A survey reveals only nine percent of Singaporean women surveyed consider themselves at personal risk of HPV, an infection that will affect around four in five women by the time they are 50.

 

In conjunction with Singapore’s Cervical Cancer Awareness Month, new survey results reveal an alarming knowledge gap among Singaporean women about cervical cancer and human papillomavirus (HPV). Commissioned by Roche Diagnostics, in association with the Society for Colposcopy and Cervical Pathology of Singapore, The Singapore HPV Survey found that only 41 percent of women surveyed have an awareness of HPV.  Of that percent, only a low 13 percent perceive HPV to be very common and an even lower five percent consider themselves at personal risk – even though published data indicates that HPV is a very common virus that affects at least four out of five women at some stage in their lives.

Awareness of cervical cancer fared better, with 89 percent of women surveyed aware of cervical cancer. However, among women aware of cervical cancer, 29 percent considered cervical cancer a common disease in Singapore, and only nine percent considered themselves to be at personal risk. This is in spite of the fact that cervical cancer is the fourth most common cancer among women worldwide, with 528,000 cases diagnosed each year. Half of these die from cervical cancer, and a majority of those deaths are in Asia.

Cervical cancer is the tenth most common cancer among Singaporean women. According to the Singapore Cancer Society, almost 200 new cases are diagnosed and 70 deaths from cervical cancer occur each year.

Commenting on the results, Dr Chia Yin Nin, gynecologist and president of the Society for Colposcopy and Cervical Pathology of Singapore (SCCPS), said: “The survey results are quite alarming. Less than half of Singaporean women are aware of HPV infections and just under half of women have never undergone a Pap smear. This clearly shows the need for continuous education for women about HPV and cervical cancer. Cervical cancer is one of the most preventable cancers and can be treated if diagnosed early.”

When asked about their knowledge about the consequences of HPV infections, only 45 percent and 44 percent of women surveyed, correctly answered cervical cancer and genital warts respectively. However, misconceptions of the consequences of HPV infections included HIV (25 percent), herpes (24 percent), ovarian cancer and chlamydia (15-percent each). Almost 20 percent of women did not know the consequences.

 

Relationship between cervical cancer & HPV

HPV is the leading cause of cervical cancer, causing more than 99 percent of cases. Most HPV infections are transmitted through sexual contact but are cleared by the body naturally. However, persistent HPV infections can cause abnormal cervical cell growth. There are more than 100 types of HPV, but 14 are the most prevalent high risk types.  Of these, types 16 and 18 are the highest-risk of all, causing 70 percent of cervical cancers. Generally, there are no symptoms of HPV infection or cervical pre-cancer, so most women do not know they have it.

 

Pap tests are not enough

The Pap test, also known as the Pap smear, is the current method used to screen for cervical cancer. However, the survey has also revealed that two in five women (aged 25 to 55) have never undergone a Pap test, key reasons being fear of the procedure and low-risk perception. In addition, three in five women are not aware of the HPV test and, because they do not think that they will personally get HPV, they do not identify the need for HPV screening.

Research has also shown that nearly one-third of the women who were diagnosed with cervical cancer had one or more negative Pap tests within the three years prior to their diagnosis. As the Pap test might have a risk of false negative results, there is a need for a more accurate screening test to prevent cervical cancer. The high-risk HPV test is now available to identify the 14 most prevalent high-risk HPV genotypes, providing specific genotyping information for HPV types 16 and 18 which cause 70 percent of all cervical cancers.

Dr Chia said: “It is important that women take time to understand HPV and cervical cancer. Any woman who is sexually-active, even with just one partner, could be exposed to HPV. Therefore, women cannot assume that they will not have HPV, even if they are in a monogamous relationship. It is imperative for women to talk to their doctors about screening options so that they can live life to the fullest during their prime years.

“In Singapore, we highly recommend that women go for cervical cancer screening, using both the Pap smear and high-risk HPV test for more accurate results. Prior to the development of the high-risk HPV test, the Pap smear was the default option. With the advent of technological advancements, it has now enabled us to precisely detect the presence of HPV directly with the high-risk HPV test. This means that the high-risk HPV test can be used as a primary screening method or co-tested with the Pap smear. Screening is an essential first step in cervical cancer prevention.  It is time for women to take health matters into their own hands.”

The Singapore HPV Survey, which surveyed 308 women aged from 25 to 55 years old between August and October 2015, aimed to find out the current level of awareness and understanding of cervical cancer and HPV and women’s attitudes towards gynecological testing.

 

SIDEBOX – The difference between a Pap and a HPV test: Ageless Online asks Dr Chia about the differences and her recommendation for screening: How is a Pap and a HPV test different – in what ways? A HPV test is more accurate than a Pap smear. It is objective and a negative test implies a true negative usually, whereas a Pap smear could be subjected to interpretation and sampling error which means there is a chance of a false-negative result. False-negative results can be reduced by more frequent screening. As such, HPV testing allows screening interval to be prolonged up to three to five years safely. (EDITOR’S NOTE: A HPV test can be done using the same sample from a Pap test or by collecting a second sample from the cervical canal.) How much is a HPV test? It depends on clinic and laboratory but a HPV test alone is about S$100 to $200. It will cost more if there is Pap smear is added on. What is your recommendation for women 50 and above on having both a Pap and a HPV test? How often – once a year till what age? It is recommended that women age 50 and above should get a Pap and a HPV test at least once every five years till the age of 69. Women can stop at age 69 provided they have three consecutive normal co-tests in the last three screens.

 

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