Avoiding your Pap smear and HPV screening? These routine tests could save your life
Women in Singapore are now much more aware of how important cervical cancer screening is, yet we remain resistant to it. CNA Lifestyle asked doctors how these checks are critical in prevention.
The first time I heard the term “Pap smear” was two years ago, when my mum did it as part of her routine health checkup.
I was 26 then, and had many questions about the test. I found out later that Mum, too, had done her first Pap smear test only at the age of 40.
It turns out that even though women in Singapore are mostly familiar with it (it's also called a Pap test), many are still resistant about going for it.
The Pap smear looks for abnormal cells in the cervix and is used to screen for cervical cancer.
Based on the 2019 National Population Health Survey, only 76.5 per cent of adults between 25 and 29 years old knew about Pap smears, as compared to 91 per cent of those between 30 and 69 years old.
“Younger women below 30 don’t see the value of and need for screening because the absolute numbers of cervical cancer among the young are low,” said Professor Tay Sun Kuie, Senior Consultant, Department of Obstetrics and Gynaecology at Singapore General Hospital.
Meanwhile, women between 30 and 45 years tend to dismiss screening, which they deem a low priority due to busy work schedules and the fear of pain associated with the test, Prof Tay added.
According to an ongoing study by Ferne Health, a women-focused sexual health platform, the top barriers preventing women from going for a Pap smear include the lack of knowledge of it, fear of discomfort, and the embarrassment of exposing one’s private parts in the clinic, especially to a male doctor.
“Many women have heard stories from their friends about how painful (the procedure) is,” said Liu, the founder of Ferne Health.
Keeping these reasons in mind, CNA Lifestyle talked to experts to gain a clearer understanding of the screening process – and why it’s such a critical health check for women.
THE DIFFERENCE BETWEEN A PAP SMEAR AND HPV SCREENING
First up, the Pap smear is just one of two health tests to screen for cervical cancer. The other is the Human Papilloma Virus (HPV) screening, also called an HPV DNA test. Which one you do depends on how old you are.
Said Dr Qi Maili, a consultant at KKH’s Department of Gynaecological Oncology: “The purpose of Pap smear is to identify abnormal changes in the cervical cells while HPV screening tests for the presence of high-risk cancer-causing HPV strains.”
According to Ministry of Health guidelines:
- If you’re below 25 years old: There’s no need to do a Pap smear yet. “This is regardless of sexual exposure,” said Prof Tay.
- If you’re 25 to 29 years old: Do a Pap smear once every three years, if you are sexually active. “Only women who are sexually active need a Pap smear test," said Dr Wong Wai Loong, Head and Senior Consultant, Department of Gynaecological Oncology at KK Women's and Children's Hospital (KKH). If you’re immunocompromised, do a Pap smear every year.
- If you’re 30 and above: Do an HPV test once every five years, which should be your primary screening. “An HPV test has been proven to be more effective than Pap smear," said Dr Qi. Even if you do regular Pap smears, she recommends having an HPV test at your next screening. If you’re immunocompromised, do an HPV test once every three years.
“Women in the immunocompromised group are recommended to be screened for life,” said Dr Ida Ismail-Pratt, an obstetrician and gynaecologist at The Obstetrics & Gynaecology Centre at Mount Elizabeth Novena and a member of Singapore Cancer Society Women's Gynaecological Cancer Awareness Committee.
According to national screening guidelines, women who are immunocompromised can be categorised into three groups: Those who are HIV-positive, have had solid organ transplants, or are taking more than two immunosuppressive medications.
Explaining why HPV screening isn’t necessary for women below 30 even though HPV infections tend to be more common in this age group, Dr Qi said: “At this age, infections with HPV can be easily cleared by one’s own body and doing an HPV test may be unnecessary.”
One of the most common misconceptions of cervical cancer screening, Dr Wong said, is that you can skip it if you’ve been vaccinated against HPV. HPV vaccination is recommended for both women and men aged nine to 26 years.
“No vaccine prevents all types of HPV that can cause cervical cancer. Women are recommended to continue with regular cervical screening,” he explained. Besides, he added that preventing cancer is more effective than treating it.
WHAT TO EXPECT FROM BOTH TESTS
The Pap smear and HPV screening are done in the same manner, said Dr Qi.
When it comes to what you should (and should not) do before and after the two tests, Prof Tay recommends:
- Scheduling your screening appointment only when your period is completely finished. For a Pap smear, you can do the test from day 10 (of your period) to the day before the onset of the next period. “The quality of cells shed from the cervix are at the best state for examination,” he explained.
- Going for HPV tests at any time, as long as you’re not on your period. Optimal samples, Prof Tay said, are those containing little or no “contaminants”.
- Delaying any cervical screening tests for seven days after the last medication application to avoid any potential chemical effects on the tests.
He added that you can have sex, with or without using a condom, before and after a Pap smear or HPV test.
If you are worried about the cost, affordable options are available. First, if you are a Community Health Assist Scheme (CHAS) card holder, the National Cervical Cancer Screening programme gives you free screening – or at a highly subsidised rate of S$2 or S$5, which includes a GP consultation.
Polyclinics, too, offer affordable rates for Singaporeans, at S$15 for a Pap smear and S$22.50 for an HPV test.
Additionally, the Singapore Cancer Society (SCS) offers free cervical cancer screening for women aged 25 and above at their clinic. The whole procedure, Dr Ida said, takes about five minutes without consultation.
You should receive your test results within one to two weeks, Prof Tay said, although it depends on the laboratory. “The exact timing of receiving the results is mostly administrative – rather than the test procedure itself,” he said.
If the screening shows mild abnormal results, you may need to repeat the test in a year’s time, or at an earlier interval. But depending on the exact nature of the abnormalities, Prof Tay said that your doctor may want to run more possible tests.
A GROWING TREND: HOME-SAMPLING HPV KITS
Only home sampling kits for HPV are available in Singapore currently, not Pap tests. Although, Liu from Ferne Health said the platform is working with its device manufacturing partner to roll one out. She added that a clinical trial in Europe is underway.
In Singapore, home sampling HPV kits are becoming popular with women looking for cervical cancer screening, primarily because of the convenience, comfort and privacy they offer.
Prof Tay explained that with such a kit, a woman introduces a device into her own vagina to obtain a sample. Then, the collected sample has to be delivered to a medical clinic by hand or by post.
The concept of self-sampling HPV tests, he added, started 10 years ago with a small number of gynaecologist clinics in Singapore. But it wasn’t until recently that these entered the Singapore market – Ferne Health introduced its HPV kit (S$200) last year.
Similarly, healthcare provider Raffles Medical Group also offers HPV self-sampling kits (S$147.66). You simply have to return the sample to any Raffles Medical clinic within 48 hours of collection.
Thereafter, and similar to what happens when you get an HPV screening at a clinic, the samples are analysed in a lab and the results mailed back to you. If you buy a kit from Ferne Health, you’ll get the results within three to five days.
After you receive the results, you should arrange a consultation with your doctor to help you understand the findings, said Prof Tay. Follow-up instructions may be necessary.
While home sampling kits offer women convenience and privacy, they do have their disadvantages.
Some women aren’t sure if they’re collecting the sample correctly, and they may also worry about accidentally contaminating the sample.
Be comfortable and relax, and adjust positions if you feel any discomfort, suggested Liu, adding that the (video) instruction reflected on the Ferne Health website is quite straightforward.
“An important tip to note is to avoid taking samples during the menstrual cycle as the sample would be contaminated by blood,” she reminded.
CNA Women is a new section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.