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Women urged to not overlook Pap smears, HPV vaccinations

SINGAPORE — When 35-year-old Charlene Loh first felt a lump just below her abdomen shortly after delivering her first-born, she dismissed it as a postnatal quirk.

A child health nurse with a vial and box for the HPV vaccine. AP file photo

A child health nurse with a vial and box for the HPV vaccine. AP file photo

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SINGAPORE — When 35-year-old Charlene Loh first felt a lump just below her abdomen shortly after delivering her first-born, she dismissed it as a postnatal quirk.

Months later, the symptoms — ­irregular menses, frequent urination, a bloated stomach and a lump that seemed to have increased in size — became too obvious to ignore.

Diagnosed with early stage ovarian cancer in 2014 when her son was only 15 months old, Mdm Loh recounted the shock and fear she had felt at the time of her diagnosis.

By then, the 22cm tumour had taken over her entire left ovary, which was surgically removed as part of her cancer treatment. Her right ovary and uterus were spared as she wished to have more children.

“I never thought it would happen to me. The word ‘cancer’ is frightening enough but what made me even more worried was my child who is still so young. I was so afraid I was going to die. Fortunately, my husband, family members and religion gave me strong mental support,” said Mdm Loh, an online baby clothing store owner.

Mdm Loh’s brush with ovarian cancer is no longer an uncommon phenomenon here. Local cancer statistics show that an increasing number of women are grappling with gynaecological cancers, which are cancers that affect a woman’s reproductive organs.

Between 2010 and 2014, there were 1,731 new cases of ovarian cancer, a figure that has increased two-thirds from the 1,054 new cases between 1998 and 2002, according to figures from the Singapore Cancer Registry.

Over the same period, the number of new uterine cancer cases has more than doubled from 907 to more than 2,000 between 2010 and 2014.

OBESITY, DIABETES DRIVING CANCER RATES UP

Besides typical risk factors such as age and family history, doctors told TODAY the higher incidence of ovarian and uterine cancers here could be partly due to rising obesity and diabetes rates.

Affecting about 11 per cent of Singapore adults, obesity is responsible for an estimated half a million cancers a year worldwide, according to a study published in The Lancet Oncology in 2014. It also suggested that cancers are more problematic for women than men due to obesity-related cancers driven by the female hormone oestrogen.

Excess fat tissue increases the production of oestrogen, which can stimulate certain cancers in women including ovarian and uterine cancers, said Dr Wong Seng Weng, medical director at The Cancer Centre, a subsidiary of Singapore Medical Group.

At the same time, excess body weight also drives the production of insulin, a hormone that controls blood sugar levels. When in excess, insulin promotes the growth of cells in the body, including cancerous ones, said Dr Wong. Higher animal-fat content in diets and smoking have also been found to be linked to a higher cancer risk, he added.

Another notable risk factor for these gynaecological cancers are women having fewer or no children, or having children at a later age.

“Childbirth is associated with a lower risk of ovarian and uterine cancer. With the decline in fertility rate in Singapore over the years, I suspect that it has bumped up these cancer rates,” said Dr Wong.

THE MOST PREVENTABLE GYNAECOLOGICAL CANCER

But not all gynaecological cancers are on the uptrend. Cervical cancer rates have been on a steady decline, falling from fifth to the 10th most common women’s cancer in the past decade.

Dr Timothy Lim, chairman of Singa­pore Cancer Society’s Women’s Gynaecological Cancer Awareness Campaign 2016, said this is likely due to an increased awareness of screening for the disease via Pap smear as well as the recent availability of a test to screen for the human papilloma­virus (HPV), improving the accuracy of cervical cancer screening. High-risk HPV types are the cause for 99 per cent of all cervical cancers.

The society’s latest campaign aims to raise awareness of gynaecological cancers. It encourages girls and young women between the ages of nine and 26 to get a HPV vaccination, as well as a Pap smear screening at least once every three years once they cross the age of 25.

About 45 abnormal results, some suggesting cervical cancer, were picked up from the 1,337 free Pap smear screenings that the Singapore Cancer Society provided at its Multi-Service Centre from January to April this year.

“Cervical cancer remains the most preventable among the three gynaecological cancers,” said Dr Lim, who is also head of the Department of Gynaecological Oncology at KK Women’s and Children’s Hospital.

“Furthermore, the HPV vaccine might also lead to a further decline of cervical cancer in the future, but it would require a good uptake of the vaccine among the young to achieve herd immunity.”

According to him, the availability of a standard screening test for cervical cancer means that the disease is typically detected in the early stages, when survival rates are better. ­Between 2010 and 2014, more than two-thirds of cervical cancer cases were diagnosed at Stage 1 and 2.

OVARIAN CANCER THE DEADLIEST

By contrast, ovarian cancer is the most difficult to detect or cure among the trio of gynaecological cancers as it rarely has early symptoms, said Dr Lim. With no proven effective screening methods for ovarian and uterine cancers available for the general population at the moment, most patients discover the disease only when symptoms show.

A significant proportion of ovarian cases in Singapore is of a type — known as clear cell carcinoma — that tends to be resistant to chemotherapy.

They make up about 15 per cent of ovarian cases here, compared to the 5 to 10 per cent of cases in Western populations, said Dr Elaine Lim, senior consultant medical oncologist at the National Cancer Centre Singapore. The centre is conducting ­research to better understand the cancer and is looking for more ­effective treatments through clinical trials.

While there is no proven method to completely prevent ovarian or uterine cancer, measures such as taking oral contraceptive pills, having more children early and breast feeding, as well as maintaining a healthy weight through a low-fat diet and exercise, may help to lower risks, said Dr Lim.

Six months after completing chemo­therapy treatment, Mdm Loh successfully conceived and delivered her second child — a baby girl — two months ago. She is in remission, but she continues to go for follow-up checkups.

“I consider my little girl a miracle baby. When I was first diagnosed, I thought I could no longer have more children and felt sorry my son could not have any siblings. But I’m so blessed my doctor was able to help me ­retain my fertility and I was able to grow a healthy baby in my womb,” she said.

Mdm Loh advised women to be vigilant about their health, and said a strong and positive mindset helps when navigating the cancer journey.

“I now truly appreciate my life, as well as my family and friends, after the hardship,” she said.

 

Singapore Cancer Society Women’s Gynaecological Cancer Awareness Campaign

From now till July 31, the Singapore Cancer Society is joining hands with 160 general practitioner clinics across the island to provide free Pap smear screening for cervical cancer. It is available to all female Singaporeans and Permanent Residents aged between 25 and 69 who have ever had sex and have not had a Pap smear in the last three years. Free Pap smears are also available year-round at the society’s Multi-Service Centre in Bishan. For more information, visit www.singaporecancersociety.org.sg.

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