Cervical cancer rates drop after Pap smear scheme

Fewer cases during first 4 years of national screening; fewer deaths too

By Poon Chian Hui, The Straits Times, 8 Mar 2013

CERVICAL cancer rates have tumbled after a national Pap smear screening programme came into play in 2004.

Not only did far fewer women contract the disease during its first four years, but the number of deaths also dropped sharply.

However, take-up rates waned as the programme went on, with fewer patients going for the tests.

Pap smears detect traces of cancer, and early treatment can prevent full-blown cervical cancer, the ninth most common form of the disease among Singapore women.

The test has been available here since 1964, but conducted mostly on an ad hoc basis. Then in 2004, CervicalScreen Singapore, the national cervical cancer screening programme, was launched by the Health Promotion Board (HPB).

Letters were sent to invite women aged 25 to 69 who had been sexually active before to get screened every three years.

Between 2004 and 2008, the number of new cases fell by 8 per cent annually - double the rate of decline in previous years. And 8.2 per cent fewer women died of the disease every year during the same period. The figures were revealed in an HPB study published in the latest edition of the Singapore Medical Journal.

Doctors described them as "encouraging".

Singapore General Hospital head of obstetrics and gynaecology Tan Hak Koon said: "The programme has been quite effective in reducing the numbers and should be continued. But just like any other screening programmes, there are loopholes to fix."

One is the poor turnout by women returning for another check within three years. Only 10 per cent did so, the study found. Gynaecologist Christopher Ng, who runs a private practice at Camden Medical Centre, said women who came for the first time and received the all-clear may not be motivated to return.

Participation rates declined as the scheme progressed, with the number of first-time screenings falling from 18,434 in 2004 to 11,624 in 2008. But doctors said the drop could also be due to patients heading to private clinics.

The procedure costs about $40 but subsidies are available at polyclinics and public hospitals. The Singapore Cancer Society offers it for free to Singapore residents.

Raffles Cancer Centre medical oncologist Lynette Ngo pointed out that the latest study has limitations. The improvements could be due to advances in treatment and patients becoming more educated, she said.

With cervical cancer vaccines approved here since 2006, some may also think that they no longer require screening afterwards.

But the jabs protect women from just two strains of the human papillomavirus, which causes 70 per cent of all cervical cancers, said Associate Professor Tan.

Regular Pap smears are still needed to rule out cancer caused by the remaining 30 per cent.

Better education is required to tackle the shortfalls, doctors believe. "Women have to feel that going for a Pap smear is more important than renewing (cellphone) contracts after two to three years when they expire," said Dr Ng.

Dr Ngo said stricter reminder systems might help to improve follow-up rates.

Measures to encourage more women to get screened are expected at the ongoing Budget debate.