Thailand’s concerned private and public sectors are accelerating their efforts to help women avoid cervical cancer, or at least avoid its worst consequences.
The moves include the introduction of HPV DNA Self-Sampling Test kits, an alternative screening tool that allows women to perform a HPV test by themselves - increasing access to an essential preventative tool, reducing women’s anxiety, and accelerating the elimination of the cancer nationwide.
According to the World Health Organization (WHO), health equity is determined by the conditions in which people are born, grow, live, work, play and age, and is achieved when everyone - regardless of those determinants - can attain their full potential for health and well-being. To eliminate cervical cancer, all countries must reach and maintain an incidence rate of less than four per 100 000 women.
As a partner to women in their health journey and committed to tackling inequities in women’s health, and in line with the International Women’s Day (IWD), marked on 8 March, Roche Diagnostics (Thailand) Limited, the leader in in-vitro diagnostics, organised a group interview on the topic of “Women’s Health in Thailand – What Can Be Done to Provide Better Care for Women to Achieve Elimination of Cervical Cancer”, held on 24 February 2023, at Chulabhorn Royal Academy.
The aim of the gathering was to raise awareness of the importance of HPV DNA screening for cervical cancer and encourage a correct understanding of cervical cancer, the worst consequences of which can be prevented by getting screened for HPV DNA, which is its main cause. Roche Diagnostics recognises the challenges women face across a region as diverse as Asia Pacific and aims to develop a deeper understanding of the factors that drive their ability to access timely diagnosis and treatment.
The event included a presentation on the HPV DNA Self-Sampling Test kit, an alternative HPV screening option that enables women to collect specimens by themselves. This can relieve various concerns such as fear of being put on a gynaecologic table and injury and embarrassment in front of medical personnel.
“Early detection and screening are very important to prevent and cure cervical cancer,” said Assist. Prof. Dr. Nuttavut Kantathavorn, Gynecologic Oncologist, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy. “Our goal is to make cervical cancer something that is rarely seen.”
“Early screening for cervical cancer in Thailand has been improving satisfactorily recently. This is, thanks to strong support from the government and related agencies that have launched related campaigns to raise awareness among the public.”
According to a survey conducted by Roche Diagnostics Asia Pacific, to better understand the perception of, and access to, healthcare for women in Asia Pacific including Thailand, as part of the ‘Freedom to be’ project, around 61% of women are ‘very knowledgeable’ and have deep understanding about cervical cancer. However, 39% of women don’t know about the cancer. The survey was made at the end of 2022 among 3,320 women from 8 countries in the Asia Pacific region. Of them, 320 were Thai women.
The survey also found that factors such as fear of pain, embarrassment, and worries about expense hinder women from cervical cancer screening. By the time the cancer is found, it is too late, and treatment options are few.
Assist. Prof. Dr. Nuttavut Kantathavorn further mentioned that: “Cervical cancer is the fifth most common cancer found in women of all ages, after breast cancer, colon cancer, liver cancer, and lung cancer. Over 9,000 new cases and 4,700 deaths caused by cervical cancer are reported each year. However, it is preventable if it is screened regularly and correctly.”
The cancer is caused by infection with HPV (Human Papillomavirus), of which there are 15 types. The high-risk strains (genotypes 16 and 18) have a disease progression period of around 10 years, from infection to cell changes, until it develops into cancer.
According to data from the National Cancer Institute (NCI), cervical cancer is curable in up to 80% of cases that are found in the early stage.
Currently, there are three types of early prevention of cervical cancer. They include: 1) HPV DNA screening which is 92% accurate and involves screening every five years if HPV is not found: 2) Pap smear test with 53% accuracy and requiring annual check-up, and; 3) vaccination for school children.
Screening now mostly takes the form of pap smears However the HPV DNA test technique or DNA test that can detect HPV with greater sensitivity and accuracy.
The cost of cervical cancer screening by HPV DNA testing is only slightly higher than that of the conventional pap smear technique and more efficient. However, due to the above-mentioned factors, the difficulty is getting women to come and get screened.
“The HPV DNA Test should increase the comfort of patients in relation to examination and enable timely planning of treatment,” explained Dr Nuttavut. “This is different from the pap smear test that detects cell abnormalities, so you must wait for abnormal cells to occur before they can be detected.”
“If HPV is not found, patients can plan a screening visit again in the next five years and there is no need to recheck every year. This is another advantage that is different from the pap smear test, the traditional cervical cancer screening test."
With the HPV DNA Self-Sampling test kit, the newest option, women can do the sampling themselves and get the results within 1-2 weeks. They simply do a self-sampling vaginal swab with a swab stick as per the instructions in a bathroom or other private area. Then they place the swab stick in the specimen box and send it to the laboratory for further analysis. The medical staff can advise how to collect samples carefully and accurately according to the instruction manual. However, in accordance with practice guidelines, diagnosis of infection must still be carried out by a healthcare professional in the laboratory or lab.
For the instruction of use, 1) Open the swab cover at the dotted line, just before use. 2) Take care now to touch anything with the tip of the swab. 3) Wash your hands thoroughly. 4) Remove the swab cap. 5) Take the swab shaft in your hand at the red mark. 6) Choose a comfortable position. 7) Insert the swab into your vagina by its tip until it reaches the red mark. 8) Rotate the swab in a clockwise and anti-clockwise motion for 10 to 30 seconds. 9) Remove the swab and place it in the tube. 10) When closing the tube, you should hear a “Click”. 11) Wash your hands thoroughly.
https://www.youtube.com/watch?v=Lm7AJw_X1qQ
However, do not take a vaginal sample during pregnancy or within 3 months after giving birth.
“However, this test kit is still not available in general pharmacies. It's a new option available at government and private hospitals where patients can opt for it according to their own needs and medical rights.”
“It is a positive step forward because it gives our patients a choice as to how they experience cervical screening, which can be a challenging and uncomfortable experience for many people. Such innovations, including establishment of a public inspection unit in community areas and health insurance rights, another mechanism increasing people's access to screening tests, helps overcome the difficulties.”
“All health-related agencies worldwide are stepping up their plans to eliminate cervical cancer and increase access to cervical cancer screening in response to the WHO’s goals with 90% of girls will be fully HPV vaccinated by age 15, 70% of women will be screened using a high-performance test by age 35, and again by age 45, and 90% of women identified with cervical disease will receive treatment.”
In Thailand, the National Health Security Office (NHSO) has launched a campaign to provide Thai women aged 30-60 years old nationwide free cervical cancer screening using an HPV DNA test. The collaborative campaign is organised by provincial public health offices and service networks.
“To sustainably save women from cervical cancer, cultivating knowledge among women and healthcare professionals, along with development of state-of-the-art analytical tools to provide high-quality diagnosis, treatment and prevention, are essential for taking care of women’s health properly and effectively,” amplified Dr Nattavut.
In conclusion, Dr Nuttavut recommended that all women should undergo periodic cervical cancer screening to check for changes to cervical cells before they turn cancerous. “Cervical cancer has a chance to be cured,” he said, “so long as it is caught and treated at an early stage.”
