Malaysia has a population of approximately 11.55 millions of women ages 15 years and older, who are at risk of developing cervical cancer. Cervical cancer ranks as the third most frequent cancer among women in Malaysia and the second most frequent cancer among women between 15 and 44 years of age. In 2018, it was estimated approximately 1,682 new cases with 944 deaths reported in Malaysia.
In Malaysia, the incidence of cervical cancer has increased to 10.5 per 100,000 population in 2018 as reported by WHO, compared to 6.5 per 100,000 population in 2011. About 1.0% of women in the general population are estimated to harbour cervical HPV 16/18 infection at a given time, and 88.7% of invasive cervical cancers are attributed to HPVs 16 or 18.
What is Human Papillomavirus (HPV)?
HPV is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex. Sexually transmitted HPV types fall into two groups, low risk and high risk. Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat. High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.
Introduction of Cervical Cancer Screening in Malaysia
Cervical cancer screening in Malaysia was initiated in 1969 using conventional Pap smear, initially introduced to all family planning acceptors. The importance of cervical cancer screening was further enhanced in 1995 when “cancer” was chosen as the theme in the Healthy Lifestyle Campaign, which was a national program back in 1995. The service later was expanded with the development of the National Pap Smear Screening Program in 1998, to all eligible women aged 20-65 yearly for the first 2 years and 3 yearly subsequently if the result is normal. The main objectives were prevention and early detection of cervical cancer and ensuring early treatment as well as proper follow up of patients.
The discovery of HPV as the necessary cause of cervical cancer has led to important technological advances, including the development of molecular tests for HPV to identify women with precancerous cervical lesions. Cytological screening for cervical cancer precursor has been very successful in countries where adequate resources exist to ensure high quality and good coverage of the population with mortality reductions in excess of 50% has been achieved.
Who Should be Tested and How Often?
All sexually active women aged 30 to 49 years should be screened for HPV. Women less than 30 years (21-29) and 50-65 years are advised for Pap smear screening. The screening intervals will be every 5 years for those who are tested HPV negative.
However for patients with positive HPV results, further diagnosis and treatment are required such as colposcopic assessment by the gynaecologist.
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