This interview was published in www.oncofocus.com on 23rd January 2020.
For our second Cervical cancer interview, we discussed with Dr. Lim Chun Sen, a leading Malaysian Oncologist, his experience in treating Cervical cancer patients, challenges with diagnosis, and key future trends in Cervical cancer screening and management.
Dr. Lim Chun Sen is a Clinical Oncologist since 2014 and is presently managing the department of Oncology in Hospital Sultan Ismail, Malaysia.
One of the challenges behind the timely diagnosis of Cervical cancer is that NOT many people come forward for the PAP smear test even after our educational and promotional efforts. There is discomfort among women to come out and get checked due to social norms.
What is Cervical cancer ranking in Malaysia?
Dr. Lim: According to the cancer registry of 2012-2016, Cervical cancer is one of the top three female cancers in Malaysia, the first being breast cancer followed by bowel (colon) cancer. The age-standardized rate is reported to be 6.2 per 100,000 population.
What are the typical signs and symptoms that can lead to the early diagnosis of Cervical cancer?
Dr. Lim: Most of the patients in Malaysia report abnormal PV (per vagina) bleeding. There could be lower abdominal pain or symptomatic anemia. But most of them are quite healthy. The early-stage Cervical cancer patients will not exhibit any symptoms.
Who are at risk of developing Cervical cancer?
Dr. Lim: The women who are exposed to early intercourse or have multiple partners are at a higher risk of developing Cervical cancer. However, in Malaysia, we seldom see women having multiple partners. Thus, most of the Cervical cancer patients we see are the ones who got married at a very young age. Regarding ethnicity, we observe a higher incidence among the Chinese population followed by Indians and Malay.
What are the barriers regarding the timely diagnosis of Cervical cancer in Malaysia? How can we further improve the diagnosis of Cervical cancer?
Dr. Lim: One of the challenges behind the timely diagnosis of Cervical cancer is that NOT many people come forward for the PAP smear test even after our educational and promotional efforts. There is discomfort among women to come out and get checked due to social norms. The common reasoning behind not going for a regular check-up is that when I am not going to deliver any baby or when I am abstinent, then I am not at risk of Cervical cancer. As a result, we diagnose Cervical cancer mostly at an advanced stage than at an early stage.
We must try and educate our young girls from high school or at the university level. To get over coyness, women must be provided premarital counseling, and expecting mothers should be educated that they should consult a doctor when they start witnessing changes in their bodies.
The one area where we need to focus is on the number of cancer centers. Currently, we have only five centers - two in Klang valley, one in Johar Bahru, one in Sarawak Kuching, and one in Sabah Kota Kinabalu.
Is there any government-mandated Cervical cancer screening program in Malaysia?
Dr. Lim: The government provides a free screening program, but it is not mandatory. During the Cervical cancer Awareness month or World Cancer month, we promote the PAP smear test for the early detection of cancer. Unfortunately, we get very less response as what I have observed is that women are shy to come out and get themselves tested.
Does the Malaysian government provide any financial assistance for Cervical cancer treatment?
Dr. Lim: Yes, definitely. I mean, they might not provide you financial aid, but, comparatively, all the treatment in government hospitals is cheaper when compared to the treatment in private hospitals. For example, radiotherapy in public hospitals would cost less than MYR 1,000, whereas, in the private sector, it costs roughly around MYR 40,000 to 50,000.
The one area where we need to focus is the number of cancer centers. Currently, we have only five centers - two in Klang valley, one in Johar Bahru, one in Sarawak Kuching, and one in Sabah Kota Kinabalu.
To overcome the problem of distance and facilities, the Malaysian government buys services from private hospitals. So, the patient that needs radiotherapy will be sent to the private hospital, and the patient needs to pay fees as per the government hospital, while the Malaysian government will bear the extra cost.
What interesting trends do you foresee with respect to Cervical cancer diagnosis and treatment?
Dr. Lim: One interesting trend in terms of Cervical cancer we see is that the Malaysian government is offering free HPV vaccination to all young girls at the age of 13. Hopefully, with this free vaccination, we can reduce the Cervical cancer rate. But even with the free vaccination, sexually active people still have to go for the PAP smear test. Our concern is that people may have a false assumption that they would be free of disease if they are vaccinated.
In terms of treatment, we can offer a curative approach if we can diagnose Cervical cancer early. In the advanced stage, only palliative treatment can be offered, which is more costly.
It was an insightful discussion. Thank you for your time and your valuable inputs. I am sure that this interview will help in increasing awareness!
Dr. Lim: Thank you!