Based on WHO statistics, Cervical cancer is the fourth most frequent cancer in women with an estimated 570,000 new cases in 2018 representing 6.6% of all female cancers. Approximately 90% of deaths from cervical cancer occurred in low- and middle-income countries.  In Indonesia, cervical cancer is the 2nd most common cancer in women after breast cancer.

What causes cervical cancer?

The scientific evidence has demonstrated conclusively that cervical cancer is due to persistent infection of high-risk human papillomavirus (hrHPV). Transmission of hrHPV is almost exclusively through sexual contact. HPV is a very common infection. Around 8 out of 10 men and women will be infected with the virus at some point in their life.

It usually doesn’t cause any symptoms and most people will never know they have it. About 70% of new hrHPV infection will resolve within 1 year and almost 90% resolve within 2 years without any effect on the cervix. But in some people, hrHPV infection will linger for a long time and become persistent. People with this persistent infection are those who are most likely to go on to develop cancer.

Risk factors for cervical cancer

The relative risk of having cervical cancer is 2.5 if the age of first sexual exposure is < 18 years old. Women with multiple sexual partners have a relative risk of 2.8 and women whose partners have multiple sexual partners are also at higher risk of cervical cancer. Cigarette smoking is a significant risk factor for cervical cancer by 2-5 folds due to the immune system being less effective in fighting hrHPV infection.

Reducing the risks

Change in lifestyle is very important to reduce risks for cervical cancer e.g. stop smoking, having only one sexual partner and late exposure to sexual intercourse.

HPV vaccine helps to protect against cervical cancer. In Malaysia, HPV vaccination is part of the national immunization program as students aged 13 are being offered vaccination in schools. Other women have the option to get vaccinated at their nearest clinics or hospitals.

Cervical screening test (Pap smear) plays an important role to detect early cervical changes before it becomes cancerous. Women who have had sexual intercourse and who are than 20 years old are encouraged to have regular Pap smear every 3 years. Women who are 30 years old or more are encouraged to have Pap smear with HPV DNA test at the same time. If abnormal cell changes are detected, further treatment can usually be done easily and successfully. If these changes are left untreated, there is a chance that these changes will become cancer in the future.

Treatment options

An early stage of cervical cancer can be treated surgically either by colposcopy cone biopsy, trachelectomy or radical surgery (Wertheim’s hysterectomy). Advanced cervical cancer is inoperable and is treated with concurrent chemo-radiation (pelvic radiation and brachytherapy). Brachytherapy is a type of radiotherapy where it allows a high dose of radiation to be given directly to cancer in your body. It works from ‘the inside, out’ to stop the tumor from growing or to shrink it. The benefits of brachytherapy are high accuracy, minimally invasive, minimal side effects, short treatment time and fast recovery. Brachythe is considered gold standard treatment for cervical cancer and it’s available in Sunway Medical Centre.

From vaccination, screening, investigations, surgery, treatment, radiation therapy (external & brachytherapy) and palliative care, all these services are available under one roof in Sunway Medical Centre as a one-stop cancer center.

In summary, cervical cancer is almost entirely preventable and treatable. Don’t be another sad statistic, women should get vaccinated, screened and treated for cervical cancer.

Article by:

Dr. Zaharuddin Bin Rahmat
Consultant Obstetrician and Gynaecologist, and Gynaecological Oncologist
Sunway Medical Centre