Ask the Expert: Is HPV Vaccination Enough to Prevent Cervical Cancer?

Cervical cancer is the only women cancer that we can effectively detect at the pre-cancer stage and offer women early simple effective treatment that will not pose a major impact in their life.

Cervical cancer is one of the most preventable cancers, yet it remains the 10th most common cancer among women in Singapore and the 4th most frequent cancer among women aged 30 to 39. Despite the availability of the HPV vaccine and effective screening methods, many women are still at risk. This raises the question: Is HPV vaccination alone enough to prevent cervical cancer?

A recent Asia Pacific survey by Roche revealed significant barriers preventing women from prioritizing their health. Nearly half of the women surveyed put their family’s needs before their own, often delaying or stopping medical treatment. Additionally, over one-third of women have never had a cervical screening and do not plan to due to anxiety about perceived pain and discomfort, fear of the results, or embarrassment.

This May, in celebration of Mother’s Day and Singapore Cancer Society’s Women’s Gynaecological Cancer Awareness Month, we spoke to Dr Ida Ismail-Pratt, a member of the Singapore Cancer Society’s Women’s Gynaecological Cancer Awareness Month Committee to learn more about the HPV vaccine – its benefits, limitations and how cervical cancer impacts the lives of mothers and women in Singapore. Read her responses to our questions below:

What are the early signs of cervical cancer that women should look out for?

Cervical cancer is caused by persistent infection by high risk or cancer-causing HPV.

The most common symptoms of cervical cancer is abnormal vaginal bleeding. This can present as irregular or intermenstrual bleeding or bleeding during menopause.

The reality is HPV infection, cervical pre-cancer and early stage cervical cancer do not have any symptoms. When symptoms like above are seen, these are due to late stage cervical cancer where the cancer has already spread.
That’s why it is important for women to get screened and not wait for symptoms to appear. Cervical cancer is the only women cancer that we can effectively detect at the pre-cancer stage and offer women early simple effective treatment that will not pose a major impact in their life.

How often should women get screened for cervical cancer, and what methods are used?

Singapore has a national cervical cancer screening guideline. Current guideline recommends that all women between 25 and 69 years old who has ever had sexual intercourse to go for cervical cancer screening, regardless of their HPV vaccine status.

The national guideline recommends women aged 25 to 29 years to have a pap smear done at a 3-yearly interval, while women form 30 to 69 years old to have a HPV test done every 5 years.

A 3 yearly Pap smear is recommended for women between 25 and 29 years old because the HPV test is too sensitive for this age group. Incidence of transient HPV infection without increasing the risk of cervical cancer in this age group is high and doing a HPV test can lead to unnecessary investigations and treatment in addition to unnecessary psychological morbidity.

For women 30 years and above, a HPV test is a much more sensitive test to predict their risk of future cervical cancer as the incidence of persistent rather than transient infection is higher.

What are some common misconceptions about HPV and cervical cancer that you hear from patients?

There are a few common ones:

‘I have been vaccinated so I don’t need to get screened’ – This is not true at all. All the HPV vaccine currenlty available do not give 100% protection. Depending on the type of vaccine, they can offer between 70-90% protection against cervical cancer. Regular screening is important to bridge that extra 10-30% protection that the HPV vaccine do not cover.

‘I am healthy so I don’t need to go for regular screening’ – As mentioned, HPV infections and precancers often do not present with any symptoms at all. Screening allows for early detection of cervical cell changes and precancers before it becomes cancer.

Regardless of how healthy you are, HPV infection is very common and all women once they are sexually active has an increased risk of developing cervical cancer. This is the reason why the national guideline recommends all women who has ever had sex need to go for regular screening when they are 25 eyars old and above.

Can you explain how the HPV vaccine works and at what age you recommend kids should get it? Are there any side effects of the HPV vaccine that parents should be aware of?

Image Source: AsiaOne

HPV vaccines works by triggering the body’s immune system to produce antibodies against some of the commoner cancer-causing HPV. The mechanism is similar to when we are exposed to a flu virus. Should there be exposure to these cancer-causing HPV in future, the antibodies that are produced will be able to prevent the infection that can lead to cervical cancer.

There is no viral DNA in the HPV vaccine, hence the vaccine confers immunity without the ability to infect the host. The HPV vaccine has a very strong safety profile and the most common side effects reported is pain at the injection site. The World Health Organisation have has recognised and endorse the safety of the HPV vaccine.

The Singapore National Childhood Immunisation Schedule (NCIS) and National Adult Immunisation Schedule (NAIS) recommend that all females between 9 and 26 years old in Singapore to receive the vaccine. For those between 9 and 14 eyars old, the 2 dose regime is recommended given at 0 and 6 months, while those 15 years and older, the 3 dose regime ( 0,2 and 6 months) is recommended.

Although not included in the NCIS and NAIS for males, the HPV vaccines are licensed for use in males for protection from future anal cancer and genitial warts. Giving the HPV vaccine in men has also been shown to protect their future female partners form developing cervical cancer.

Is HPV vaccine free in Singapore? Where can parents go to get their children vaccinated against HPV?

The Singapore School HPV vaccination program has been available since 2019. All girls attending Ministry of Education-registered secondary schools, Special Education (SPED) schools, Privately-Funded schools and full-time Madrasahs will be offered the HPV vaccine in Secondary 1 free of charge.

Females who are Singapore Citizen (SC) between the ages of 9 – 26 years are eligible for government subsidies at both CHAS GP clinics and polyclinics. Permanent Resident (PR) females aged 9 – 26 years are eligible for government subsidies only at polyclinics. SC and PR females aged 9 – 26 years can use MediSave to cover the out-of-pocket costs at both locations.

SC females aged 18 – 26 years old with a valid Orange or Blue CHAS card can receive the HPV vaccination at no cost under the Temasek Foundation HPV Immunisation Programme or through the Singapore Cancer Society.

What is your advice to women and parents who are hesitant to get a cervical screening?

Cervical cancer is a preventable cancer.

Cervical cancer is the only women cancer that has the anti-cancer vaccine (HPV vaccine) and a very effective way of detecting abnormal cell and treat it long before cervical cancer can develop.

Cervical cancer is not a woman’s problem. Cervical cancer is everybody’s problem. Everybody including parents and the community needs to come together to increase awareness and empower women to get the HPV vaccine and go for regular screening.

It is a woman’s nature to put the health and happiness of others and those that she loved before hers, even though the fear of cancer is in her mind.
It is therefore important as well for those around her to support and empower her to go for regular cervical screening and take the HPV vaccine so that she too can continue to live her life as she desires without having cervical cancer take it away from her prematurely.

Ask the Expert: Is HPV Vaccination Enough to Prevent Cervical Cancer?