MRCA Women’s Division Health Talk: Only One Test to Say I’m Ok

In line with its commitment to “Empower. Educate. Eliminate”, MRCA Women’s Division conducted a virtual health talk entitled “Only ONE Test To Say I’m Ok”.

eld on 6 February

H2021, the health talk featured distinguished speakers, Dr Evelyn Ho, Consultant Clinical Radiologist from ParkCity Medical Centre and Professor Dr Woo Yin Lin, Consultant Gynaecological Oncology from University Malaya Medical Centre. The session was held in conjunction with World Cancer Day.

CANCER SCREENING

In addressing cancer screening, Dr Evelyn said that people need t o be aware of the many invisible risks, the biggest of which is people’s tendency to overestimate danger and underestimate their ability to cope.

She stressed that this in turn paralyses people to either take no action at all or excessive action, which is harmful. She reminded the audience that with fake news spreading rapidly in today’s digital era, people have to be careful in digesting information.

Dr Evelyn explained that in order to stay healthy, there needs to be a proper understanding of public health. The concept of prevention in public health encompasses three levels: • LEVEL 1 The first level is predisease, which calls for the adoption of healthy choices, avoiding risk factors and taking vaccinations. • LEVEL 2 The second level is during the disease, which calls for the prevention and reduction of the severity of the disease through early detection. • LEVEL 3 The third level is postdisease, which is limiting long-term impairment whereby a patient can return to as normal a life as possible through counselling, rehabilitation, and pain relief, among others.

As much as people are afraid of cancer, Dr Evelyn stressed that the main cause of death in Malaysia is not cancer. In fact, heart disease is the highest cause of death among Malaysians, followed by pneumonia.

She shared that between 2012 and 2016, the top cancers among Malaysians included colorectal cancer, breast cancer, lung cancer, lymphoma and nasopharynx cancer. In explaining screening, Dr Evelyn said, “Screening is testing for the presence of a disease or a condition with risk markers.”

Dr Evelyn warned that although screening reveals high genetic risk or family history of a certain disease, it does not mean an individual will definitely suffer from the same disease as well. The predictive value of tests may be low, which means that it often cannot predict accurately.

In speaking about breast cancer, Dr Evelyn explained that the biggest risk of breast cancer is being female. The majority of women with breast cancer have no known risk factors. She said that a mammogram can save one’s life, even when a woman feels that nothing is wrong with her breasts.

She stressed that the earlier the cancer is detected, the easier it is to treat. However, she cautioned that not all changes in the breast are cancer, and that very early cancer cannot be felt or is situated deep in the breast, hence early detection is key.

She advised women aged 40 and above to consider doing regular mammograms every two years. She also cautions women to carry out regular self-examination and to consult a doctor if there are any irregularities.

ELIMINATING CERVICAL CANCER

On the topic of eliminating cervical cancer, Professor Dr Woo explained that there are currently tools to eliminate this form of cancer. She said that there is no effective screening for ovarian cancer today, and the way to look out for signs and symptoms is to be aware of changes in one’s own body, such as pain and bloating, among other symptoms. She explained that in the case of womb cancer, the main symptom is abnormal bleeding.

“The cervix is a very small portion and part of the uterus. When you screen for cancer of the cervix it does not screen for the risk of uterine or ovarian cancer,” said Professor Dr Woo.

She added that cervical cancer is one of the most common cancers among women globally. It can be eliminated through intensified vaccination against human papillomavirus (HPV), screening and treatment.

HPV, she stated, is a very common viral infection that is passed between people through

skin-to-skin contact and is not necessarily a sexually transmitted disease. She added that most people, both male and female, would have been exposed to HPV at some point in their lives. However, HPV can cause cancer in people with low immunity or when the immune system is down. The process of progression to become cancerous takes 10 to 15 years.

Testing for this type of cancer can be done through a pap smear where a sample of cells are taken from the cervix. However, this test is not 100% accurate and there is a possibility of sampling errors occurring. “Hence, regular pap smears should be done so that cells can be taken regularly from the cervix for examination, thus reducing error.” Currently, the World Health Organisation (WHO) advocates HPV testing to test the presence of high risk cancer-causing HPV.

In summarising the steps needed to be taken to prevent cervical cancer, Professor Dr Woo advised for girls below the age of 15 to be vaccinated against HPV. The next step, she said, is to ensure that every woman gets at least two HPV tests in their lifetime – twice or every five years maximum. This should then be followed up with appropriate medical care, if there are any irregularities found.

Professor Dr Woo stated that more than 450 million doses of HPV vaccine have been given worldwide, mainly to young girls. Currently, there are three types of vaccines in the market and these vaccines target different types of high-risk cancer-causing HPV.

She explained that in order for pap smears to be effective, a woman has to have at least 15 pap smears throughout her lifetime, as the test is imperfect. “If the test misses a problem at any one time, the next pap smear may pick up an abnormality.

“But the fact is, having an invasive test with a pelvic examination is associated with fear, embarrassment and inconvenience. Sometimes we think, I don’t need it, it won’t happen to me. Even if you are postmenopausal, you should have your screening tests as recommended” said Professor Dr Woo.

She explained that realising the inaccuracy of pap smears, WHO recommends women to undergo HPV testing which is more accurate. In HPV testing, screening is now done with a very simple swab, and only needs to be done twice in the lifetime of a woman. Professor Dr Woo explained that it is now possible for women to selftest using swab test kits after which the results are sent to their mobile phones. To a question from the floor, Professor Dr Woo explained that for HPV vaccines no boosters are required.