Hussin, Mohd Ariff and Ismail, Aziz asSafi and Othman, Shukri
(2004)
Epidemiology of cervical cancer
in Kelantan.
Epidemiology of cervical cancer in Kelantan.
(Submitted)
Abstract
Cancer of the cervix is one of the most serious illnesses affecting women today -
particularly in developing countries. It is the fifth common cancer worldwide and is
second only to breast cancer as the leading cause of deaths in women. Half a million
cases are diagnosed annually with the highest rates occurring in developing countries
(Crook T and Farthing A.,l993). In the South as well as in Central America; sub-Saharan
Africa; south and as well a south-east Asia; it is the most or second most common cancer
among women (Walboomers J1vnvf et a/.,1999). In Malaysia, a figure of 2191 new cases
of cancer of the cervix was reported in 1993 (Ministry of Health, 2002). The most
common ~ancer in women was breast cancers, cervical cancers, colon, ovarian, and
leukemia's. However, the actual number of cases could be expected to be more in view
of the fact that notification of cases is notoriously inaccurate in the Malaysian context.
The vast majority of cervical cancer cases are caused by infection with certain subtypes
of human papilloma virus (HPV), a sexually transmitted virus that infects cells and may
result in precancerous lesions ~and invasive cancer (Walboomers JMM et a!., 1999).
Developing countries accounted for 370 000 out of the total 466 000 cases of cervical
cancer estimated to occur in the world in the year 2000 (Ferley J. et a/.,2000).
Worldwide, cervical cancer claims the lives of 231 000 women annually, over 80 % of
whom lived in developing countries.
Key risk factors to the cancer of the cervix in some countries have been investigated
extensively. Potentially strong cofactors have been identified as smoking, oral
contraceptive use, parity and interaction with other sexually transmitted viruses (Larsen
NS, 1994). Sexual practices (e.g. age at first coitus, number of sexual partners) (Brinton
LA et al., 1987) and male factors ( eg circumcision, occupation ) have been incriminated
too in increasing the risk of developing cancer of the cervix.Cancer of the cervix is found mainly to occur in older women, especially those between
40 and 50 years of age. There is, however, a new trend evolving whereby younger
women are found to be developing the disease (Azhar MT.,l994) This may be due to
changing sexual norms and physico-psychological developments (e.g. earlier age at
menarche, widespread availability of contraceptives, sexual liberation etc).
Cancer of the cervix is the one type of cancer for which a lmown and effective preventive
strategy exists. The natural history of the disease, with its precursor state or 'dysplasia'
and in-situ changes, as well as the anatomic availability and easy access of the cervix for
repeated examination, are call circumstances particularly suited to a screening
programme (CMA Journal, 1976). Added to this is the fact that many of the risk factors
for cancer of the cervix is related to sexual practice, an intimate and highly confidential
aspect of a person's life, as well as her socioeconomic status. These two aspects of life
are known to be difficult to penetrate, perpetrate and modify, hence health promotion
strategies are not cost effective. Hence, early detection of disease via screening measures
is the logical solution.
The Papanicolaou (Pap) smear remains the most effective screening tool for this cancer.
It has been found to reduce the incidence of cancer of the cervix in many areas of the
world (Miller AB., 1992). The risk of developing cancer of the cervix is three times
higher in unscreened women as compared to those screened for the disease (Herrero R. et
al., 1992). However, problems abound with the use of the Pap smear, chiefly those
dealing with technical and interpretational aspects. Other methods of screening are also
being evaluated for suitability and cost effectiveness. These include cervico-graphy and
'down-staging' a WHO propagated method of screening.
In Malaysia at the present moment, there is no existing nationwide screening programme
for cancer of the cervix. Opportunistic screening and time to time campaigns are being
done on a relatively modest scale (with low yields) using the Pap smear screening method
done by the Ministry . of Health (Maternal and Child Health services), the NationalPopulation and Family Development Board as well as the private sector. As in the case
of many countries, there is under-utilization of available screening services and low
uptake of screening especially among those women at high risk.
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