Dr Hajah Roselina Dato Paduka Haji Yaakub MBChB, DRCOG, DFFP, MRCOG.
Specialist Obstetrician and Gynaecologist
RIPAS Hospital

Viruses are microscopic organisms that can live in the cells of our bodies and may cause disease. Symptoms vary depending on the type of virus.

Human Papillomavirus is the name for a family of viruses that affect your skin and the moist membranes which line your body, for example, in your cervix (neck of the womb), mouth and throat. There are over 100 types of HPV that affect different parts of the body.

The 40 types of HPV that affect your genital area are classed either as high risk and low risk. High risk types can cause cervical cancer and low risk types cause genital warts. Anyone who has ever had sex can have been in contact with HPV. Most people will have HPV at some time and never know it. The body’s immune system usually clears the virus in around one to two years.

Cell changes found by having a Pap smear test are nearly always caused by HPV, and usually return to normal when the body has cleared the virus. If the changes persist, they can be treated before they become more serious.

What are the high risk types of HPV?

The most common high risk types of HPV are HPV-16 and HPV-18 which cause over 70% of cervical cancer worldwide. In Southeast Asia, the most common HPV types associated with cervical cancer are HPV-16, HPV-18, HPV-45, HPV-52 and HPV-58.

Persistent infections with certain high risk types of HPV play a major role in the development of cancer of the cervix in at risk group of women. Women who have a weakened immune system such as HIV/AIDS or prolonged chronic illness such as renal failure or on prolonged steroid therapy or who smoke are at risk of having persistence of HPV infection.

If your immune system does not deal with a high risk HPV infection, it can lead to cell changes (dyskaryosis) and abnormal growth of precancerous cells in your cervix. This is also known as cervical intraepithelial neoplasia (CIN). Although CIN is not cancer, if left untreated, it can develop into cancer in some women. This cancerous change usually takes 10-20 years.

HPV-18 is also thought to cause around 50% of all adenocarcinomas, the other main type of cervical cancer. Adenocarcinoma develops from glandular cells which line the cervical canal (endocervix).

Approximately 95% of cervical cancers are squamous cell and the remaining 5% are adenocarcinomas.

Vaccination against some types of HPV

Vaccination can protect you against some types of HPV infection. Research has shown that HPV vaccination is most effective when given to females before they start to have sex.

Vaccination will prevent most of the more serious precancerous cell changes. However, the vaccines do not protect against all types of HPV. They only protect against HPV-16 and HPV-18 which cause 70% of cervical cancers. It is therefore not guaranteed that vaccination will prevent cervical cancer. You will still need to have the Pap smear test regularly.

Brunei Darussalam Cervical Cancer National Screening Policy

Brunei Darussalam National Screening Policy recommends women between the ages of 20 and 65 years to have Pap smear tests routinely every three years. Estimates from mathematical models indicate that regular three-yearly screening would achieve 91-96% of the benefit of yearly screening, while greatly reduce the cost, potential harms and inconvenience. Screening before the three-year-period may result in over-diagnosis of cervical lesions (which would have regressed spontaneously) leading to inappropriate intervention and resulting in more harm than good.

The age for starting cervical screening is 20 years, that is, for any woman who has been sexually active. Any woman who is sexually active is at risk of cervical cancer due to possible exposure to high risk types of HPV infection. The youngest recorded age of onset of sexual activity in Brunei Darussalam was 13 as shown by the youngest teenage pregnancy ever recorded in RIPAS Hospital while the youngest woman diagnosed with cervical cancer in Brunei Darussalam was 25 years of age.

Screening before the age of 20 years has not been proven to be cost-effective. In women 15-25 years of age, 80% of HPV infections are transient. Hence treating pre-cancerous diseases among these young women may cause unnecessary suffering and harm their reproductive health instead.

The age of stopping cervical screening is 65 years, provided that the woman has had three normal Pap smear tests in the previous 10 years. Mathematical modelling estimates that in women aged over 65 years with a history of regular screening and negative smears, continued screening is inefficient, produces diminishing yields and increases costs. Screening is, however, more cost-effective for women over the age of 65 years with a history of infrequent routine Pap smear testing.

All women who are sexually active and between the ages of 20 and 65 years are welcomed to have their routine three-yearly Pap smear test at their nearest Health Centre or Clinic. Please contact and make arrangements with your nearest Health Centre or Clinic during office-hours.

Cervical cancer is preventable if you have your pap smear test routinely every three years.

Your health is in your hands. Together we can move towards a healthy nation!

(Ministry of Health Public Awareness Programme)

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