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When it comes to treating cervical cancer, early detection is crucial for a good prognosis. Yet only 43.1% of women (aged 25–74) in Singapore went for cervical cancer screening in 2022, a dip from 57.9% in 2007. Here is what you need to know about why screening matters and the options available today.

WHAT IS CERVICAL CANCER?

Cervical cancer starts in the cervix, the lower part of the uterus that connects to the vagina. It is primarily caused by persistent infection with high-risk human papilloma viruses (HPV), especially Types 16 and 18. While most HPV infections clear on their own, repeated or unresolved infections can lead to cancer. A small proportion (5–11%) of cervical cancers are HPV-negative and tend to have poorer outcomes, often due to late detection.

WHY IS SCREENING IMPORTANT?

Women who do not attend screening are at higher risk of developing cervical cancer due to the potential for persistent high-risk HPV infections to go undetected and untreated.

When caught at Stage 1, cervical cancer is highly treatable, and the five-year survival rate is around 95%. This statistic drops to 15% for those diagnosed at Stage 4. On top of that, in the early stages, there are no symptoms for cervical cancer. By the time there are symptoms such as abnormal vaginal bleeding, the cancer has usually progressed significantly.

This is why screening is so crucial. Screening helps to detect precancerous changes in cervical cells before they turn cancerous. With intervention, it is possible to stop the disease before it develops, or allow better treatment outcomes when detected at an early stage.

WHAT ARE THE SCREENING OPTIONS AVAILABLE?

There are two types of screening tests available for cervical screening depending on one’s age.

Pap test: The Pap test is recommended for those between the ages of 25 to 29 years old. During a Pap test, the doctor will insert an instrument (speculum) to gently open the vaginal walls and allow the healthcare provider to access the cervix for cell collection. The healthcare provider then gently brushes or scrapes cells from the cervix using a small brush or spatula. These cells are then sent to a lab to check for abnormalities. This test is effective in identifying cell changes at an early stage.

HPV test: The HPV test is recommended for those from 30 years old and above. The sampling procedure for an HPV test is carried out in the same way as a Pap test. In HPV sampling, vaginal swab samples are taken and sent to a lab to test for high‑risk HPV strains. This does not detect cancer but confirms if the virus strains responsible for cancer are present.

DIY HPV SAMPLING

To reduce the barriers for women in accessing cervical screenings, cervical self-sampling kits have been developed. At present, self-sampling kits are available through selected private clinics and providers in Singapore. Those who opt for this method would be able to do their own screenings at the clinic and return the samples on the spot. This option is currently not offered under the national cervical screening programme.

While the Singapore Cancer Registry states that 99.7% of cervical cancer are attributable to HPV, HPV-negative cervical cancers do exist. Such cancers are usually discovered when women report symptoms such as abdominal pain, pelvic pain, or abnormal vaginal bleeding. Unfortunately, there are no suitable screening tests currently available for HPV-negative cervical cancers.

WHY SELF-SAMPLING?

Traditionally, HPV sampling in clinics involves a doctor performing a speculum examination and collecting cells from the cervix. This can be an uncomfortable or intimidating experience for some women, as highlighted in a 2024 study by Singapore Cancer Society.

Self-sampling kits make it far easier and convenient for women to test for HPV infections. A 2022 study in Singapore of 300 women showed that most participants found self-sampling easy and believed that it would increase their likelihood of participating in regular screening.

Another recent study funded by Singapore Cancer Society Cancer Research Grant also found that over 80% of women participants reported self-sampling to be easy to perform and comfortable as well.

WHAT DOES A SELF-SAMPLING KIT DO?

Similar to doctor administered cervical screening, these kits allow women to collect their own vaginal sample using a swab and send the samples to be tested for high-risk HPV strains.

ARE SELF-SAMPLING SWABS ACCURATE?

Yes, vaginal self-sampling is comparable in efficacy to samplings by doctors in detecting the presence of high-risk HPV. The Society for Colposcopy & Cervical Pathology of Singapore has also updated their cervical cancer screening guidelines to recommend HPV self-sampling as an alternative.

DO I NEED SCREENING EVEN IF I’M NOT SEXUALLY ACTIVE?

The answer? Yes.

While HPV, the main cause of cervical cancer, is mainly transmitted through sexual contact, it can also be spread via skin-to-skin contact.

Additionally, HPV is not the only cause for the disease. There are other contributing factors such as a weakened immunity and family history of cervical cancer. Though it is extremely rare for virgins to develop cervical cancer, there have been documented medical cases.

HOW OFTEN SHOULD I GO FOR SCREENING?

Experts recommend that women should start going for screenings from the age of 25, or within three years of first sexual activity, whichever happens first. The recommended screening schedule for women is:

• Aged between 25 and 29: Pap test every three years
• Aged 30 and above: HPV test every five years

Cervical cancer screening is a powerful tool that can save lives. Safeguard your health by going for regular screening. With early detection and timely care, cervical cancer can be stopped in its tracks.

¹National Population Health Survey (2022)
²https://www.cancerresearchuk.org/about-cancer/cervical-cancer/survival
³Singapore Cancer Society, “Making Cervical Screening Easier: Singapore Cancer Society Trials HPV Self-Sampling in the Community for the First Time”, 2024.
⁴https://mjz.co.zm/index.php/mjz/article/view/551/502
⁵https://www.parkwaycancercentre.com/sg/learn-about-cancer/types-of-cancer/cancer-details/cervical-cancer