Cervical cancer mainly affects young women, mostly in their 30s and 40s. Globally, cervical cancer is the 4th most common female cancer. In Hong Kong, it is the 9th commonest, and is the 8th leading cause of female cancer deaths, resulting in about 150 deaths every year. It is a largely preventable disease through screening and vaccination, and is treatable if diagnosed early.
In most cases, the first symptom is abnormal vaginal bleeding, that is any bleeding in between periods, during or after intercourse, or after menopause. You should visit your doctor if you notice any abnormal bleeding.
Almost all cervical cancer is caused by the Human Papilloma Virus (HPV). There are many strains of HPV, and most women with HPV will not develop cervical cancer. Just two strains, HPV 16 and 18, are associated with most cervical cancers. The virus is transmitted through sexual contact.
Smoking doubles a woman’s risk of developing cervical cancer, likely from the chemicals in tobacco affecting the cells of the cervix.
Increased risk of cervical cancer is also associated with multiple sexual partners; taking oral contraceptive pills for more than 5 years; having more than 3 children; or having children early (below 17 years). The link between cervical cancer and pregnancy is unclear, but is thought to be due to hormonal effects.
Cervical cancer is preventable by screening and treatment of pre-cancerous cells. Two types of screening tests can be performed by your doctor during the same procedure.
- Papanicolaou (Pap) Smear – A Pap smear looks for the presence of abnormal (or pre-cancerous) cells in the cervix. An abnormal smear result does not mean you definitely have cancer.
- HPV test – This looks for the presence of HPV, which can cause these abnormal cells.
The Hong Kong Department of Health Cervical Screening Programme recommends that women should screen from 25 to 64 years of age. They can stop at 65 if the last 3 tests within 10 years have been normal. Women above 65 years of age who have never had a smear test should have one. Those aged below 25 should talk their doctors if they have increased risk factors such as smoking; early motherhood; multiple sexual partners; or weakened immunity.
If your first Pap smear is normal, you should have a second one 1 year later. If the second test is also normal, you should have screening every 3 years. Please consult your doctor if you experience any symptoms in between screening tests.
Menopause does not protect against cervical cancer. It is recommended that if you’ve ever had a sexual partner, you should have screening even if you have reached menopause.
One of the most important things you can do to protect yourself and your daughters from cervical cancer is HPV vaccination.
There are 3 types of HPV vaccines. The most recommended is Gardasil 9, which is used in Hong Kong. It protects against 9 different types of HPV, which account for approximately 90% of cervical cancers. In addition, the vaccination also protects against certain mouth and throat cancers, and some cancers of the anal and genital regions. There is also about 90% protection against genital warts.
The Hong Kong Childhood Immunisation Programme offers Gardasil 9 to girls in Primary 5 and 6. Although boys are not included in the Hong Kong programme, some countries, e.g. Australia, also vaccinate boys. If you want your son to be vaccinated, speak to your doctor.
The HPV vaccine is safe. The most common side effects are similar to those of other vaccines. Serious side effects are rare. The consensus from health bodies is that the benefits of HPV vaccination outweigh the risks.
HPV vaccination is ideally given before first sexual contact, however it is recommended for all women up to 26 years of age, even if they have already had sex. Women 26-45 years may benefit, and should discuss with their doctors.
Receiving the HPV vaccine does not yet preclude you from undergoing screening. The vaccine does not protect against all HPV types, and it does not eliminate existing infection. We can hope that universal vaccination will one day greatly reduce the incidence of cervical cancer.
Centers for Disease Control, USA
National Health Service, UK
Human Papilloma Virus (HPV) and cervical cancer. World Health Organization.
Cervical Screening Programme, Department of Health, HKSAR
Centre for Health Protection, Department of Health, HKSAR