Articles on Women Matters:

The Silent Killer - Protecting Yourself Against Cervical Cancer

Many women in the region have misconceptions about cervical cancer, some even thinking that they may be too young to get the disease.

However the fact is , even girls as young as nine may be at risk of cervical cancer; some girls in their teens are already in the advanced stages of the disease. Moreover, in most cases, cervical cancer affects women in the prime of their lives, when their careers are in mid-track and they are caring for children or other members of the family. This causes an immense social, economic and emotional burden on the society.

What causes Cervical Cancer?
Every two minutes, a woman somewhere dies from cervical cancer. In Singapore alone, 200 women are detected with cervical cancer each year and nearly half die from the disease, making it the fifth most common cause of cancer deaths in Singaporean women. However, these deaths may very well have been prevented.

Cervical cancer develops at the cervix (the part of the womb that opens to the vagina) and gradually becomes more invasive if felt untreated. It is caused by persistent infection with human papillomavirus (HPV), an extremely common virus that spreads through sexual contact.

While HPV is transmitted through sexual contact, it does not necessarily require penetrative intercourse, and may simply spread from skin-to-skin contact of the genital area. For this reason, condoms do not offer full protection from this disease.

Amongst the 100 different strains of HPV, only 15 have been identified to be cancer-causing, the most common viruses being HPV 16, 18, 45 and 31. Most genital HPV infections just develop into warts that appear on or around the female and male genital organs. These size of these warts range from being barely visible to being several inches in width. Most of the time, these infections clear on their own without any treatment. However, when they don't, they may develop into abnormal cells.

Close to eight per cent of women with abnormal cells will develop early cancer, and one to two per cent will develop invasive cancer. These cellular changes usually take place over many years. In other words, these HPV infections may be deadly cervical cancer cases waiting to happen.

Screening for Cervical Cancer
However, there is no reason for things to come to such a pass. Since cervical cancer has a pre-malignant phase before it turns cancerous, it can definitely be prevented.

One of the best ways of prevention is to ensure that women go for regular screening. To this end, the Health Promotion Board (HPB) in Singapore has organised a cervical cancer screening programme in 2004 encouraging sexually active women aged between 25 and 65 to have a Pap smear once every three years. During this procedure, cells are collected for testing, and if abnormalities are detected, they are promptly treated to prevent them from turning cancerous.

Women in the high-risk bracket are strongly urged to go for regular screenings. These include women who:
- Had their first sexual experience at a young age.
- Sexually active women
- Have had many pregnancies.
- Smoke
- Use oral contraceptives over a long period.
- Have other sexually transmitted infections such as HIV and Herpes.

Preventing Cervical Cancer
While screening programmes are vital, they may not detect all pre-cancerous lesions. And they certainly will not prevent pre-cancerous cells from developing in the first place.

Hence, since the late 1990s, studies have been done to determine if a vaccine may be effective in preventing HPV virus. The results of this study are exciting given that HPV 16 and 18 together account for 70 per cent of all cervical cancers worldwide. Effectively, this could mean that the vaccine has the potential to prevent more than two-thirds of cervical cancer occurences.

In fcat, according to Professor Suzanne Garland, president of the Asia-Oceania Research Organization in Genital Infection and Neoplasia (AOGIN(, "The best time for vaccination is before girls reach puberty. Each country will make the decision about the age themselves.

For example, in Australia, it is indicated in females aged nine to 26, and for young boys (aged) nine to 15. In other countries, for example USA, (the vaccine is recommended for women) nine to 26 years of age."

Potential Problems
While vaccines are important advancement in the battle against cervical cancer, they are not foolproof. One of the main reasons is that vaccines do not protect against all HPV types. Furthermore, as studies are still ongoing, it is uncertain how long vaccines will last and if booster shots are necessary.

Indeed, without a marked effort to prevent cervical cancer, it is estimated that there will be more than one million cervical cancer cases each year by 2050. So protect yourself and the women you love against this silent killer.

Annie Tan
Singapore
20 Apr 2007

This article is an abstract from the magazine Ezyhealth & Beauty, issue Nov 2006. Singapore's prime health and beauty magazine.

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Excessive Menstrual Bleeding

Menorraghia is genrally defined as a condition in which there is excessive blood loss during menstruation or a very heavy period. Menorraghia is quite prevalent amongst women, with some studies putting the incidence rate as high as one out of every five women.

Menorraghia has many causes. Usually, heavy periods are due to hormonal imbalances, which can be either temporary or due to age-related diseases. The most common cause is the dysfunctional uterine bleeding which is simply heavy bleeding that cannot be explained. But there are other reasons for menorraghia, such as:

1) pelvic inflammatory disease
2) uterine fibroids
3) tumours, polyps or infections in the pelvic cavity
4) bleeding disorders
5) liver, kidney or thyroid disease

Diagnosis
Heavey period can be defined as the passing of more than 80ml of blood during each period. However, since it is not practical to measure the actual blood loss, doctors will ask for a description of the period.

The symptoms of menorraghia may differ between individuals but generally they include having a period so heavy that it requires the sanitary product to be changed every hour. Generally, periods are considered heavy when the bleeding occurs for a period of between eight to 10 days. Also periods are heavy when the bleeding is so severe that the woman becomes anaemic or when there is so much bleeding that it prevents her from going about her normal routine.

A gynaecologist will first evaluate the patient's medical history and carry out a pelvic examination. For women who are above 40 years of age, a pelvic ultrasound scan or a biopsy of the lining of womb is usually done, so as to make sure that there are no abnormal cells. Menorraghia can only be diagnosed after other menstrual disorders or medical conditions have been ruled out such as cancer or uterine fibroids.

Other tests to diagnose menorraghia include:

1) the Pap smear
2) a hysteroscopy in which the canal of the cervix and interior of the uterus is checked by inserting a viewing instrument through the vagina.
3) a biopsy or dilation in which the cervical canal is widened and the uterine cavity is scraped.

Treatment
Treatment for menorraghia really depends on several factors such as one's age, the cause of the bleeding as well as tolerance for specific medications, amongst others. If doctors find no abnormalities, treatment is not entirely necessary although some women with menorraghia prefer to have their problems addressed in some way.

One way to treat heavy periods includes using contraceptive pills to regulate periods as part of a hormonal treatment. Non-hormonal medicines include tranexamic acid which can help reduced blood loss by up to half. For women who are anaemic (blood disorder caused by a deficiency of red blood cells or haemoglobin), iron or folic acid supplements will be recommended.

There are other more invasive methods to treat menorraghia. The doctor may suggest endometrial ablation surgery to destroy the lining of the womb with laser or using heat treatment on the lining with hot water in a balloon. Another way is to have a complete hysterectomy and remove the uterus altogether.

Edmund Wee
Singapore
20 Apr 2007

This article is an abstract from Ezyhealth & Beauty magazine, issue Nov 2006. Singapore's prime health and beauty magazine.

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