More accurate method of screening for cervical cancer

Now that our government has taken the initiative to provide free Cervical Cancer Vaccine to school children, i felt happy that the Ministry of Health recognize the need to take action against this number 2 killer among Malaysian women. I felt disappointed that doctors are not taking their time explaining the need, implication, protection rate ,screening method, and many more related to the vaccination and follow up on the screening as such.
Its rather unfortunate to know that most doctors in Malaysia in the private sector are still using the conventional "Pap smear" for screening for cervical carcinoma.
Have you heard of stories of patients who regularly goes for their annual pap smear and was told to be normal, but died after a few months? ......due to cervical cancer?
Do you know that false negative results (which means patient has cancer or pre cancerous lesion but was not detected by conventional pap smear) is between 10%-50%!













The above two pictures are the conventional Pap smear kit, where by using a spatula inserted into the vagina until the end of the wooden spatula touches the cervix, a rotatory movement to get samples from the surface of the cervix.
However, the high false negative result is due to missed or inadequate sample collection from the endocervix.(the deeper part of the cervix).
Thin prep pap smear is an improvised version of Pap Smear.
Thin prep pap smear was introduce back in 1996, and currently being widely used in the US where conventional Pap Smear is almost obsolete. In view of the faulty collection of samples and high percentage of misinterpretation of the result, Thin Prep was designed to solve the problem.

Unlike conventional Pap Smear, where the samples are fixed on a slide, the sample collected from Thin Prep are placed in a solution medium.
As Pap smear's result is purely based on human's ability to detect the abnormal cell, Thin Prep undergoes two process instead. First, they would be subjected to a Thin Prep imaging, where a computer will scan through the sample to look for presence of abnormal cells. Upon completion of the first step, then a review by experienced pathologist to confirm the finding.
As you can see, the designed of the collection brush for Thin Prep pap smear is designed differently (on the right) where the central longer bristles are made to reach the endocervix, while the peripheral outer shorter ones are for the ectocervix.
This enable Thin Prep sample collection to be far more efficient and a more complete sampling obtained.






Hence whenever you are going for your routine check up, be sure to ask for Thin Prep Pap smear instead. It is surprising to know not many general practitioner do not know about the availability of such improvised Pap smear.
In conclusion, insist on Thin Prep method to prevent the possibility of a false negative. It gives a more accurate for diagnosing intraepithelial lesions, higher degree of accuracy detecting high grade lesions in the genital tract, decreased number of misinterpretations of Pap results, improved sample collection noted with use of Thin Prep preparation, amd the same sample can be used to test for other problems and disease including HPV and sexually transmitted diseases without having need to collect another sample.

What do i think about Cervarix.

It a pity whenever a new revolutionary drug is made available, there is almost always a number of individuals who aren't from medical background started passing negative remarks about this drug based on what they've read from postings in the internet by another non medical background individual. They would come up with paranoid ideas that these drugs are part of the government conspiracy for population control, accusing these giant pharmaceutical companies for producing these useless and potentially harmful drug just for the sake of financial gains.
People.....use your God given grey matter!(brain)
1. Population control, Jezz.... isn't easier to pass out law like in China where one couple-one child policy?
2. Why would Government approve of them if they don't meet certain safety criteria and felt the need to have such a drug?
3. These companies spent hundred of million of dollars conducting test for years to establish a standard of efficacy and safety for the consumers.
4. Yes, 32 people died as reported after receiving the vaccine. that's 32 out of tens of millions of people.
Well, does that means road traffic fatalities which increases yearly, the government should ban the use of vehicles?
5. I stand by the new vaccine Cervarix, based upon the data of their medical case studies. What studies was conducted to prove otherwise?
6. Dr Quek, who is the world renowned consultant gynaecologist who specializes in pre cancer screening who is not affiliated to any of these pharmaceutical companies urges doctor to create awareness among the community about Cervarix and cancer screening. Do you seriously think he is part of the "Government Conspiracy" too?
7. What about Professor Peter Leslie. You can check his profile in the internet. Why would he even bother to come down to Malaysia to give talks and held seminars about these vaccines? Are these two mentioned intellectuals are part of the government conspiracy??/
8.Considering the fact that Cervical cancers is the number 2 killer among all cancers affecting women at their prime of their life. This vaccine marks a quantum leap in science and medicine, its important is unparallel to other medical milestones, like the discovery of Penicillin, Eradication of small pox. The only other discovery which its significance is in par with discovery of cancer vaccine is vaccine against HIV.
9. I am sure you would not be passing out bold remarks about how bad and harmful these vaccines are if someone you know, you friends, family members was diagnosed with cervical cancer.

One step closer in preventing premature death

What else would you think when i mention these words other than Cervical cancer Vaccination. Indeed man has come a long way in studying this deadly disease which previously one has no control of. Since 400BC, the father of modern medicine, a Greek Physician as well as a sophist, Hippocrates, had described in his writings about cervical cancer patient with impending death. Later German Gynaecologist who invented the colposcope to identify early precancerous lesion on the cervix. in 1925.
Dr Hans Hinselmann- inventor of the colposcopy machine to detect early precancerous lesion of cervical cancer.

The colposcope

Three years later a Greek Physician, Georgios Papanikolaou, a pioneer in cytology in early detection of cancer developed the Pap Smear.
In `1974, A German virologist, Dr, Harald zur Hausen was studying and did research on Carcinoma of Cervix,has found Human Pappilloma Virus DNA in cervical cancer cells, and for this great discovery, he attributed HPV virus as a major causative factor in the development of cervical cancer.
For his discovery, he received the Nobel Prize in Physiology in 2008.

Dr Harald zur Hausen
winner of the Nobel Prize in Physiology for his discovery in Human Papilloma virus as the causative agent.

In 2007, the first ever vaccine against Cervical cancer, Gardasil, which gives protection not only cancer but prevention of genital wards. However cost is a real factor on why it didn't get much response from the community.

GARDASIL
When it was initially introduced, naturally due to its cost (as being the first anti cancer drugs) It boast to be a tetravalent vaccine, since it covers serotype 18 and serotype 16, then the other 2 that contribute to genital warts.

GSK, a giant pharmaceutical company that produce Cervarix came into the market in the mid 2008.
Being bivalent vaccine that provides 100% protection against HPV16 and HPV 18, with some cross protection with serotype 31 and 45.
However, the latest data indicated that Cervarix give 100% protection against HPV 16,HPV18,HPV31, and HPV 45. So, my friends! Cervarix has become a tetravalent vaccine now.

Data has shown that due to the added ingredient ASO4, its like a turbocharger in production and sustaining high level of antibody for a long duration.. at least from calculated formula, it would last at least 20 years.
Based on the head to head studies, Cervarix has been proven to be far more superior than Gardasil.
So, what are you waiting for?

For those who had this injection, the next challenge is to get and encourage women to step forward for your annual pap smear. Again and again, I would emphasize, cervical cancer is currently ranked number 2 killer among all cancers affecting women. Science and medicine has come a long way, and with this vaccine,it has taken a quantum leap in its progress, and marks a milestone in the history of mankind by making it the first step in preventing cancer.

2nd Cervical Cancer prevention symposium

I received an invitation to attend another symposium on Cervarix, which is on 29 July held at Le Meridien Hotel. The presenter was  Professor Peter Leslie Stern, who is a Head of Cancer Research UK, Paterson Institute for Cancer Research, University of Manchester Based at the Christie Hospital.
He will speak on "Targeting a challenging virus." It should be an interesting talk judging from the Curriculum vitae.
I have prepared a list of questions which i m eager to ask.
The second speaker was Dr Goh Choo Beng, who graduated from the medical faculty of the National University of Singapore in 1994. He obtained his specialization training in Radiology Oncology at the Singapore General Hospital, and National Cancer Centre Singapore. His resume is impression and i can't type them all here.........I'll go straight to the point. He joined GSK in May 2007 as part of the Asia Pacific HPV vaccine Medical Affairs/Clinical R&D team and presently manages the medical affairs for the GSK adult and adolescent vaccine franchise in Asia Pacific.
As before, I think I'll skip the dinner and head for home just right after the Q & A sessions.
I hope I will enjoy this talk as much as did on the first one.

Cervical cancer vaccination

note: this post on revolutionary discovery and the product are not influenced by any means by the company that produces the product. The content of this post is based on the knowledge of the author and statistics are attained by Medical Publications.
This blog was initially intended for medical related topics. However, after a while, gradually the post became more personal. How would you classify my blog? Its up to you. Whether its personal, cosmetic, medical, poetry.
As a doctor, i feel the need to share with the masses about something totally revolutionary in the field of medicine. In the past, TB killed millions of people throughout Europe. People diagnosed with pulmonary tuberculosis is as good as dead as there wasn't any treatment or vaccination available.
Today with modern science and technology, we have fought back many of these diseases and had prevailed with the discovery of new drugs, early prophylactic vaccinations, social awareness.
Very often these killer diseases are preventable by means of healthy lifestyle. Unfortunately our gene dictates the probability of developing certain diseases despite leading our life the best we could. For years, there is a battle between Heart Disease and Cancer for the number one spot as a killer disease.
For women, breast cancer has been the number one killer for years, followed closely by cervical cancer. Today, technology and science has reduced the death mortality statistics drastically by the discovery of the first ever cancer vaccine. As for today, there are 2 major medical companies that produce this life saving vaccines. They are widely used throughout the globe. Before continuing, i would like to state some facts about cervical cancer.
Fact 1: Cervical cancer is the 2nd most common cancer affecting Malaysian women, after breast cancer.
Fact 2:In 2002, cervical cancer accounted for 12.9% of all female cancer in Malaysia.
Fact 3:Virtually every women is at risk of cervical cancer, regardless of their age or lifestyle.
Q: What is cervical cancer?
a: The cervix is the neck of the womb(uterus). It connects the body of the uterus to the vagina(birth canal) . Cancer occurs when the cells of the cervix become abnormal and grow out of control. The cancer can spread to other parts of the body.

Q: What is HPV(human papillomavirus)
a: Human papilloma virus(HPV) is a family of more than 100 viruses that is very common. Some types of HPV are associated with certain types of cancer. These are called "high-risk) cancer causing HPVs.
Q:What is the relation between HPV and Cervical Cancer?
a: Most HPV infections occur without any symptoms and will go away without any treatment over the course of a few months
Infection by the "high-risk" (cancer causing) HPV is necessary for the development of cervical cancer. These infections are asymptomatic and majority will resolve without any need for treatment.
However, in some cases, the infection can persist, leading to the risk of progression to cervical cancer. This process can take more than ten years.
Therefore it is important to be protected against the "high-risk" HPVs
Q:How is HPV transmitted?
a: HPV is a common virus that is transmitted through genital skin to skin contact so it can affect virtually any women, regardless of her ahe or lifestyle. Sexual intercourse is not necessary to become infected.
It is estimated that about four out of five sexually active women will have an HPV infection during their lifetime, even if they've only had one or two sexual partners.

Q: Will I still be at risk of HPV infection if I am already married?
a: The risk of HPV starts from the first sexual encounter and lasts throughout a women's life. It is estimated that up to 80% of women will acquire a genital HPV infection in their lifetime irrespective of their age or lifestyle.
Q: Do condoms reduce the risk of HPV infection?
a: Condoms reduce the risk but are not fully protective.
Throughout her life every women is at risk from the virus that causes cervical cancer.
Q: What is Pap Smear?
a: A Pap smear is a quick and simple test to find abnormal cells at the surface of the cervix. Usually cells are collected from the cervix and sent to a laboratory where they are tested for changes
A Pap smear kit set
Q: Can Cervical Cancer be prevented?
a: Until recently the only way to prevent cervical cancer was regular Pap smear testing to look for early signs of the disease.
Vaccination is now available to prevent HPV infection and cervical cancer.

Since the first introduction of HPV vaccine in Malaysia, less than 1% women has been vaccinated. This could either be due to cost and public awareness on importance and availability of vaccine.

Currently, there are two brands of Cervical Cancer Vaccination available, they are Gardasil, produced by Merck & Co., and Cervarix by GlaxoSmithKline.

As mentioned earlier, the choice of product in this post is not influenced by company that produce them. This post is not intended to be an advertisement, but rather an attempt to create public awareness and a better understanding regarding availability of these life saving vaccines towards the public.

Cervarix by Gsk. Ask your doctor today regarding Cervical Cancer Vaccination.
A complete vaccination has a similar timing as vaccination for Hepatitis B, which would be
1st dose : 0 month
2nd dose: 1 month later
3rd dose: 5 month after the 2nd dose.
However, what sets this particular brand apart from other vaccines is its flexibility. Studies shows that even the timing between 1st and 2nd dose is prolonged to 54 weeks, blood serology indicates a persistent high degree of immunity, hence it would be convenient for individuals who is pregnant and had received the 1st dose before conception. 2nd dose can be administered after delivery of baby. However there is no studies to establish safety during lactation.
The price for each dose has been reduced drastically, from 450RM-RM500 per dose to 200RM-250RM. The decision to reduce the price by the producers to encourage more women to get vaccinated by increasing its affordability. According to Department of statistics of Malaysia, a total of 7,500000(58%) women are exposed to the risk of cervical cancer.(age between 10-45 years)

To ensure your beneficent insist on checking the expire date of the vaccine.
Each box of vaccine comes with a pre filled syringe o.5ml of vaccine.
As an advice to women, get vaccinated before contributing to part of mortality statistics, as cervical cancer today has become a preventable disease.

Cervical Cancer Awareness- Please Read.

This would be my 4th post in the effort to create an awareness among the public on a revolutionary vaccine, Cervarix. I am a local Private practitioner who is always on a watchful eye for drugs that benefits the community, as a doctor's job is not only to treat and save life, but to create awareness among the public for new and available drug.
If my previous postings did not have enough impact on the public concerning the number 2 killer among cancers that inflicts women,this time i will try harder.I've contacted MAKNA and requested for cases of mortality and survivors of cervical cancer, hoping to get information on them, the things that they had to go through, the painful,psychologically and mentally traumatizing experiences while undergoing treatment, and how they cope with other burden, particularly in their finance.
I can imagine how they would wish Cervarix was available then.
REMEMBER
For a clearer picture , I'll present the statistics....hmm... statistics...these numbers was once individuals like you and me. Now they are just statistics.



Cervical cancer accounts for 12.9% of all cancers amongst women. Woman who were someone's mother, someone's wife,someone important and meant dearly to their love ones,
is now being represented in numbers in the form of statistics.

The silent killer that grows within you that presents it's first symptoms only at the advance stage.
Cervical cancer normally manifest itself after it infiltrates into the body and takes 10-20 years to develop,most at the prime of a woman's life.... 30-59. These cancer manifest mostly at middle age when woman are at their most productive years.
Stages of cervical cancer:
As you can see, from the time of exposure to a full bloomed cervical cancer may take as long as 10 years.
Hence, it is recommended that women who are in their 20s and sexually active to perform a pap smear test annually. There is nothing to be ashamed of, find a doctor whom you are comfortable with and know well,get it done annually. Though it is recommended that Cervarix to be injected before the first sexual encounter.

Celebrities who has succumbed to Cervical cancer includes:-
British reality TV star Jade Goody
And seven months later upon diagnosis.....

Bea Arthur of the Golden Girls

The Beautiful Sarah Fawcett of the original member of Charlie's Angel
And not forgetting ...the famous Anita Mui
These celebrities would have been alive if they had their annual pap smear and
wished that Cervical Cancer Vaccine would have been available to them.

In view of the noble intention of GSK to reduce the price to make it more financially accesibly,
I've decided to reduce my cost from RM 180 to RM165 per dose. So, ladies, please get vaccinated now.

Reduced price for Cervical Cancer Vaccination

The pharmaceutical company GSK made a noble decision by cutting the cost of their revolutionary product, the vaccine against Cervical Cancer, Cervarix. Its unlike any company that prioritize profits and gains. For this, I thank the management of GSK.
I had given a long thought about this, and i asked myself, I shouldn't raise the charge on the patient otherwise it beats the purpose for providing a protection against a deadly disease that is the number 2 killer of all cancers, Cervical cancer.
In support of GSK noble intention, i have lowered the price much further.
I am trying to convey the message to the masses that DO NOT EVER think Cervical cancer cannot happen to you. As long as you are a female, and sexually active, you should get yourself vaccinated in addition to your annual Pap Smear. 
I would like to explain a little bit more on Cervical Cancer.
Though i had posted 2 postings on importance of getting Cervical Cancer Vaccination.
First of all, never assume that cervical cancer would never happen to you. Get this, in 2003, 12.9% women died. In Asia Pacific, a woman dies of cervical cancer every 4 minutes.
My sincere advice is for you to get yourself vaccinated.Our price per dose is certainly a small price to pay compared to the financial,emotional, and psychological trauma that you had to endure while getting treated IF being diagnosed to have Cervical Cancer in future, and bear in mind that the carcinoma of cervix would be in advanced stage by the time they exhibit the first symptom.
Go to the nearest clinic and look for this sticker that say:-
Graph indicating cervical cancer at the 2nd leading killer amongst women cancer patient
It normally manifest itself while you are at the prime of your life.
Human Papilloma Virus(HPV) is the responsible virus that causes cervical dysplasias which would lead to Carcinoma in situ.

Its various stages of spread of the cancer. Lets have a closer look
Normal stage on examination over at the left picture. Right picture showing early stage 1B cervical cancer
If still left untreated....
Middle picture shows early stage 1B cervical cancer.Cervical cancer still limited to cervix. Left untreated, it will worsen to late stages of 1B where cervical cancer still limited to cervix.
Look at the picture at the far left, Stage 2B , Carcinoma Cervix.
So ladies or parents who are concern for themselves or their loves ones, please get vaccinated as soon as possible. I can't emphasize on the saying that prevention is better than cure!

Ladies, if you were to speak to cervical cancer survivor, they will definitely tell you, if there is such a vaccine available previously,they would have got themselves vaccinated without hesitation.