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Cervical cancer is the fourth most common cancer among women worldwide and the tenth most common cancer among women in Singapore.

Cervical cancer is cancer that starts in the cervix, the organ connecting the uterus and vagina.

There are many types of cervical cancer. The most common type, squamous cell carcinoma (SCC) constitutes about 80 to 85 percent of all cervical cancers.

Fortunately, with regular screening and early detection, cervical cancer is one of the most highly preventable and curable type of cancer.

Symptoms and risk factors of cervical cancer

Early cervical cancer may have no symptoms. Some symptoms associated with cervical cancer when it is more advanced include:

• Vaginal bleeding
• Back pain/pelvic pain
• Pain during sexual intercourse, bleeding after sexual intercourse
• Abnormal vaginal discharge
• Painful or difficult urination or cloudy urine
• Chronic constipation and feeling of presence of stool despite having emptied bowel
• Leaking of urine or faeces from the vagina

Human Papilloma Virus (HPV) infection is a major risk factor in the development of this cancer. These viruses are transmitted during sexual intercourse, as well as oral or anal sex.

All women who engage in sexual activity are at risk of developing cervical cancer. Some sexual behaviours, such as multiple sexual partners, having partners who have had multiple sex partners, and having sex at an early age further increase the risk.

Other risk factors include:

1. Cigarette smoking
2. Long-term use of oral contraceptives
3. Having a weakened immune system which weakens the body’s ability to fight infections and other diseases. This may be due to infection with Human Immunodeficiency Virus (HIV) or taking medicine to help prevent organ rejection after a transplant
4. Having given birth to many children

Screening for cervical cancer

Early cervical cancer usually has no signs or symptoms. However, it can be detected early with regular check ups.

The Pap test, also called the Pap smear, is a cervical cancer screening test. This is done in an outpatient setting. The test is conducted using a plastic or metal instrument, called a speculum, to widen the vagina. The doctor or nurse will then examine the vagina and cervix, and collect a few cells from the cervix and the area around it with a swab. These cells are then placed on a slide and sent to the laboratory to be checked for abnormal cells.

The high risk HPV (hrHPV) test can also be done on these cells to look for the type of HPV virus that causes cervical cancer.

Women who have ever had sex should begin cervical cancer screening at age 25, or within three years of their first sexual activity—whichever happens first.

• Ages 25–29: Pap test every 3 years
• Ages 30 and above: HPV test every 5 years

Taking steps against cervical cancer

You can lower your risk of getting cervical cancer with the following steps:

• Get regular cervical screening tests, even though one has had HPV vaccination. This will help detect and treat early abnormal cells that may turn into cancer.
• Alter sexual behaviour. Reducing exposure to HPV infection reduces risk of cervical cancer. Use condoms to prevent any sexually transmitted disease including HPV.
• Getting vaccinated against HPV. HPV vaccines have been developed against the strains of HPV responsible for 70 to 85 percent of all cervical cancers. HPV vaccines are targeted at girls and women ages 9–26 and works best before the start of any sexual activity.

Overall, cervical cancer is a highly preventable disease that is treatable and curable when detected early. With greater awareness, we can go a long way in eliminating cervical cancer.