The Evolution of Cervical Cancer Control Program in Malaysia: Trials and Tribulations

Abstract

Background and context: Cervical cancer remains a major burden to many countries worldwide particularly in underdeveloped and developing countries. It continues to have a huge impact on women not only physically but also socially and sexually. However, the good news, because of its slow progression and cytologic identifiable precursors and provided it is detected early and managed effectively, it is herald as one of the preventable and treatable forms of cancer. Despite the decades of awareness campaigns and progress in technology, the coverage and uptake remains low, more so among the younger and high risk women. Sadly too of those diagnosed, more than 76% were at stage II and above when intensive and invasive treatment will be required. Conventional Papanicolaou test is the only primary screening tool available since 1969 and it is considered the most successful cancer screening program to date. Nevertheless, cytology has its limitations especially technical limitations regarding sampling and laboratory errors in screening and interpretation. Noticing the laggardness of a single approach, Malaysia doubles up her strategy by introducing primary prevention using the HPV immunization to hasten reduction of cervical cancer. While Pap smear remain as a strategy, improving the quality of the laboratory services is paramount to ensure effective early detection of precancerous lesion. In 2015 the Ministry of Health introduced the liquid-based cytology in a phased implementation starting with Kelantan, Johor, Negeri Sembilan and Selangor gradually the whole country. Does HPV DNA testing be available soon to further enhance diagnosis? The topic has a fair share of several rounds of discussions. Aim: To share the latest challenge, gap, strategy and the way forward for the transformation of the cervical cancer prevention and control program comprehensively taking into consideration of HPV DNA test as a screening tool. Strategy/Tactics: The milestone of the Papanicolaou test program was analyzed to see the gap and the options of the improvement. The performances of Papanicolaou test services were analyzed through the annual data and report of Papanicolaou test services from all the states. Later, we also map the analysis with the latest incidence of cervical cancer in Malaysia to see the impact of the program. Program/Policy process: The planning process involved several discussions at ministry level, series of workshop to develop the important documents for the implementation, being collaborative partner in organizing HPV workshop and effective discussions with VCS, Australia. Outcomes: Mandate of the way forward of comprehensive strategy for cervical cancer control program being approved. What was learned: Malaysia is optimistic that cervical cancer reduction program remain a high-profile agenda in the country and therefore we are ready for the change to give a better impact of the program.