In developed countries, organised cervical screening using the PAP smear has led to a steady decline in the incidence of cervical cancer. Organised screening is very expensive to sustain, so most countries in Asia have opportunistic screening, where women who attend for health checks are offered screening. This is a less effective screening programme. Cervical screening detects the pre-cancerous disease to allow treatment. To further reduce the incidence of cancer, we have to eradicate the cause of the cancer. In 1999, research concluded that infection with high risk human papillomavirus (HPV) is necessary for the development of cervical cancer. HPV infection is acquired through intimate genital contact. Although the infection is highly prevalent, it is transient as most people are able to clear the infection, so the number of women with cervical cancer is comparatively low. HPV research has extended to development of HPV vaccination and screening test. HPV vaccines are available to prevent infection against 2 to 7 high risk HPV subtypes that are responsible for 70 – 90% cervical cancers worldwide. HPV vaccine is safe and global population studies have started to demonstrate a decline in the incidence of the precancerous disease CIN in the vaccinated population.
HPV vaccination does not preclude the need for cervical screening. Cervical screening tests which detect high risk HPV subtypes have been validated as a more sensitive and standardised screening tool. In many countries, HPV testing is beginning to replace the PAP smear in the cervical screening programme. The Malaysian government has implemented National HPV Immunisation Programme in schools since 2010, with catch up programmes in the LPPKN clinics. We hope to see a decline in cervical cancer in the next few decades. However, awareness and attendance for cervical screening is poor. We should be looking to move towards using HPV test as our cervical screening tool as it has a high negative predictive factor, allowing screening to be extended to every 3 to 5 years. There are also feasibility studies to assess the self-collection kits for HPV test to promote compliance with screening. With the advances in our understanding of the natural history and the development of vaccination to prevent cervical cancer, it is a crime for a woman to die from cervical cancer. We should encourage women to attend for cervical screening and vaccination against cervical cancer in order to eradicate this deadly disease.
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