What is Pap Smear?
Pap smear is a cervical cancer screening recommended every 3 years for all sexually active females starting from age 25 years old.
This is a quick, simple and painless procedure that can be done in the clinic and it only takes a few minutes. A brush will be used to collect some cells from the neck of the womb (cervix) and it will be sent to the lab to identify any precancerous and cancerous cells.
In Singapore, cervical cancer is the 3rd leading cause of cancer deaths in women age 15-44 years old.
Cervical cancer risk is increased with :
- Multiple sexual partners
- Human papillomavirus (HPV) infection
- Unprotected sex
What is Human papillomavirus (HPV)?
Human papillomavirus (HPV) is one of the commonest sexually transmitted infection. It can affect both men and women.
There are 2 types of HPV – the low risk and high-risk types.
- Low-risk HPV can cause genital warts in both female and males. These are flesh coloured growths on the genitals, and they are infectious.
- High-risk HPV plays a significant role in the increased risk of cancer, such as cancer of the cervix, vulva, and vagina in women as well as anal cancer in men who have sex with men (MSM)..
The American College Obstetrician and Gynaecologist (ACOG) strongly recommends co-testing using Pap smear and HPV DNA testing (high-risk HPV types) especially for women ages 30-65 years old.
Patients are advised to repeat these tests in 5 years if pap smear and HPV results are negative.
This allows patients to extend their screening interval.
However, for women who test positive for high-risk HPV types, this means their risk is increased and hence, may need to have Pap smear screening at a closer interval, i.e once a year and depending on the results of the pap smear, some may need a referral to a gynaecologist for early intervention.
Remember, women can have no symptoms with an abnormal pap smear and HPV infection. Hence, early detection and screening are crucial as early intervention can be life-saving. Symptoms such as bleeding and pain during sex (postcoital bleeding), bleeding in between periods, heavy vaginal bleeding, and bleeding after menopause are usually late signs of cervical cancer.
The good news is cervical cancer can be prevented through vaccination.
GARDASIL 9 is a vaccine that helps protect against Human Papillomavirus (HPV). Most people infected with HPV show no signs or symptoms, this means they can transmit the HPV virus to others without knowing it in any kind of sexual activity or skin to skin contact.
Gardasil 9 provides protection against 9 major strains of HPV, which includes HPV types 6,11,16,18,31,33,45, 52 and 58 which are responsible up to 90% of genital warts and cervical cancers or precancer changes.
The vaccine, however, does not treat the infection.
It can be given to both females and males from the age of 9 up to 45 years old.
From the age of 9-14 years, 2 doses 6 months apart is recommended while those age 15 onwards, 3 doses will be recommended according to the schedule of 0, 2 and 6 months.
The side effects post vaccination is usually mild and temporary including pain, swelling, bruising over injections site and very rarely may cause fever and nausea.
HPV vaccine reduces your risk significantly but it does not mean your risk becomes zero.
After the completion of HPV vaccination, all women who are sexually active and above the age of 25 should still undergo routine screening via pap smear.