Cervical cancer is second only to breast cancer as the most common cancer found in Thai women. However, for Thai women aged between 30 and 60, cervical cancer is actually the most fatal form of cancer. According to the latest findings released by the World Health Organization’s International Agency for Research on Cancer (GLOBOCAN 2008), there are approximately 10,000 new cervical cancer cases annually. Locally, 5,200 Thai women die of cervical cancer per annum (14 individuals a day), despite the fact that cervical cancer can be prevented.
A research conducted in 1980 found that cervical cancer is caused by the Human Papillomavirus (HPV), the different types of HPV are given numbers and the most common types are 16 and 18, together accounting for 70% of all cervical cancer. The different types of HPV can be grouped into families according to their characteristics, and all HPV families are categorized into two groups: those with a high-risk of leading to cervical cancer and those with a low risk. Most cases of genital infections of HVP occur as a result of sexual intercourse with a partner who is infected with HPV. In most cases, HPV is asymptomatic in both men and women.
• Having many sexual partners
• Starting to have sexual relations at a young age
• Being pregnant or having many children
• Having a history of venereal disease
• Taking contraceptive pill for a long time
• Failure to be screened for cervical cancer
• Having husband with penile cancer
• Having husband whose previous wife had cervical cancer
• Having male sexual partner with a history of venereal disease
• Having male sexual partner who started to have sexual relations at young age
• Having male sexual partner who has had many sexual partners
• Weak immune system
• Low social and economic status
• Lack of certain nutrients
For women who are already sexually active, cervical cancer can be prevented by taking an annual screening for cervical cancer, starting from the age of 25 years old. Ways to prevent cervical cancer from developing include avoiding or reducing the risk factors by, for example, abstaining from sexual relations, being faithful to only one sexual partner, using condoms for birth control, and receiving HPV vaccination to strengthen the immune system against HPV.
Widely accepted and commonly used by gynecologist, cervical screening is a method of finding abnormalities in the cervix before developing into cervical cancer inits early stages. There are two types of cervical screenings for cervical cancer.
• Cervical cytology,or a Pap smear,is a method used to examine the cells of the cervix for abnormalities caused by HPV infection. After identifying any occurrence of abnormality in its early stages, it can be treated before developing into cervical cancer.
• HPV DNA testing is a method used to look for pathogens in the cervix or the wall of vagina.
In the past, cervical cytology has been found to effectively reduce the occurrence of cervical cancer when it is widely performed on a large number of citizens in a society, such as in developed countries. Therefore, cervical cytology is a globally-recognized screening method.
Although specimens of liquid-based cytology (LBC) collected by gynecologists are found to be more effective, this method has many limitations. Most importantly, many women are afraid to have such a test because they are embarrassed, are afraid of the pain, or do not have enough time. In some cases, a screening is performed on young girls or teenagers before they are vaccinated against HPV but this become difficult due to the reason above. Therefore, a possible alternative screening method of looking for HPV is a Urine Test for HPV.
The new innovation in finding HPV virus from urine samples is a concerted attempt by three organization – The National Cancer Institute, The Center of Excellence of Clinical Virology under the Faculty of Medicine of Chulalongkorn University, and Samitivej Hospital – to establish a method of identifying the presence of HPV from urine samples. This research project aims to develop alternatives to the traditional techniques, which is taking samples from urine instead of cervix to look for HPV. More importantly, this is the very first attempt of the Thai medical professionals that will lead to a reduction of cervical cancer.
The first step is to collect approximately 15-30 milliliters of urine in a sterile container (sample taken from the beginning of each urination are the best). The sample then needs to be taken to a lab for testing. The lab testing takes four hours and the result is ready after three days.
In case the result is positive and HPV is found, gynecologist will perform a Pap smear to find out any abnormal cytology of cervix.
In case the result is negative, then the patient does not have HPV. However, all patients are recommended to have a test on a yearly basis.
• Offers an alternative pre-screening program for women who are afraid of undergoing a pelvic examination to collect specimens
• Makes specimen collection easy – women can perform by themselves
• Reduces the number of cervical cancer cases because more women can receive a standard screening
Urine test for HPV cannot replace Pap smears. However, they can help women who are afraid of pain or embarrassed, or who refuse a pelvic examination. This is, therefore, a viable alternative method of solving such problems. It can help to increase the number of women who have a cervical screening, and consequently, reduce the number of cases of cervical cancer. However, for those who already have cervical screening annually in the form of a Pap smear test conducted by a gynecologist, the urine test for HPV is not necessary because you are already receiving the best and most accurate test.
Diploma of Thai Board of Anatomical Pathology