January is recognised as Cervical Cancer Awareness Month, a time when conversations around prevention, screening and HPV vaccination are amplified. However, awareness should not be confined to a single month. Cervical cancer is almost entirely preventable, and efforts to educate, screen and vaccinate must remain just as strong throughout the year as they are in January.

Sustained, year-round commitment is essential to ensure that no woman is left behind in the fight against this largely preventable disease, which continues to pose a significant health concern in Malaysia. We sat down with Dr Kirshanti Purushothman, Consultant Obstetrician and Gynaecologist at Prince Court Medical Centre, to discuss the critical importance of early detection and the shifting landscape of prevention

With over seventeen years of experience across various Malaysian hospitals, Dr Kirshanti has seen the devastating impact of this disease firsthand. Her sense of urgency is supported by sobering data: while cervical cancer currently ranks as the sixth most common cancer among women in Malaysia, the rate of late-stage detection is climbing.

Recent figures reveal that 47.1% of cases were now diagnosed at stages 3 and 4 between 2017 and 2021, a significant rise from the 41% reported between 2012 and 2016. For Dr Kirshanti, these numbers represent more than just data; they are a call to action. Dr Kirshanti’s message is clear: we must prioritise prevention and screening to ensure that no woman must undergo invasive treatment for a disease that can be prevented.

The Silent Progression of a Preventable Disease

Cervical cancer does not appear suddenly. It typically develops over decades, providing a wide window for medical intervention. Dr Kirshanti explains that the disease often progresses from abnormal cell changes that, if left untreated, it eventually become cancerous. This slow progression is exactly why clinical intervention is so effective; there are numerous opportunities to catch the disease before it becomes a life-threatening issue.

The challenge lies in the fact that early stages are often asymptomatic. Many patients only seek help when they experience abnormal bleeding, intermenstrual bleeding, or pain during intercourse, which can indicate a more advanced stage. This aspect is why Dr Kirshanti advocates for opportunistic screening. Whenever a patient visits for any concern, even for a simple urinary tract infection, she takes the opportunity to ask about their last cervical screening.

Catching these changes early is a game changer for the patient. Early detection allows for less invasive procedures, lower financial costs, and significantly higher cure rates. When diagnosed at an invasive stage, the journey becomes much more difficult, involving complex surgeries or intensive chemotherapy and radiotherapy that carry a much higher burden on the physical and mental health of the patient.

From Pap Smears to HPV DNA Testing

The traditional Pap smear has been the gold standard for years, focusing on detecting abnormal cell changes. However, the medical field is now shifting towards HPV DNA testing, which Dr Kirshanti describes as a major global advancement.

While a Pap smear looks for the damage already done to cells, the HPV DNA test identifies the root cause: the presence of high -risk human papillomavirus (HPV) strains. This allows doctors to catch potential issues even before cell changes occur. If the results are normal, the screening interval can even be extended to five years, compared to the three year cycle recommended for conventional Pap smears.

For those who find clinical examinations uncomfortable or are too busy to visit a hospital, the HPV DNA self-test kit is a significant breakthrough. These kits allow women to collect their own samples at home. While a clinical examination is still preferred for the best sample quality, these kits are an excellent alternative to ensure more women are screened.

Breaking the Stigma through Education

Despite the availability of life-saving tests, many women avoid screening due to fear of pain, embarrassment, or the potential results. Dr Kirshanti emphasises that the procedure is quick and straightforward, often involving just a simple scraping or wiping of cells. She believes that normalising conversations about sexual health within the family is the first step towards breaking these barriers.

This education must extend to the younger generation. The HPV vaccine is most effective when administered before sexual exposure, which is why the national programme targets 13-year-old girls. However, the responsibility does not rest solely on women.

Dr Kirshanti notes that while the focus is often on females, vaccinating boys is equally important to reduce the overall transmission of the virus in the community.

To address this, the National Cancer Society Malaysia (NCSM) is currently conducting the Leaving No One Behind 2.0 initiative. This year, in addition to free vaccinations for underserved communities, the programme is opening up a subsidised option where HPV vaccines can be purchased for as low as RM190. This initiative is available for both boys and girls aged 9 to 14 in partner clinics across Malaysia, ensuring that cost is not a barrier to protection.

The Human Touch in Modern Medicine

While technology like AI and advanced screening kits enhances the ability to diagnose and treat, the human element remains irreplaceable. When a diagnosis is made, especially in young women or during pregnancy, it is a deeply emotional experience that requires a multidisciplinary team and a compassionate touch. Dr Kirshanti recalls cases where women in their twenties were diagnosed during pregnancy, requiring complex care that balanced the health of the mother and the baby.

Dr Kirshanti urges everyone not to let a busy schedule or fear stand in the way of their health. Cervical cancer is a disease we can beat, provided we take the first steps towards screening an