Cervical cancer is the only cancer that can be prevented by a vaccine – against the human papillomavirus (HPV).
It’s Cervical Cancer Awareness month in Singapore and here’s what you need to know about the HPV cancer-causing virus, and the vaccines you can get to protect yourself against it. Read on to get informed about HPV and how it is and isn’t transmitted.
The Human papillomavirus (HPV): What is it?
The human papillomavirus (HPV) is one of the most common viruses in the world and should be something that is the topic of conversation not only with your medical provider, but everyone you know. It consists of a group of more than a hundred virus strains. Cervical cancers are typically caused by the HPV – and is known to be sexually transmissible via penetrative intercourse. Anyone who’s had sexual intercourse are at risk for contracting HPV, even if it’s protected sexual intercourse. (And yes, skin-to-skin genital contact can be a risk too!) An HPV infection can result in a pre-cancerous condition called dysplasia, which can progress into cervical cancer if left undetected.
While more benign strains won’t cause malignancy, HPV 16 and 18 are strains that are responsible for 70% of cervical cancer and pre-cancerous cases.
What are the signs and symptoms of cervical cancer?
Did you know? In Singapore (as of 2018), 1 in 10 healthy women have HPV and cervical cancer remains as the fourth most common diseases here. The worrying part? Because HPV testing is not as prevalent as with other diseases like the human immunodeficiency virus (HIV), most people go for years with undetected symptoms. Look out for: vaginal bleeding after intercourse, bleeding between menstrual periods or, after menopause, if there is abnormal vaginal discharge tinged with blood or emitting a foul smell.
Dysplasia: How is it diagnosed and treated?
Dysplasia refers to precancerous changes and is discovered through a pap smear. If abnormal changes are found, the cervix is examined in a colposcopy procedure where biopsies may be taken – small pieces of tissue are removed and sent to a laboratory for further examination.
Precancerous changes and early cancer stages can be treated by removing abnormal tissue through a Loop Electrosurgical Excision Procedure (LEEP) – using a hot wire loop to remove tissue – or through laser therapy.
For advanced cancer stages, a radical hysterectomy is often needed – removing the uterus and most of the surrounding tissue, lymph nodes and the upper part of the vagina. Radiation and chemotherapy can also be used before or after the surgery.
HPV: Are there any risk factors?
An active sex life with multiple partners increases one’s risk for contracting HPV. But if you think that’s it, you’re in for a shock. Founder of Cervivor.org, Tamika Felder noted:
“Recently, news just came out in a U.S. study that stated that HPV could be transmitted without penetrative sex, which isn’t that shocking because for years the medical community has been saying this: that HPV is spread skin-to-skin. But, here is what was shocking about the study – it claimed that HPV could be spread at the gym, on things like bicycle seats and, worse, your own doctor’s office (say, what?). Don’t be so quick to panic, though. As a global cancer advocate — specifically, cervical cancer, I want Singapore expats to know that there is so much more that you need to know.”
But! No need to freak out, here are ways you can prevent it:
“Firstly, there are more than 100 strains of HPV,” says Tamika. “Some cause warts on the hands and feet and others cause genital warts and certain cancers. So, yes, HPV should be on your radar, but there is no need to freak out. It is highly unlikely that you will catch HPV from your spin class.”
1. Vaccination. The HPV Vaccine (read more about how to get it in Singapore below) is highly effective in its prevention against cervical cancers. A common misconception is that only females need it. HPV can cause penile cancer in males too. So, girls and boys aged 9 to 26 are highly encouraged to get it. In addition, women should have regular cervical cancer screenings – pap smear and HPV, specifically.
2. Being honest about your sexual history and practice safe (and responsible) sex. “And then there is this… people are not always honest about sex.” says Tamika. “It’s still such a taboo topic, and there is no way to know that those who were surveyed were indeed virgins.” She notes that there’s a handful who misconstrue sex as merely penetrative. “Oral sex (of any kind) and genital-to-genital touching are risk factors too.”
3. Regular screenings. Women who have lost their virginity should consider getting a pap smear, and especially so if they’re active. To be extra cautious, they may choose to add an HPV test at age 30. Why? Because HPV doesn’t just cause cancer, it can cause a lot of minor issues that almost always go away on it’s on, but it also does cause things like genital warts and HPV-related cancers like cervical, oral, vulvar, vaginal and anal.
HPV vaccine in Singapore: What types are available and how much do they cost?
There are currently 3 types of HPV vaccines available in Singapore, all of which provide different levels of protection against the many HPV strains. Regardless of which type of vaccine you choose, they are administered in 3 doses of injections over a period of 6 months.
1. Cevarix (for women only)
Cevarix offers the most basic (but most important!) protection against the 2 major cancer-causing HPV strains (16 and 18). However, it’s only suitable for females aged 26 and below.
*Price: approx. $360
Where to get it: All Singapore polyclinics
2. Gardasil 4
Gardasil 4 protects against 4 strains of HPV (6, 11, 16 and 18). This is most commonly available in most Singapore clinics.
*Price: approx. $280 to $480 depending on the clinic
Where to get it: Available at most medical clinics/centres in Singapore.
3. Gardasil 9
This provides the most comprehensive protection against HPV strains. It’s also the newest HPV vaccine available. It covers 9 strains of HPV (6, 11, 16, 18, 31, 33, 45, 52 and 58).
*Price: approx. $530 to $750
Where to get it: KK Women’s & Children’s Hospital, DSC Clinic, Raffles Medical, Asia HealthPartners, Mount Elizabeth Hospitals, Dr. Tan and Partners, Kensington Family Clinic.
*Please note that all prices listed exclude GST, consultation costs and procedure fees.
For Singapore citizens and PRs, up to $500 can be taken from one’s Medisave to cover the cost of the HPV vaccine. However, it doesn’t apply to the newest Gardasil 9 vaccine.
When should I get vaccinated for HPV?
Girls and boys from as young as 9 are suitable for the HPV vaccine. In fact, since April 2019, all 13 year-old girls in Singapore (citizens and PRs) can opt to get the vaccine for free. It’s key to note that the HPV vaccines (as with all vaccines) are preventive measures and should not be in place of treatment. Hence, the best time to get the vaccine is before one becomes sexually active. The more sexually active one is, the less effective the vaccine would be because one may already have been exposed to virus strains one may not know of. In most cases, it’s still worth getting the HPV vaccine if you haven’t caught the virus before.
FYI, boys aren’t given the all-pass too and are encouraged to get vaccinated if possible. Why? Because HPV can develop into cancers of the throat, genital and even anus – regardless of an individual’s sex.
What should I do if I develop symptoms similar to those of cervical cancer?
Always consult your doctor if you develop indications consistent with early cervical cancer, or if you would like more information about HPV vaccination and treatment options. In any case where you’re unsure, it does more good than harm to clarify with a medical professional.
While the HPV vaccine is effective in reducing the risk for cervical cancer, it’s not 100 per cent preventive (as with all vaccines). Vaccinations are just one form of preventive measure, getting regular screenings an adopting safe and responsible attitudes towards sex is also key in reducing one’s risk from developing cancer.
About Tamika Felder
Cervivor.org founder Tamika Felder is a cervical cancer survivor, global cancer advocate, speaker, purposeful living expert, writer, producer, host, world traveller, foodie, Pinterest addict and HuffPost contributor. Connect with her at @tamikafelder and tamikafelder.com.
Text adapted from Tamika Felder, cancer advocate and founder of cervivor.org + MoneySmart / Sources: Singapore Cancer Society, HPV Information Centre + Health and Fertility Centre for Women / Additional reporting by Willaine G. Tan
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