Cervical Cancer Screening & HPV Vaccination In Singapore – A 5 Min Guide

by Dr Juliana Latif
Sunday, May 17, 2020

How HPV Is Linked To Cervical Cancer

Human Papillomavirus (HPV) is one of the most common Sexually Transmitted Diseases (STDs). It is also the single largest risk factor that leads to Cervical Cancer 

There are currently over 200 strains of HPV, and some of these are high-risk strains that can cause cervical cancer.

Most HPV infections will eventually go away on their own after about 1 to 2 years, or cause genital warts which are painful but can be cured.

However, high-risk strains such as HPV 16 or HPV 18 can stay in the cervix for a long time. These strains infect your cervix and may cause the development of cancerous cells, which lead to cervical cancer.

This process can take many years, so an infection you got when you were 25 can start causing pre-cancerous changes when you’re 35, and develop into full-blown cervical cancer by 42. 

That’s why regular screening is so important because you could have a HPV infection developing without showing any symptoms at all.

How Is HPV Transmitted?

HPV is transmitted through skin-to-skin contact such as sexual intercourse, oral sex and anal sex. If you are sexually active or share contaminated sex toys, there is a high chance that you can transmit or contract a HPV infection. 

If you have multiple sexual partners or your partner has multiple sexual partners, you are also at high risk for HPV infection. Condoms do not provide 100% protection against the transmission of HPV.

If you are on long-term oral contraceptives or have a weakened immune system, you also face the increased risk of HPV infection.

Other risk factors include being sexually active from a young age, or having a history of Sexually Transmitted Diseases like herpes or chlamydia, or smoking. 

You can’t catch HPV from touching common surfaces, casual contact such as shaking hands or hugging, or from toilet seats. 

Symptoms Of HPV Infection

Most HPV infections do not show any symptoms. Even the pre-cancerous changes that take place after a persistent HPV infection may not show any symptoms.

Some strains of HPV may cause genital warts. 

Many women often only see the symptoms of cervical cancer, long after transmitting HPV and after any preventative treatment could have taken place.

This is why doctors keep stressing how essential it is for you to undergo regular screening especially if you are sexually active. If detected early, treatment can be undertaken before a high-risk HPV infection can develop into cervical cancer.

Symptoms Of Cervical Cancer

If you have cervical cancer, you may display some or all of the following symptoms:

  • Bleeding between your periods or after menopause
  • Bleeding after intercourse
  • Periods that are heavier and last longer than normal
  • Pelvic or back pain that is unusual and may not be related to your period
  • Pain during intercourse
  • Abnormal vaginal discharge that may be thick and foul in odour
  • Pain during urination 
  • Increased frequency of urination
  • Constipation and feeling like stool is present despite your bowels being empty
  • Urine or faeces leaking from the vagina

HPV Vaccination In Singapore

Fortunately, it is possible to get HPV vaccinations in Singapore to reduce the risk of cervical cancer. The vaccinations can protect you against 70-90% of the high-risk HPV strains that can cause cervical cancers.

In Singapore, these vaccinations are recommended for girls and women 9 to 26 years and it is recommended you take the vaccination before you first have sexual contact and have not had exposure to HPV.

Even if you are sexually active, you can still benefit from the HPV vaccinations as you may not have been infected with the high-risk HPV strains. You can check with your doctor to find out if you are suitable to receive HPV vaccinations.

Remember that HPV vaccinations do not guarantee 100% protection so you still should go for regular screening even if you have had your injection.

The different types of HPV vaccinations in Singapore are Cervarix, Gardasil and Gardasil 9. All of them require multiple vaccinations taken a certain amount of time apart. 

As of April 2019, all 13-year-old Singapore Citizens or PRs can get the HPV vaccination for free. However, this is optional and parents must opt-in for their daughters to receive the free vaccination.

Cervarix

Cervarix protects you against HPV 16 and HPV 18, two of the high-risk HPV strains that are responsible for more than 70% of cervical cancer cases.

This vaccination is approved for girls and women from 9 to 25 years old, or as advised by your doctor.

For girls between 9 to 14 years of age, you need to take two vaccinations between 5 to 13 months apart.

Females between 15 to 25 years of age need to take three vaccinations with the second vaccination between 1 to 2.5 months after the first vaccination, and the third vaccination 5 to 13 months after the first vaccination.

Polyclinics only have the Cervarix vaccination available which costs $360 excluding consultation fees and GST. You can use Medisave to subsidise the cost of your vaccination for up to $500.

Gardasil 4

Other than protecting you against HPV 16 and HPV 18, Gardasil also vaccinates you against HPV 6 and HPV 11 which can cause genital warts and lesions. 

Females between 9 to 14 years old need two injections 6 to 12 months apart, while ladies aged 15  and above require 3 vaccinations. You take the second injection 2 months after the first injection, and the third vaccination 6 months after the first one.

The cost of Gardasil varies between clinics but you can expect to pay $386 at least including GST. Gardasil 4 vaccination can be subsidised using Medisave for up to $500. 

Gardasil 9

Gardasil 9 is named as such as it vaccinates you for 9 strains of HPV. These are HPV subtypes 6, 11, 16, 18, 31, 33, 45, 52 and 58​.

The vaccination schedule is the same as that of Gardasil.

At this time, you cannot use Medisave to subsidise your Gardasil 9 vaccination even though it is the most expensive, costing at least $632 with GST.  At Fusion Medical, a package of 3 doses of Gardasil 9 costs S$642 nett.

Can Pregnant Women Get Vaccinated For HPV? 

If you’re pregnant, you’re advised not to get the HPV vaccination.

If you find out that you’re pregnant after taking one or more of the vaccinations, don’t continue with the vaccinations until after the end of your pregnancy.

Let your doctor know if you’ve inadvertently taken the HPV injections while pregnant and seek his or her advice.

Can Medisave Be Used For HPV Vaccination?

Yes, you can use up to $500 of your Medisave to subsidise your Cervarix or Gardasil vaccination if you are between 9 to 26 years old.

However, Gardasil 9 injections are not eligible for the subsidy. 

If you are using Medisave, you can also use the Medisave of your parents or spouse to make payment. Medisave deductible and co-payment rules are not applicable for HPV vaccinations.

Cervical Cancer Screening In Singapore

There are 2 main tests for cervical cancer screening which are Pap smears and HPV tests (or HPV DNA test). 

You should start going for regular screening within the first 3 years of your first sexual contact or when you are 21 years old, whichever is earlier. 

Ladies who are between 21 to 29 years old should get a Pap smear every 3 years. If you are between 30 to 64 years old, you should get a Pap smear and HPV test every 5 years, or a Pap smear every 3 years.

Once you’re 65 years old and over, your doctor may allow you to stop going for cervical cancer screening if you have had normal results in all your previous tests. But if you’re 65 years old and you’ve never had a Pap smear, you should go for it to check that you are not at risk for cervical cancer.

The purpose of the Pap smear is to detect cell changes in your cervix. The doctor uses a speculum to widen your vagina, examine it, and swabs cells from the cervix to send to the laboratory for analysis.

You might feel some discomfort or pain during your Pap smear and you should let your doctor know once you feel discomfort.

As with most medical testing, Pap smears are not 100% accurate. 

Don’t go for your Pap smear test if you’re having your period as the blood shed might affect your test results. Make sure you do your test at least 14 days after the start of your period.

If you have had a total hysterectomy (removal of the uterus and cervix) for a non-cancerous condition, you may not need to go for regular Pap smears and you should verify this with your doctor. He or she may recommend having one Pap smear done after your hysterectomy procedure.

If you had a partial hysterectomy and your cervix was not removed, or your total hysterectomy procedure was done for a cancerous or pre-cancerous condition, you will still be required to undergo regular Pap smear testing.

HPV tests, which you can start undergoing after you’re 30 years old, tests for the presence of high-risk HPV strains in your cervix.

Don’t put off your screening because early detection saves lives. Even if you have no family history of cancer, you might still be at risk of getting cervical cancer. There are no symptoms for HPV infection so you should still go for a Pap smear even if you feel healthy.

If cervical cancer is found in the very early stages, the five-year survival rate is as high as  90%. However, if you only detect it when the cervical cancer has reached Stage 4 or spread to other organs, the five-year survival rate drops to 10%.

Is Cervical Cancer Screening Required After HPV Vaccination?

Yes, it is.

Even though you’ve had the HPV vaccination, you are not 100% safe from cervical cancer. This is because the vaccine can reduce the risk of cancer by protecting you against 70-90% of high-risk HPV strains but not 100%.

Furthermore, if you got the vaccine after being sexually active, you might have already been exposed to a HPV infection. 

 

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