Health screenings crucial to early detection of breast and cervical cancer

As a medical student in her early 20s dedicated to advancing women's health, my observation is that awareness of health screenings, especially among younger women, remains low. In Malaysia, breast cancer is the most common among women, followed by colorectal, ovarian, and cervical cancers. Given the prevalence of breast and cervical cancers, regular and proactive screening is encouraged for early detection and better treatment outcomes. 

Below is essential information on screenings you can start in your early 20s to safeguard your health. 

Breast Cancer Screening

Breast cancer is the most frequently diagnosed among Malaysian women, with a lifetime risk of 1 in 20 - with the racial divide being Chinese and Indian women (1 in 16), followed by Malay women (1 in 28).

Breast cancer is one of the least preventable cancers worldwide. The common risk factors include long term use of oral contraceptive pills, early onset of menstruation, use of hormonal replacement therapy and late-age pregnancy. 

Women aged 20-39 should undergo a clinical breast examination (CBE) by trained healthcare professionals every 3 years. A CBE refers to a physical examination of the breast to check for any abnormalities or changes in the breast tissue. It is a painless procedure which looks for lumps, skin changes or nipple discharge.

For women aged 40 and above, it is recommended to undergo mammograms annually. Mammograms are X-ray images of your breasts, your breast would be gently compressed on a flat platform to take images, which are then analyzed by a radiologist.

For women with a family history of breast cancer, it is advisable to consider genetic testing for BRCA1 and BRCA2 mutations as women carrying the BRCA1 mutation have a 50-70% lifetime risk of developing breast cancer. 

The Malaysian government offers subsidized mammogram programmes to promote early detection of breast cancer. The National Population and Family Development Board (NPFDB) also provides mammogram subsidies for women aged 40 and above, focusing on those from lower socio-economic backgrounds. 

Cervical Cancer Screening

Cervical cancer is the 4th leading cancer among women worldwide and the 2nd most common among Malaysian women. The average number of hospital admissions for cervical cancer in Malaysia is 2,000 to 3,000 cases per year, with most cases detected at FIGO stage II or higher – indicating a late-stage diagnosis.

Alarmingly, up to 90.5% of Malaysian women do not adhere to regular Pap smear screenings.

The key risk factors for cervical cancer include Human Papillomavirus (HPV) infection as the primary cause, followed by smoking, long-term use of birth control pills, having multiple sexual partners and having a weakened immune system. 

All sexually active women aged 20 to 65 are recommended to undergo Pap smear screening. The first two tests are to be done annually. If both results are normal, the subsequent screening can be done every 3 years. A pap smear is a simple test done to detect changes in the cervix before they become cancerous. You would be asked to lie down with open legs. A trained healthcare professional would gently insert a small instrument into the vagina to reach the cervix. Using a tiny brush, they would scrape the walls of your cervix to obtain a few cells to be sent to the lab, looking for any abnormal cells that might be cancerous.

Women aged 30 to 65 may opt for HPV testing every 5 years. HPV is the main cause of cervical cancer and it could be done via 2 ways: HPV DNA Test and HPV Self-Sampling. 

For the HPV DNA test, it is similar to a Pap smear but instead of looking for abnormal cells, it looks for DNA of high-risk HPV strains that can cause cancer. If HPV is found, doctors can monitor more closely and take action before it causes serious problems.

For HPV Self-sampling, it allows women to collect the samples themselves using a self-sampling tool, which is then sent to a lab to check for HPV. You would receive a special swab or brush and be required to insert it a little way into the vagina, rotate it to collect a sample. Think of it like a COVID-19 test, where instead of a nasal swab, a vaginal swab is used to collect the sample.

Pap smear tests are offered free at public health clinics in Malaysia. The government has also initiated free HPV self-sampling tests in 2023 to encourage more women to get assessed.

Regular cervical cancer screening is vital to detect pre-cancerous changes and early-stage cancers, enabling timely treatment and reducing the risk of invasive cervical cancer. Early detection would significantly improve treatment outcomes and survival rates. 

Early health screenings are a cornerstone of effective healthcare for women in Malaysia. Addressing low awareness and participation rates in screenings is crucial for better health outcomes. By prioritizing regular breast and cervical cancer screenings, women can detect potential risks early and receive timely treatment – ultimately saving lives.