PREVALENCE OF CERVICAL CANCER

PREVALENCE OF CERVICAL CANCER: 15.

Dr Lam Pin Min asked the Minister for Health (a) what is the prevalence of cervical cancer in Singapore; (b) what is the current screening programme available and its take-up rate; and (c) whether there is a need for a national vaccination programme against such cancers.

The Minister for Health (Mr Khaw Boon Wan): Sir, our age-standardised incidence rate of cervical cancer has been dropping steadily, especially in the last decade. The latest available data for the period 2003 to 2007 reported a rate of 8.8 per 100,000 women per year. Ten years ago, it was 10.6 and 20 years ago, 15.1 per 100,000 women.

Survival of these patients has also improved over the years. The five-year age standardised relative survival rate was 65% for the 1998 to 2002 cohort of patients. It was less than 50% in the 1970s and 1980s. Our survival rates are comparable to that of other developed countries.

Cervical cancer is treatable, especially if detected early. Pap smear screening is the main prevention measure. We have a national cervical cancer screening programme for all married women to go for pap smears once every three years. Pap smear screening is easily available in general practitioner (GP) clinics, polyclinics and hospitals. We have recently also launched a specially customised bus that brings such service to the housing estates.

As a result, three in four women (74%) aged 25 to 69 years had

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undergone a pap smear test, with six in 10 (59%) within the past three years. I think the take-up rate is not bad but we will continue to promote it.

Vaccines against two strains of Human Papilloma Virus (HPV) are now available. They are effective against these strains, but there are other strains that can cause cervical cancer. So vaccination itself does not eliminate the need for regular pap smear screening.

Our Expert Committee on Immunisation has recommended that young girls should be vaccinated against HPV. However, it has not recommended compulsory vaccination.

Dr Lam Pin Min (Ang Mo Kio): I would like to thank the Minister for the reply. Whilst vaccination may not completely eliminate the cervical cancer incidence, we understand that the vaccine actually provides a 100% protection against the two commonest HPV that causes 70% of cervical cancer. If the vaccination can be extended to the national immunisation programme, then that will be a great boost in terms of the mortality rate and the incidence of cervical cancer. I understand that the cost of the vaccine is about $200 per dose and we require about three doses. This can be prohibiting to many low-income families and I wonder if some form of subsidy or even the use of Medisave can be considered for this vaccination programme.

Mr Khaw Boon Wan: Sir, I stand advised by our experts. Their recommendation is, yes, it is effective against the two main strains. But whether we should include it in the national immunisation programme, they have not given such a recommendation. But it is a topic that is ongoing partly because it is still a relatively new vaccine. Part of their consideration is: what is the long-term

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effect of such a new vaccine? For mass immunisation programmes, we have heavy responsibilities. It is easier for a voluntary programme, in which case the doctor would simply sit down with the parents, explain the pros and cons and it is a personal decision whether the parents want to proceed or not. Just like pneumococcal vaccination, the Expert Committee also took quite some time to deliberate, and quite rightly so. We should be careful when recommending any kind of compulsory immunisation at the national level.