Contributed by Dr Nur Sadrina binti Haji Marsidi, Senior Medical Officer, Early Detection and Cancer Prevention Services, The Brunei Cancer Centre, Pantai Jerudong Specialist Centre
“You have cancer”. Hearing these words is terrifying. It does not matter if it is stage 1 or stage 4.
It does not matter if it is skin cancer or breast cancer. We never want it to happen even to our worst enemy.
Yet every day, about two Bruneians receive the diagnosis of cancer (more than 700 Bruneians receive the diagnosis of cancer annually).
The incidence (number of new cases) of cancer in Brunei Darussalam has shown an alarming trend.
Cancer is the nation’s top cause of death since 2009.
To control this trend, the government established Brunei Darussalam’s National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (BruMAP-NCD), including cancer, in 2013.
Additionally, the National Health Screening Programme launched in 2019 is a nationwide health screening programme to detect and prevent noncommunicable diseases such as colorectal cancer, breast cancer, cervical cancer, high blood pressure, diabetes mellitus and high cholesterol, to allow for early and effective management of these diseases.
FEARING THE SMEAR
The National Cervical Cancer Prevention and Control Programme was introduced earlier in November 2009 whereby married Bruneian women between the ages of 20 and 65 receive mail invitation to attend routine cervical cancer screening every three years.
The primary screening test used in Brunei Darussalam is Papanicolaou (Pap) test.
It is a procedure that gathers cells from the cervix, a narrow “neck” that joins the uterus to the top of the vagina, which are then sent to the lab for analysis.
Data states that the coverage rate of cervical cancer screening in Brunei Darussalam is only 44 per cent despite Pap smears being offered free of charge.
In 2019, a study by Universiti Brunei Darussalam and Ministry of Health was conducted at one of Brunei-Muara’s health centres to explore the reasons behind non-attendance of Pap smears.
Of the 174 women who enrolled into the study, the top three reasons of not attending Pap smear screening were: feeling embarrassed being examined by a doctor or nurse, feeling scared of pain because of previous bad experience, and feeling scared of getting a bad result.
CERVICAL CANCER IS PREVENTABLE
There are many risk factors associated with cervical cancer.
However, the main one is infection with Human Papilloma Virus (HPV), a common virus that is passed from one person to another during sex.
Around 90 per cent of HPV infections clear within two years. For some women, their immune system will not be able to get rid of HPV and this is called a persistent infection.
A persistent HPV infection causes the cells of the cervix to change, which can slowly develop into cervical cancer.
Cervical cancer can be prevented through HPV vaccination. The vaccination is most effective when given to pre-adolescents prior to exposure of HPV (before sexual debut).
The National School-based HPV Vaccination programme implemented since 2012 aims to vaccinate all female students of ages 10–17, from both government and private schools nationwide.
Through the school-based vaccination programme, the coverage of HPV vaccination is high at 91.9 per cent in 2015. HPV vaccination has proven to reduce the incidence of HPV-related cervical cancer in many countries.
Although necessary, HPV infection alone is not sufficient to promote cervical cancer.
There are other risk factors like smoking and passive smoking that can affect the risk of HPV infections progressing to cervical cancer.
FEW MINUTES THAT SAVE LIVES
Get your Pap test done. For the few minutes of discomfort, it is worth it. It can detect early or precancerous changes in the cervix.
These changes usually do not have any symptoms.
A Pap test is available to women in Brunei Darussalam who are between 20 to 65 years of age and is recommended to be performed every three years.
It is available in healthcare facilities including at the Early Detection and Cancer Prevention Services at PJSC, government and private outpatient clinics as well as Well-Women Clinics.
You may also be eligible for other cancer screenings under the National Health Screening Programme like colorectal and breast cancer screening.
LISTEN TO YOUR BODY
We know that “health is wealth” and without it, things that matter to us can be difficult, for example, being able to help our loved ones. However, adopting the mindset of making ourselves a priority can be a bit of a shift, especially if you tend to put your own needs aside.
If you feel something is not right with your body, get it checked. Do the safest, smartest thing for yourself. Most cervical cancer is slow growing, but not all types. Once it gets past the cervix and into other organs, chances for successful treatment start to drop. This is true for most types of cancer if detected late.
When cervical cancer has spread, it can start showing symptoms like bleeding after intercourse, spotting in between menses or menses that is heavier or longer than usual.
Other symptoms include unusual discharge from the vagina, pain in the pelvic area or back, or pain during intercourse.
World Cancer Day, which is commemorated around the globe every February 4 each year, is a reminder to each and every one of us to acknowledge one of our greatest medical and health challenges, that is cancer.
Through the Union for International Cancer Control (UICC), this global movement has set a three yearly theme in tackling cancer. This year 2022 is the start of a new campaign theme: Close the Care Gap.
The first year of the ‘Close the Care Gap’ campaign is all about understanding and recognising the inequities in cancer care around the globe.
To overcome some of these inequities, we must understand the perspectives of the people living with cancer and let those experiences guide our actions.
By shedding light on patients’ and caregivers’ stories of hope, courage, positivity, determination, difficulties, harsh realities, death and dying – we hope that this will serve as a constant reminder that cancer is still our nation’s top cause of mortality.
And there is still a lot more for us to do, especially in terms of early detection, screening, and prevention of cancer as well as providing support, including social and educational, for cancer patients and their families.
Let us work together as a nation to bring down the cancer incidence, staging and burden in