though not all HPV infections will lead to cancer.

The transmission of this virus is largely associated with sexual behaviour, such as having multiple sexual partners or engaging in early-age sexual intercourse. Other risk factors include smoking, the presence of other sexually transmitted infections, and an immunocompromised state.

Cervical cancer does not occur immediately after exposure to HPV. In 90% of women, recovery is the norm; in others, depending on the type of HPV progression, a precancerous lesion could lead to cancer.

This generally takes 15 to 20 years in otherwise healthy women. In women with a weakened immune system, this may take five to 10 years.

The Malaysian scenario

The Malaysian National Cancer Registry and the Penang Cancer Registry reported 48,639 new cancer cases and 29,530 cancer deaths last year. Among women, the most common cancers were breast, colorectal, ovarian, cervical, and uterine.

The cervical cancer national screening programme recommends regular screening for those between the ages of 20 and 65. Despite this programme having existed since the 1960s and being offered free since 1995, only 45.7% of Malaysian women have been screened, in contrast with the minimum target of 80%.

Reported obstacles include individual-based factors such as costs, embarrassment, lack of knowledge or time, and fear of the procedure.

Systemic factors that have impeded screening include long wait times for an appointment, no call-recall system, patient overload, and lack of resources, manpower and educational material.

One silver lining is the inception of the cervical cancer vaccination programme. The vaccine was approved for use in 2007 and was incorporated into the national vaccination programme in 2012. Population coverage now exceeds 80%.

Another innovation is the Removing Obstacles to Cervical Screening (ROSE) programme, which was launched in 2019, allowing women to self-test for HPV instead of seeing a healthcare professional for a pap smear. This test, apart from being self-administered, is sensitive in picking up the risk of cervical cancer.

Eliminating cervical cancer

Cervical cancer can be eliminated as there is a clear cause in many patients, a relatively long period before cancer develops, effective screening methods and, most importantly, an effective vaccine.

It has been reported that the number of HPV infections and pre-cancerous lesions has dropped in countries with a vaccination programme, and in time this should lead to a drop in new cervical cancer cases.

A healthy lifestyle, vaccination against HPV, regular pap smears, and the recent availability of self-testing kits for HPV play an important role in preventing cervical cancer.

Pre-invasive lesions caught during screening can also be treated easily and effectively. More than 99% of future invasive cancer may be prevented by screening for and treating pre-invasive lesions.

Furthermore, the improvement of socioeconomic and educational status will empower women over time to manage their health and possibly eliminate this disease.

In conjunction with the WHO’s elimination strategy of cervical cancer, Taylor’s University School of Medicine will be organising a two-day Cervical Cancer Elimination Symposium on Nov 13 and Nov 17 from 10am-1pm.

To register, click here. For more information, email tusom.taylors@gmail.com.

Associate professor Dr Ganesh Ramachandran is the head of school for the School of Medicine, Faculty of Health & Medical Sciences at Taylor’s University.Subscribe to our newsletter and get news delivered to your mailbox.

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