SINGAPORE – Cervical cancer is almost entirely preventable through vaccination and regular screenings, but Singapore still has a long way to go before it can totally get rid of this disease as a public health problem.

About 300 new cases of cervical cancer still surface here a year.

Nearly all cervical cancers are caused by an infection by human papillomavirus (HPV), a common group of viruses transmitted through sexual contact that usually causes no symptoms. Thirteen of the 150 varieties of HPV stay in the body for a long time and are known to cause 99.7 per cent of cervical cancers.

“The unique part of cervical cancer is that it is largely preventable through vaccination and early detection of pre-cancer stage. This will need to reach above 90 per cent to be near our eradication goal,” obstetrician and gynaecologist Christopher Chong said.

It was almost two decades ago in 2006 that the HPV vaccine was introduced. It is strongly recommended for girls from age nine to women up to the age of 26. This is the age range deemed to be more exposed to HPV.

However, it was only in 2019 that fully subsidised HPV vaccinations were offered to all 13-year-old Secondary 1 female students in Singapore on an opt-in basis.

The vaccines here protect against strains that are most likely to cause cancer and genital warts. Women should ideally get the vaccine before they become sexually active and exposed to the virus.

The World Health Organisation has set a target for cervical cancer to be eliminated by 2120. Experts in Australia are highly optimistic that the country will achieve this by its 2035 target, while Britain on Wednesday said it will be one of the first in the world to eliminate the cancer in the next two decades.

“We are still far from eliminating cervical cancer in Singapore, with about 300 new cases a year,” Dr Chong said.

He said there is an uptake of about 91 per cent for the vaccination among 13-year-old girls because it is free, “otherwise, it may not even reach 50 per cent”.

“Many also may not know what they are getting is the bivalent vaccine that protects against two varieties of HPV that cause 70 per cent of cervical cancers. So even if they have taken this, they should consider taking the nanovalent one as additional protection – it covers nine strains or up to 90 per cent of cervical cancer prevention.”

A proponent of vaccinating boys and young men as well, Dr Chong said the vaccine also protects against all other cancers caused by HPV, such as anal, mouth and throat. Vaccination also prevents them from spreading the virus.

“Unfortunately, the estimated male vaccination rate in Singapore is less than 5 per cent,” he said.

Apart from vaccination, cervical screening for women aged 25 to 64 provides another form of defence, allowing early intervention. This includes a yearly pap smear to check for changes to the cells in the cervix caused by HPV and an HPV test every five years.

“Still, many women do not go for regular yearly checks or screening. And when it comes to preventing cervical cancer, it is very important to drive home the point of seeing a doctor when you are well and not when you are unwell. By then, it could be too late,” Dr Chong added.

Cervical cancer screening should not stop after 64, he advised. “Screening should be as long as one has a cervix, irrespective of age.”

Businesswoman Shirley Wong, 48, had never been for any pap smear or woman wellness check, and she was 42 when she first saw a gynaecologist. “I had unusual bleeding between my period while holidaying with friends in South Korea in December 2016. When we got back, they took me to see the gynaecologist,” she said.

It was then she was told that she had Stage 2 cervical cancer.

Shocked by the news, Ms Wong sought a second opinion from her sister-in-law’s doctor, who gave her the same diagnosis and advised her to go for surgery immediately.

She was “tremendously upset and terribly depressed” that her womb and ovaries were removed a week after her consultation, said Ms Wong, who has been married for 19 years. “I felt so hopeless then, and I still do, that I can no longer bear my own children,” she said, her voice breaking.

Her silver lining is that she is currently in remission, having passed the five-year mark.

“I hope that by telling my story, other women would go for regular checks and pap smears and, if possible, they should also take the vaccine to lessen the risk of forming cervical cancer,” Ms Wong added.