LPPKN chairman Datuk Seri Rohani Abdul Karim said the programme aims to screen 32,000 women as part of early detection efforts to enable timely preventive and treatment measures.

“I urge women to set aside embarrassment and fear and not delay undergoing the HPV DNA test, as early detection of cervical cancer significantly improves the chances of recovery,” she said.

Rohani was speaking to reporters after officiating the Perak state-level Cervical Cancer Awareness Month programme at the General Operations Force Battalion 3 headquarters in Bidor, near here, today.

She said LPPKN has appointed Ethnic Ambassadors from various communities, including the Orang Asli, to promote awareness of cervical cancer screening and encourage greater participation.

“These ambassadors are trained with comprehensive information on screening procedures and specimen collection, enabling them to clearly explain the process to target groups in their respective dialects, including among the Chinese, Indian and Orang Asli communities,” she said.

Meanwhile, Rohani said a total of 198,001 women underwent HPV DNA screening from 2019 until last year, with 15,315 testing positive for HPV.

“Of that number, 210 women were diagnosed with precancerous conditions, while 24 were confirmed to have cervical cancer,” she said.

Source: Bernama

By Associate Professor Dr Ganesh Ramachandran and Associate Professor Dr Khine Pwint Phyu – School of Medicine, Faculty of Health & Medical Sciences at Taylor’s University.

Cervical cancer is the fourth most common cancer among women worldwide, with approximately 660,000 new cases in 2022. Low- and middle-income countries, particularly in Sub-Saharan Africa, Central America, and Southeast Asia, bear the highest incidence rates due to socio-economic factors, affecting vaccination uptakes, screening, and treatment. ¹

In Malaysia, 1,740 new cases were reported in 2020 with a mortality rate of 57%. ² This cancer, primarily linked to Human Papillomavirus (HPV) infection (especially types 16 and 18), is influenced by risk factors such as early sexual activity, pregnancy before the age of 20, promiscuity, unprotected sex, multiple full-term pregnancies, smoking, long-term oral contraceptive use, Human Immunodeficiency Virus (HIV) infection, and sexually transmitted infections. These factors are often exacerbated in lower socio-economic communities, increasing their vulnerability.

Global efforts and WHO’s call to action

The World Health Organization (WHO) issued a bold call for the global elimination of cervical cancer by 2030, achievable through effective HPV vaccination, screening mechanisms for detecting pre-cancerous and early cancer stages, and access to treatment. Elimination implies less than 4 cases per 100,000 population. WHO’s targets include fully vaccinating 90% of girls by age 15, ensuring 70% of women undergo high-performance screening by ages 35 and once more at 45, and treating 90% of women with cervical cancer.³  High-performance testing, which includes HPV testing alongside pap smears or visual inspections of the cervix with acetic acid, should be done every five years. Self-testing kits can improve screening uptake by eliminating the need to visit a health care provider thus saving time and addressing the stigma associated with the disease.

Malaysian scenario

Cancer of the cervix stands out as the second most common cancer among Malaysian women aged 15 to 44, primarily caused by HPV. The disease is largely preventable through vaccination, screening, and treatment.  Up to 1% of women may carry the virus, with 40% potentially becoming chronic carriers. ⁴These women are at high risk of developing cervical cancer.

Malaysia has implemented an HPV vaccination or primary prevention programme since 2010, targeting 13-year-old girls in schools. The WHO reported that 80% of girls received the final dose by age 15 in Malaysia. Although the COVID-19 pandemic slowed the programme, the untiring efforts of the Ministry of Health and non-governmental organizations (NGOs) such as the National Cancer Society of Malaysia in providing catch-up vaccination should ensure that Malaysia is likely to continue to do well in vaccinating the population at risk.

The Ministry of Health recommends yearly pap smears for sexually active women aged 21 to 65 for two years, followed by every three years if initial smears are normal as a secondary prevention method. High-performance HPV testing is recommended every five years and for women above the age of 65 who have never been screened. Despite the existence of a government-run cervical screening programme since 1969 and the availability of free screening since 1995, uptake remains poor at 35% to 48% which is far below the WHO requirements. A 2020 WHO report indicated only 4 in 10 women had been screened in the previous five years with educational status, awareness of the availability and the effectiveness of screening, knowledge of the disease, and family support being likely factors in determining access to screening. Other factors hindering screening were time constraints, embarrassment, and lack of knowledge.

Improving screening uptake

To improve screening acceptance, education about cervical cancer must begin early, and the stigma and embarrassment associated with pap smears must be addressed. This requires educating not only girls and women but also men, who play an important facilitative role.

Many women face significant barriers such as fear of discomfort from the invasive procedure and cultural sensitivities about male doctors. There are also technical challenges with the procedure that may necessitate retakes thus inconveniencing patients. Hence, accommodating patient preferences, such as the availability of female practitioners, improving procedural techniques, allaying anxiety, and promoting the use of less invasive HPV DNA testing and making available self-testing kits, can enhance the screening experience.

The final piece of the puzzle for eliminating cervical cancer is the availability and accessibility of diagnostic and treatment facilities. While diagnostic and treatment facilities exist in both the government and private sectors, costs are high in the private sector and waiting times are long in the public sector which compounds the problem. Smart partnerships between the government, private sector, and NGOs are being put into place to optimise resources, which will positively impact combating cervical cancer in the coming years.

High vaccination rates are a success story in Malaysia’s initiative to eliminate cervical cancer. Improving screening acceptance and building capacity in the form of gynaecological oncology surgeons, radiation, and medical oncologists are crucial to effectively combat cervical cancer and achieve the goal of elimination by 2030. With concerted efforts, collaboration, and education, we can indeed win the battle against cervical cancer.

Sources:

1. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
2. https://www.thestar.com.my/news/nation/2024/01/14/statistics-on-cervical-cancer-in-malaysia-alarming
3. https://www.who.int/initiatives/cervical-cancer-elimination-initiative
4. https://hpvcentre.net/statistics/reports/MYS_FS.pdf?t=1557678064474

By Dr Muralitharan Ganesalingam, Head of Department, Obstetrics and Gynaecology, School of Medicine, International Medical University (IMU) and Consultant Obstetrician and Gynaecologist at IMU Healthcare

Every decade brings new health challenges, and regular health screenings can help to detect problems early. Most people approach health screenings with reluctance. After all, it is never anybody’s idea of a fun time! In fact, many people take every opportunity to postpone or avoid them completely, with thoughts like these:

I’d rather not know. Better to just live my life.

What’s the point? It’s just a waste of time and money.

It’s so inconvenient. I would rather be doing something else.

Do these sentiments sound familiar? While it is only natural to feel this way, especially when you consider how busy life can be with work and family responsibilities, this type of thinking can be detrimental to a person’s long-term health. As women – especially mothers – are more likely to put others’ needs above their own¹, it is important that more women learn to prioritise and be proactive about their health.

Why go for a health screening?

The goal of screening tests is to detect changes in the body before they become unmanageable. In this way, you have the chance to modify your lifestyle and steer away

from a particular illness. In a nutshell, this means you should go for health screenings while you are healthy!

When should I start going for health screenings? Our bodies go through a natural aging process, and the goal is to age in a healthy manner. Generally, women between 19-24 years of age are considered to be at the peak of health. Thereafter, from the age of 25, fat begins to accumulate, especially in the hips, thighs and abdomen, while muscle mass deteriorates. From the age of 35, bone mass depletes at a rate of 0.5-1% per year.

While everybody is different, these are natural changes, and it is advised to have annual screening from early adulthood, such as when you start working, and twice a year after the age of 45.

There are so many different types of tests. Which screening tests should I prioritise? Non-communicable diseases like diabetes, hypertension (high blood pressure) and high cholesterol have been on the rise for years, so annual health screenings for all healthy adults should begin. ^2-3

Blood pressure to check for hypertension. This disease, known as the silent killer a sit progresses without noticeable symptoms, affects 3 in 10 Malaysians, approximately6.4 million people and increases the risk of stroke and heart attack.

Blood count to detect conditions like anaemia. On average, anaemia affects 3 in 10women aged 15-49 years and can cause complications during pregnancy such as miscarriage and premature birth.

Blood glucose test to check for diabetes. Approximately 1 in 5 adults have diabetes, equivalent to 3.9 million adults.

Body Mass Index (BMI) to monitor weight gain and help prevent obesity. National statistics show that 1 in 2 adults are overweight or obese, and 1 in 2 have abdominal obesity, of which women accounted for 54.7% and 64.8% respectively.

Lipids test to check for elevated levels of cholesterol, which can lead to heart disease. Around 4 in 10 Malaysians, approximately 8 million people, have raised cholesterol levels, with women being more likely to have higher levels than men. Inspite of this, 1 in 4 people are unaware they have high cholesterol.

Kidney function and liver profile as chronic kidney disease affects 1 in 7 Malaysians, and diabetes is a significant risk factor.

As you age annual eye checks, hearing tests and dental check-ups are also recommended.

What about tests specifically for women?

Some screening tests are particularly important for women, namely Pap smears to check for cervical cancer, breast examinations to check for breast cancer and bone mineral density scans to detect osteoporosis.

. Cervical cancer – “One of the specific diseases we look for as women grow older is cervical cancer. Historically, cervical cancer used to be one of the dominant cancers in women, with 500,000new cases a year worldwide and 250,000 deaths. But because we have an efficient screening programme through the use of Pap smears, we have been able to reduce the incidence of cervical cancer substantially. It is the most significant advancement in the control of cancer, hence annual screening for cervical cancer is something I emphatically encourage.

.  Pap smears – this involve taking a small tissue sample from the cervix, which will be checked for abnormalities or changes that could be a sign of cervical cancer. However, despite its efficacy as a screening test, a recent study found that only 45% of Malaysian women have ever gone for a Pap smear.

.  Breast cancer – Breast cancer remains the most common cancer among Malaysian women. By recent estimates, 1 in 20 women will develop breast cancer and at least 9 individuals die of breast cancer every day. ⁴ Despite these statistics, only 1 in 2 women aged 18 and above do not practice breast self-examination and only 1 in 4 women above 40 years have ever had a mammogram. ⁵As breast cancer is highly treatable when detected in its early stages, he said, it is essential for all women to be disciplined about performing their own breast examinations, with an annual check by a doctor, who will advise if a mammogram is needed.

.  Osteoporosis – Finally, as bone mineral density decreases with age and the risk of fractures increases, postmenopausal women 50 years and older should be screened. Among older persons aged65 years and older, screening should be done at least once a year, according to Malaysianguidelines.⁶

High-risk – what it means

There are certain things such as family history and lifestyle factors that increase your risk for developing certain health problems, explained Dr Murali. Factors that may warrant more frequent screening is increasing age, family history, high levels of stress and lifestyle habits like smoking, alcohol consumption and having multiple sexual partners. Be cautioned also that the impact of lifestyle habits would only show later in life and that chronic stress, be it from work, family or financial situations, is a great threat to health.

Take what is only necessary

As a final word of advice, noting that more people are taking health screenings seriously, this should be done with care as needless testing can lead to anxiety. For example, yearly mammograms may not be necessary as up to 50% may reveal something abnormal but not all of these turn out to be cancerous.  Therefore, screening tests only make sense if they are required and can lead to improved health.

At the end of the day, it is important for you to speak to your regular doctor about any health concerns and discuss what health screenings may be beneficial for you, based on your age, lifestyle and family history.

References:

1 Ipsos. 80% of Women Recognize Value of Self-Nurture, Yet Few Care for Selves as They Care for Others.

https://www.ipsos.com/en-us/80-women-recognize-value-self-nurture-yet-few-care-selves-they-care-others

2 National Health and Morbidity Survey 2019. Non-communicable diseases, healthcare demand, and health literacy: Key Findings. https://iptk.moh.gov.my/images/technical_report/2020/4_Infographic_Booklet_NHMS_2019_-_English.pdf

3 New Straits Times. #HEALTH: CKD – 1 in 7 Malaysians have the disease.

https://www.nst.com.my/lifestyle/heal/2023/03/888779/health-ckd-1-7-malaysians-have-disease

4 The Star. One in 20 Malaysian women at risk of breast cancer.

https://www.thestar.com.my/starpicks/2022/10/30/one-in-20-malaysian-women-at-risk-of-breast-cancer

5 National Health and Morbidity Survey 2019. Non-communicable diseases, healthcare demand, and health literacy: Key Findings. https://iptk.moh.gov.my/images/technical_report/2020/4_Infographic_Booklet_NHMS_2019_-_English.pdf

6 Clinical Practice Guidelines (CPG) on Management of Osteoporosis 2022 (3 rd Edition).

https://moh.gov.my/moh/resources/Penerbitan/CPG/Rheumatology/221115_MOS_CPG-Management_of_Osteoporosis-ed3_PREVIEW.pdf

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Every year, almost 800,000 women die of cervical and breast cancer, with two-thirds of breast cancer deaths and 9 out of 10 cervical cancer deaths in developing countries, according to a study.

Some diagnostic and treatment options such as mammography and radiotherapy are often not available in poor countries, but several low-cost interventions have a potential to save lives, the scientists said.

In a statement, Ophira Ginsburg from the University of Toronto, said that there is a widespread misconception that breast and cervical cancer prevention and treatments are too difficult and expensive, especially for women in resource-poor countries where the burden of these diseases is highest.

“But nothing could be further from the truth. Recent estimates suggest that a basic cancer control package could be introduced in low- and middle-income countries for as little as US$1.72 per person – equivalent to just 3% of current health spending in these countries,” Ginsburg said.

Breast and cervical cancer kill nearly three times as many women each year than complications from pregnancy and childbirth, the scientists from University of Toronto, University of Cape Town and King’s College London, said.

With the number of women diagnosed with breast cancer expected to almost double to 3.2 million in 2030 and the number of women diagnosed with cervical cancer projected to rise by at least a quarter to over 700,000, the scientists warned the cost of inaction will be “huge”.

They said human papilloma virus (HPV) vaccination of girls in the world’s poorest countries over a period of four years could prevent 600,000 deaths from cervical cancer.

Low- and middle-income countries receive just 5% of global funding for cancer and persistent under investment has exacerbated the problem.

Reducing inequalities and improving cancer survival for women should be seen as a part of international commitments to achieve universal health coverage, they added.

They recommended immunizing 70% of girls against HPV by 2030 and enabling access to early diagnosis and treatment to all women with breast cancer.