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Dr Quek Swee Chong, Medical Director of Parkway Gynaecology Screening & Treatment Centre, talks about how women can prevent some of the top 10 cancers in Singapore.

Cervical cancer: The 100 per cent preventable cancer

There’s a reason why cervical cancer has dropped from fifth place to last on the top 10 cancer chart in Singapore: it is the one cancer that is almost completely preventable.

The cancer is related to the Human Papillomavirus (HPV), which has about 150 types but only around 13 of them cause cancer, with the top two types namely 16 and 18, causing 70 per cent of cervical cancer. The virus is most susceptible to women who are sexually active, and therefore the vaccines, Cervarix and Gardasil, are best administered to young girls, preferably before they start sexual activity.

Both vaccines are considered safe by the World Health Organization, which has run many tests on either drug. It uses an empty shell of the virus to prevent 70 to 80 per cent of cervical cancer. Both Cervarix and Gardasil consist of three doses to be administered over six months.

Risk factors

Women who :

• Are sexually active
• Have multiple sexual partners
• Have had sexual intercourse at an early age
• Have a history of sexually transmitted diseases (i.e.: herpes, genital warts)
• Have weakened immune systems
• Have long-term consumption of combined oral contraceptive pills
• Smoke

Symptoms

In the early stages, the cancer may not show any symptoms. But as it progresses, watch out for these signs:

• Vaginal bleeding following intercourse, or in between periods or after menopause
• Bloody discharge that may be heavy or smell foul
• Lower abdominal pain or pain during intercourse

Prevention

• Get vaccinated with a HPV vaccine
• If you have been sexually active before, do a Pap smear from age 25 onwards, every 1-3 years until 69 years of age

Breast cancer: The most common gynaecological cancer

More than 25 per cent of cancers diagnosed in women are breast cancers and the risk increases with age. You can take steps to monitor your breasts so as to be aware of any anomalies and changes.

Physical signs

• Lumps in breasts and armpits
• Persistent rash around nipple/s
• Bleeding or discharge from nipple/s
• Skin over breast appears thick, swollen and hard
• Nipple is suddenly retracted (pulled inwards)

Screening tests

• Women above 40 should go for annual mammograms, while women between 50-69 years of age should do it every two years
• Women with a family history of breast cancer should opt for mammograms earlier than the age of 40
• Perform breast self-examinations every month, after menstruation

How to perform breast self-examinations

Self-examinations will get you used to how your breasts feel, so when there are changes, you will be able to tell. Observe your breasts carefully while going through the motions.

1. Look at your breasts

• With your arms at your side
• With your arms above your head
• With your arms on your hips

2. Feel your breasts

• With a pillow under your shoulders
• In a circular motion from armpit to nipple

3. Squeeze your nipples gently

• Look out for bleeding or discharge
• Breast milk discharge during breastfeeding is not a cause for concern

Ovarian cancer: The cancer with no ideal test (yet)

Women with a family history of ovarian cancer have the highest risk of developing ovarian cancer. There is no ideal screening test for this yet but an ultrasound scan will usually be performed to detect ovarian cancer.

Risk factors

• Increasing age
• Family history
• No children
• Use of fertility drugs
• High-fat diet
• No use of contraceptive pills

Symptoms

• Bloating/mass in abdomen
• Sudden weight loss and decrease in appetite
• Abnormal bleeding after menstruation and menopause

Uterine cancer: The most common cancer in developed countries

Uterine cancer – also known as endometrial cancer – is fed by estrogen, and apart from the ovaries, fat cells in the body can also produce estrogen. One of the reasons that women in developed countries are getting more uterine cancers is that they generally have fewer children. Another reason is that obesity that results from excessive eating and a sedentary lifestyle can predispose to uterine cancer.

Risk factors

• Obesity
• Increasing age
• No children
• Early onset of menstruation and late menopause
• Polycystic ovaries

Symptoms

• Vaginal bleeding after menopause
• Bleeding in between periods

Did you know?

• Women who have had a full-term pregnancy have reduced risks of ovarian and uterine cancer and the risks of these cancers decrease with each additional full-term pregnancy.
• Pregnancy and breastfeeding are associated with a decreased risk of both hormone receptor-positive and hormone receptor-negative breast cancer.
• However, the older a woman is when she has her first full-term pregnancy, the higher the risk of breast cancer. Also, women who are older than 30 when they give birth to their first child have a higher risk of breast cancer than women who have never given birth.