Workflow adopted by the National Cervical Cancer Screening Programme2 for women who are 30 years and above
Cervical cancer screening can help prevent cervical cancer1 or find it early. Please don’t delay scheduling your cervical screening appointment.
I really care about you. When was your last wellness appointment with your gynaecologist?
Did you know there are tests that can catch changes in your body before they become cancer? Your doctor can let you know what tests are right for you.
My cervical cancer screening is coming up soon. Have you scheduled yours yet?
Regular cancer screening is really important. Is there anything I can do to help you get screened, like find information, schedule an appointment, help with the kids or drive you to the clinic?
References
Let's talk about cervical cancer screening
Cervical cancer is one of the most common cancers in women worldwide. It starts in the cervix, located at the lower part of the uterus. Persistent infection of certain high-risk types of the HPV virus are known to increase the risk of cervical disease. Cervical disease, if left unchecked can progress over time to cervical cancer. Cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively.1
Human papillomavirus (HPV) is a common virus that is primarily transferred by skin-to-skin sexual contact. In fact, HPV is so common that over 80% of sexually active adults will get HPV at some point in their lives.
While over 150 types of HPV have been identified, only some are high-risk HPV types, known to cause health problems such as genital warts and cancers. Testing positive for HPV is not a negative reflection on you, your partner, or your lifestyle.
There is no treatment for the HPV virus. Most high-risk HPV infections have no symptoms, are harmless, and are cleared by the body’s immune system within two years. Since there are often no symptoms, a woman may never know that she or her partner has HPV. However, when the presence of HPV continues, certain types of high-risk HPV can progress to precancer or cancer. In women, HPV 16 and HPV 18 are the two highest risk types, known to cause close to 70% of cervical cancer cases.
Over 80% of sexually active adults will get HPV at some point in their lives2
90% of HPV infections are cleared within 2 years3
Around the world, cervical cancer is one of the most common cancers in women4
70% of cervical cancers are caused by the two highest risk types, HPV 16 & HPV 185
I’m overdue for screening because of the COVID-19 pandemic. Is it safe to get screened?
Yes! However, please check with the facility offering your screenings to ensure you know what is required ahead of time, if they have safety precautions in place. Your healthcare provider should be able to inform you whether it is safe to resume regular screening, and it’s best to schedule your tests as soon as you can. Don’t wait!
I’m nervous about screening tests. Is that normal?
It’s okay to be concerned about medical procedures, possible findings, affording tests or even seeing a doctor. But knowing the current state of your health can make it easier to take care of any issues and can potentially lengthen or save your life.
What can you expect at your cervical cancer screening?
There are two main kinds of cervical cancer screening tests available. Pap cytology (sometimes referred to as a smear test or Pap test or Pap Smear) and HPV DNA test.
To perform a Pap test or clinician collected HPV DNA test, healthcare providers use an instrument, called a speculum, to help open the vagina, so that the cervix can be viewed. Another device is then inserted to collect a sample of cells from the cervix. The samples are then either placed on a glass slide or placed in a collection vial containing preservative fluid, which are then sent to a laboratory.
Sample collection for cervical screening may feel a bit uncomfortable, and some women may experience some slight pain or pressure when the speculum is inserted or when the sample is taken from the cervix.
There is now an alternative simple procedure to collect your own sample for cervical screening. Learn more about collecting your own vaginal samples for cervical screening here.
What is the difference between the Pap and HPV test?
The Pap test (sometimes called the Pap smear test) looks for changes in cells before they develop into cancer. The HPV test looks for the presence of high-risk HPV which is known to cause about 99%6 of all cervical cancers. Hence, the HPV test can be a better predictor of risk for cervical disease. In Singapore, HPV DNA test is the first, primary test used in the Singapore Medical Guideline for women aged 30 and above. Ask if your provider offers HPV testing as part of your cervical screening program. Learn more about your HPV and cervical cancer screening options here.
Do you ever wonder why there is a perceived stigma about HPV or even the diagnosis of cervical cancer?
HPV is so very common and healthy sexual activity and partner relationships will likely (unknowingly) involve sharing the virus. Most of the time there are no symptoms or problems, and it can be transmitted through sexual touch, with or without actual intercourse, and with or without condom use. There is no reason to point blame or feel shame in testing positive for HPV, or in a cervical cancer diagnosis. To help combat the myths surrounding HPV, it helps to talk about it openly with your healthcare provider. You can also test your knowledge about the facts by checking out this quiz to help address some of the long-standing misinformation.
References
Let's talk about booking your cervical screening appointment.
Getting screened for HPV and cervical cancer is one of the most important things you can do for your health. All women above a certain age, even those in monogamous relationships or with the same long-term partner, need to be tested for HPV. A positive test result doesn't indicate when you got the infection or from whom, and some research suggests that HPV can lay dormant for some time.1 Testing positive is not a reflection on you, your partner or your lifestyle. So, while testing HPV positive doesn't necessarily mean you have, or will develop cervical cancer, it does mean you could be at an increased risk. It's important to know which HPV type you have to fully understand your risk.
Although the available HPV vaccines cover some high-risk HPV types (including HPV 16 and HPV 18, the two highest risk types), they do not cover all high-risk HPV types. Therefore, experts still recommend that you continue to get screened regularly for cervical cancer even after you’ve received the vaccine.6
Pap Test |
HPV DNA Screening |
|||||||||
| Clinician-collected only4 | Specimen collection |
Clinician-collected4 or self-collected11 | ||||||||
| Looks for abnormal changes in cervical cells7 using a microscope4 | Purpose |
Identifies the presence of high-risk HPV strains even before cervical cell changes occur12 | ||||||||
| A sample is taken from the cervix and examined for abnormalities13 | Sample type |
A sample can be taken from either the cervix14 or vagina and checked for the presence of HPV11 | ||||||||
|
What is required?
|
|
Self-collection for cervical screening is easy and comfortable!
You can prevent cervical cancer before it starts .
One case of cervical cancer that could have been prevented is one case too many.
Cervical cancer affects more than 200 women annually in Singapore. Early detection and regular cervical screening makes cervical cancer highly preventable and curable⁶.
HPV DNA screening and Pap test are a part of cervical screening.
Pap test, also known as Pap Smear or Cytology, looks for cell changes on the cervix that may develop to cervical cancer7.
On the other hand, HPV DNA screening detects HPV infection, as persistent HPV infections with high-risk HPV strains can increase your risk of cervical cancer8. It will be able to detect cervical cancer at its pre-cancer stage9. This is why cervical cancer is known to be a highly preventable cancer10.
Women who have had sex in the past or present, are advised to start cervical screening from the age of 25 and those above the age of 30 are encouraged to go for a HPV DNA screening every 5 years as recommended by the National Cervical Screening Programme in Singapore⁴. For HPV DNA screening, you may opt for your healthcare provider to collect a sample or you may choose to collect your own sample.
With the option of self-collection for cervical screening, women can now privately collect their own sample in a quick and easy way, without having to feel shy or embarrassed.
Self-collection for cervical screening is an option to be considered for women who are:
30 years old and above4
Sexually active or have been sexually active11
Not pregnant11
The above is not an exhaustive list. Speak to your healthcare provider to understand better if collecting your own sample for a HPV DNA screening is the right option for you. Your healthcare provider will provide personalised recommendations and further information pertaining to cervical screenings.
If you have decided to collect your own vaginal sample for HPV DNA screening, do inform your healthcare provider about your choice.
Your healthcare provider will explain how to collect your own sample and hand you a self-collection kit.
Wash your hands with soap
Your doctor or nurse will hand a swab and a bottle with a clear solution.
Turn cap to remove swab.
Hold the swab at the red marking, do not touch the tip of the swab.
Stand or sit in a comfortable position.
Insert swab until your fingers at vagina opening.
Rotate swab.
Carefully uncap the bottle with a clear solution.
Swirl swab while ensuring that it remains fully immersed.
Drain fluid from the swab.
Return swab and bottle to your healthcare provider.
You may choose to stand or be seated when collecting your own vaginal sample as you should feel comfortable during the self-collection process.
Here are some positions you can get into to help you with collecting your own vaginal sample.
Stand with one leg raised to rest your one leg on a stool15.
Sit on the toilet bowl with your legs slightly spread open15.
There is no need to be too concerned about reaching the right spot. Collecting a vaginal sample would mean that you do not need to ‘reach in deep’ or collect from a specific ‘spot’. All you need to do is to insert and twirl the swab as per the instructions and you have collected your own vaginal sample!
It’s been a couple of years since Eva last did a cervical screening test. Upon returning to the doctor this time, she was advised to keep up with regular screenings. Since Eva has 2 kids and a busy schedule, her doctor recommended that she get a self-collection kit so she did not need to wait for a doctor’s examination.
With a few explanations from the helpful nurse, Eva was able to easily collect her sample at the GP. This self-collection method offers Eva a private and accessible way to prioritise her own health and well-being despite her packed schedule.
By performing a self-collected sample for cervical screening, Eva can take proactive measures and seek timely medical attention if necessary, ensuring early detection and better chances of successful treatment.
Take action now, get screened today.
You have the choice to collect your own vaginal sample to check for HPV. Collecting your sample for cervical screening is:
Cervical screening is conveniently available at:
The Singapore Cancer Society provides cervical screening at no cost for eligible candidates. Subsidised screening is also available at Polyclinics and Community Health Assist Scheme (CHAS) clinics for women who are eligible.
Ask your healthcare provider if the option to collect your own vaginal sample privately for HPV DNA screening is available or you may walk into your neighbourhood clinic to find out more.
Frequently Asked Questions
What is HPV? Can a virus really lead to cancer?
Almost all cases of cervical cancer are caused by the human papillomavirus (HPV).5 The virus is sexually transmitted and infects most men and women at some point in their lives. Although not everyone who tests positive for a high-risk HPV infection will go on to develop cervical cancer, if the virus is persistent and not managed by a woman's immune system, over time the infection could cause cellular changes that may lead to cancer. This process can take many years, or even a decade, so managing a woman's wellness over time is important. Link to cervical cancer screening page.
Can viral infections such as HPV really lead to cancer?
Persistent HPV infection with high-risk strains is the cause of 99.7% of cervical cancer cases¹⁸. HPV is a common infection with at least 4 out of 5 women would have had a HPV infection by the age of 50¹⁹. The virus is transmitted through skin-to-skin contact such as through sexual intercourse²⁰.
Most HPV infections resolve by themselves within two years but some of them can last longer and cause cancer including cervical cancer²¹. It takes about 15 to 20 years for cervical cancer to develop among women with a normal immune system⁸.
HPV DNA screening can help with early detection and prevention of cervical cancer by detecting the presence of HPV, including high-risk HPV strains¹⁴.
Will a healthcare provider explain to me about my self-collected cervical screening test results?
Your healthcare provider will advise you of your HPV DNA screening results, upon receiving them from the laboratory. If necessary, you may request for an explanation of it.
If your HPV DNA screening results are negative, you will be advised to repeat the HPV DNA screening in 5 years⁴.
On the other hand, if your HPV DNA screening results are positive or abnormal, this indicates that the screening has identified the presence of HPV²² but it is important to take note that a HPV DNA screening does not directly indicate if you have cancer¹⁴. Instead, it identifies the presence of HPV, including high-risk HPV strains that increase your risk of developing cervical cancer¹⁴. You may be required to return for a Pap test²², which looks for abnormal changes in the cervical cells¹⁴.
(The information provided is for educational purposes only and does not substitute for professional medical advice)
Can a healthcare provider collect my sample for the HPV DNA screening instead of me?
Sure, the choice is yours. Speak to your healthcare provider if you prefer to have your healthcare provider collect your sample for your HPV DNA screening.
How does a woman know if she has cervical cancer?
During the early stages of cervical cancer, there are no symptoms²³. Symptoms of cervical cancer such as vaginal bleeding between periods and pelvic pain during sex usually present itself after the cancer has progressed²⁴.
One way to detect cervical cancer at its early stage is through a cervical screening. Through this screening your healthcare provider will be able to identify early changes in the cells as well as the presence of HPV strains. As a matter of fact, cervical screening can detect cervical cancer at its pre-cancer stage, hence making it possible for you to prevent it⁹.
Is the swab for collecting my sample a ‘one-size-fits-all’?
Yes, there is only one option available but not to worry, a self-collection for cervical screening is a vaginal swab. You do not need to insert the swab deep in towards your cervix. Therefore, the swab is not the length that you might imagine it to be. It is also slim, flexible and comfortably reaches just to the vaginal wall for you to collect a sample.
What happens if my test results are positive?
You will be asked to return to your healthcare provider so that a sample can be collected by your healthcare provider for further screening²¹. If HPV strains 16 and 18 were detected (these strains are responsible for 70 percent of cervical cancers)²⁵ in your HPV DNA screening results, your healthcare provider will follow-up with another type of test for cervical screening, known as colposcopy. If other HPV strains were detected, a Pap test will be conducted and the next steps will be advised accordingly depending on the results²².
If I am in a wheelchair, will it be possible for me to consider collecting my own vaginal sample for HPV DNA screening?
There are suggestions that self-collection for HPV DNA screening might be an option as there is no need for a speculum examination. If you are in a wheelchair or with disabilities, it would be best for you to discuss with your healthcare provider about the option to collect your own vaginal sample for cervical screening ²⁶.
How can I prevent cervical cancer?
Cervical cancer is one of the most preventable cancers¹⁰. Some steps you can take to reduce your risk of developing cervical cancer includes:
References
Let's talk about your HPV results and the next steps
Understanding your primary HPV screening test results
HPV screening can help your healthcare provider identify if you are at risk for cervical cancer. If you receive a positive test result, it’s normal to feel anxious or worried. However, it’s important to remember that a positive HPV test result does not automatically mean that you already have, or will develop, cervical cancer. Talk to your healthcare provider, who will discuss next steps with you.
It’s important to remember that abnormalities can usually be treated easily and successfully if detected early. If untreated there is a greater chance of developing cervical cancer1.
Workflow adopted by the National Cervical Cancer Screening Programme2 for women who are 30 years and above
Dependent on your results you’ll be asked to:
Breaking down the stigma surrounding HPV and cervical cancer
A positive HPV result does not necessarily mean you or your partner have been unfaithful, as the virus can stay dormant (latent) for years before an infection is detected. Having HPV is not a reflection on you, your partner or your lifestyle and it isn't something to be ashamed or afraid of. The majority of men and women with a healthy, active sex life will be exposed at some point, and may never know it. In most cases, the infection has no symptoms, and usually resolves on its own without causing a problem. However, <10%3 of women will test positive for HPV, and of those, some may develop cervical disease if an HPV infection is left undetected and untreated.
We have the power to protect cervical health
Every year >600,000 4 women are diagnosed with cervical cancer globally - this disease is highly preventable. With a combination of vaccination, advances in screening and appropriate treatment, cervical disease can be found and stopped. The goal is to identify women at risk, before invasive cancer ever develops. We have the power, by helping to spread the word about the role of Human Papillomavirus (HPV) in the cause of cervical cancer, to protect women from this preventable disease.
Frequently Asked Questions
What happens after a HPV positive result on a self collected vaginal sample?
A positive result from a self collected vaginal sample usually means that the virus is present. It is essential to follow up with your healthcare provider for further guidance. They may recommend additional tests or discuss potential implications for your health. Regular screenings are crucial for early detection and management.
What is triage?
In the medical world, "triage" refers to the process of sorting people based on whether a patient may benefit from an immediate intervention or can be allowed more time before follow-up or retesting. In the case of cervical cancer screening, it may be recommended that women who receive a positive high-risk HPV and/or abnormal Pap result get managed more closely, with follow-up care or testing.
What is Colposcopy
Depending on your HPV or Pap test result, you may be asked to come back later for repeat testing, or your healthcare provider may request more tests be run on your sample to further determine your risk for cervical disease. It may also be recommended that you come back for a colposcopy, to examine your cervix more closely. A colposcopy is an important step toward prevention after receiving abnormal test results. During a colposcopy, a doctor uses a colposcope (a lighted magnifying device) to see problems in the cervix that would be missed by the naked eye. A tissue sample or cervical biopsy may also be taken for laboratory analysis to determine if there are cellular changes indicating cervical precancer or cancer. After the procedure, it is normal to feel some soreness and have some vaginal bleeding or discharge.
What is a biopsy?
During colposcopy, the healthcare provider may decide to take a closer look at the cells on the cervix by taking a biopsy or small tissue sample. The biopsy is sent to a laboratory to determine if there are cell changes indicating cervical pre-cancer or cancer. After the procedure, there may be some soreness and vaginal bleeding or discharge."
What are biomarkers?
Biomarkers provide biologic information that can help healthcare professionals understand what is happening in the body at a molecular level and could help them identify if something is wrong.
Biomarkers help us understand if there are signs an HPV infection is transforming, and could potentially develop into cancer if allowed to progress. In March 2020, the U.S. FDA approved for the first time a biomarker-based test, giving women with positive high-risk HPV screening results a new option to get additional information, sooner.
This next generation cervical screening technology detects the simultaneous presence within a single cell of the two biomarkers -- p16 and Ki-67. When found together, this is an abnormality associated with an HPV infection that shows signs of transformation towards pre-cancer or cancer.5
A positive "dual-stain" result does not mean a woman already has, or will definitely develop cervical cancer, but it indicates she is more significantly at risk for disease. The use of this type of biomarker test helps guide clinicians in making patient care decisions, and helps distinguish who may benefit most from immediate referral to colposcopy versus who can wait for later, repeat testing.6
References
Let’s talk about finding additional resources about cervical screening
Cervical cancer prevention begins with education, HPV awareness and access to women’s wellness resources that can help you be proactive about your health. Swipe or scroll below to see the valuable resources offered by many different organizations in Singapore and around the world.
