Over 90% of Sec 1 girls receive HPV vaccine each year: MOH

In 2019, schools began offering the HPV vaccine to Secondary 1 female students as part of the school health vaccination programme. PHOTO: LIANHE ZAOBAO FILE

SINGAPORE - Over 90 per cent of the Secondary 1 female student cohort here has received the human papillomavirus (HPV) vaccine each year since 2019, said the Ministry of Health (MOH).

In 2019, schools began offering the HPV vaccine to them as part of the school health vaccination programme, to protect them against cervical cancer.

Dr Chia Yin Nin, a gynaecologist and gynae-oncologist at Gynaecology & Oncology Specialists in Gleneagles Hospital, said last Monday (May 9) that HPV can cause genital warts, anal and oropharyngeal cancer, and is also a major cause of cervical cancer.

HPV is sexually transmitted via bodily fluids, and although the main mode of transmission is penetrative sexual intercourse, it can also be transmitted via fondling or petting, and affects both males and female, she said.

"A lot of girls and boys are exposed to the virus in their late teens and early 20s when they start to date," said Dr Chia.

She explained that HPV infection usually comes without any signs or symptoms. In 80 per cent of cases, the virus will go away on its own.

However, if the virus remains in a person's body for 18 months or more, this sets the stage for pre-cancer cell changes to occur in the body - in the case of cervical cancer, in the cervix.

If the condition is detected during this time through an HPV test or a pap smear, the affected cells can be removed relatively simply, without affecting the patient's fertility, and with a 95 per cent cure rate, said Dr Chia.

"The moment we detect we will treat, and we can prevent cancer from happening to her in the future," said Dr Chia.

But if the condition is left untreated and progresses to cervical cancer, symptoms such as bleeding, discharge and abnormal menstruation can occur - even if a patient appears otherwise fit and healthy, she said.

At this point, more drastic methods such as major surgery or radiation treatment will be required, said Dr Chia, adding that this will affect the patient's fertility and may have other side effects such as premature menopause.

If the cancer has progressed too far, the only treatment available may be palliative.

"A lot of times, the patients have young children or a family, and it's really sad. I think it's a shame," she said, adding that cervical cancer is 100 per cent preventable through vaccination and treatment following early detection.

While Dr Chia felt the 90 per cent take-up rate among female students was good news, she said more needs to be done to raise public awareness about cervical cancer, HPV, and the importance of getting screened and vaccinated, especially in the face of common myths about the disease.

"Every day, women with cervical cancer who walk into my clinic are those in stable relationships... not promiscuous. And because they are in stable relationships, they think they're not at risk," she said, emphasising that even women in committed relationships are at risk of cervical cancer.

MOH said that between January 2018 and December 2021, more than 105,000 women aged 25 and above had undergone cervical cancer screening.

"All women who have ever had sexual intercourse are encouraged to undergo screening for cervical cancer from the age of 25," said the ministry.

Dr Chia said she hopes that in the future, the HPV vaccination programme will be extended not just to female students, but males as well.

This will help bring about herd immunity to HPV, and also protect them from anal and oropharyngeal cancer, she said.

In April 2019, MOH said that while HPV vaccination also protects against genital warts and other cancers, such as anal cancer, which are applicable to males, they are not at risk for cervical cancer.

"Genital warts are a much less serious problem compared to cervical cancer, and the incidence of anal cancer is much lower than cervical cancer in Singapore. HPV vaccination for males is therefore not part of the (Expert Committee on Immunisation's) current recommendations," it said at the time.

MOH added that it would review its policy when new developments and evidence emerge on the vaccine's clinical and cost effectiveness.

Dr Chia also hopes MediSave will be extended to cover the HPV vaccine Gardasil 9, which protects against more HPV subtypes than Cervarix.

The latter vaccine is the one currently offered to students, and provides protection against HPV types 16 and 18, which account for 70 per cent of all cervical cancers.

In August 2020, MOH had said that it had not included Gardasil 9 under the national immunisation schedules - meaning that MediSave could not be used for it - because, at the price proposed by its manufacturer, it was not cost-effective compared with alternative HPV vaccines.

It added that it would continue to engage the manufacturer to achieve a reasonable price so the vaccine could be included in the schedules.

The Straits Times has approached MOH for updates on the matter.

Dr Chia said: "All of us can be at risk, so it's important to protect ourselves when we're young, to get vaccinated before any sexual contact, and when you're older, you can still get vaccinated, but please go for your screening."

She added: "(Cervical cancer) is a cancer that can be totally prevented."

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