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The Ultimate Guide Getting a Pap Smear in Singapore (2021)

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Dr Michelle Chia

September 18th, 2019· 5 min read

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All women need to know what a Pap smear is — a simple and yet important procedure that could be life saving.

Cervical cancer is the 4th-most common cancer in women around the world [1]. In Singapore, it is estimated that 429 women are diagnosed and 208 women die from the disease each year. This is unfortunate, as cervical cancers are preventable and curable when detected early [2].

The Pap smear has been widely recognised as an effective way to detect early-stage cervical cancer. It is affordable and easily accessible in most countries, and crucial in detecting and thus preventing early-stage cervical cancers from developing into a more invasive stage [1].

I wrote this article to help you understand the importance of cervical cancer screening with Pap smears. Read on to find out more on the procedure, function, and costs of a Pap smear in Singapore!

Sneak peek: It can be Free!

What is a Pap smear?

pap-smear

A Pap smear, or Pap test, is a test that obtains and analyses cells from the cervix, also known as the neck of the womb.

A Pap smear is used in cervical cancer screening to detect:

  • Early cancerous cells
  • Pre-cancerous cells (changes in the cervical cells that may develop into cancer)

Other than that, a Pap smear may also detect:

  • Infection
  • Inflammation
  • Certain sexually transmitted diseases (trichomoniasis, etc.)

The early stages of cervical cancer often do not present any physical symptoms [3]. Thus, they are often left untreated, and the cancer is detected only after it reaches an invasive stage.

A Pap smear is important as early detection of cervical cancer significantly improves the chances of a full recovery. Research has shown that mortality rates of cervical cancer are much lower in countries that implement a solid Pap smear and human papillomavirus (HPV) screening programme [4].

Also read: You Can Prevent STIs And HIV; This Singaporean Doctor Explains How

What is the trend of cervical cancer in Singapore?

cervical-cancer-trend-singapore

Image source: Statistics Singapore

Data from the National Registry of Diseases Office (NRDO) shows that cervical cancer was the 10th-most common cancer in Singaporean women in 2015 [5]. In the 1970s, it was 4th.

The incidence rate has continued to decrease over the past few decades. This is most probably due to:

  • Better education and knowledge on cervical cancer screening
  • Improved availability of screening
  • Increasing use of HPV vaccine
  • Introduction of the Cervical Screen Singapore (CSS) programme

There have also been improvements in healthcare technologies and treatment options for cervical cancer.

Regardless, the overall survival rate has remained stagnant. This, again, shows the importance of early diagnosis and screening in improving the mortality rate [6].

By going for regular screenings, abnormal cells in the cervix can be treated and cleared completely. The rate of survivability is much higher when the cancer is detected early!

Am I at risk of cervical cancer?

risk-factor-cervical-cancer

99% of cervical cancer cases are linked to some strains of HPV [7]. Thus, any woman who has had sexual intercourse will carry a risk of developing the disease.

In most cases, HPV is transmitted only through sexual contact. This is why your sexual behaviour is an important risk factor. The risk of transmission, and thus the risk of developing cervical cancer, is much higher in women who have had multiple sex partners. The risk also increases if your partner has had multiple partners [8].

There is also a higher risk of HPV in: [9]

  • HIV patients
  • Transplant patients requiring long-term immunosuppressants
  • Patients with autoimmune disease
  • Smokers
  • Patients with a history of sexually transmitted diseases or other gynaecological diseases
  • Those who had their first sexual intercourse at an early age

Also read: Dealing With Cervical Cancer: A Women's Gynaecological Cancer Awareness Campaign

If I have HPV, does it mean I have cervical cancer?

cases-high-risk-HPV

Not necessarily. You might be surprised to know that HPV is actually very common! It is expected that 8 out of 10 people will get HPV at some time in their life [10].

HPV strains are classified into high-risk and low-risk depending on whether or not they are linked to cancer. In reality, most HPV infections are low-risk. Some of them might not even present any symptoms and clear by themselves.

High-risk HPV strains include HPV16 and HPV18. Those two strains are found in cases of:

  • Cervical cancer
  • Anal cancer
  • Vaginal cancer
  • Penile cancer
  • Oral cancer

You might have heard that the HPV vaccine can significantly decrease the risk of cervical cancer. That is very true!

There are 3 types of HPV vaccinations available in Singapore, all of which target HPV16 and HPV18, among a few other strains.

Male or female, I would really recommend that you get the HPV vaccine!

Also read: 13 Important Facts About HPV Vaccination in Singapore

Even though HPV vaccines offer protection from cervical cancers, a Pap smear is still necessary!

Women who have had sexual activity should be getting a Pap test routinely from the age of 25. I will touch more on that in the next section.

How often should I go for a Pap smear in Singapore?

duration-pap-smear

As mentioned before, screening and early diagnosis are very important factors in increasing survivability from cervical cancers. That is because treating an early stage of cervical cancer is much easier and shows a greater chance of success.

In most cases, early-stage cervical cancer has no symptoms. This is why it can only be detected through a routine check-up. A Pap test can detect abnormalities in the cervical cells even before they develop cancer.

You should get a Pap smear if you are sexually active. That said, I would still recommend all women aged 25 and above to get the test once every 3 years regardless of their sexual activity.

Even if your results are normal, you should still repeat the Pap smear once every 3 years [11].

If you have had previous abnormal results, you may be required to do a Pap test once every 6 or 12 months [12]. This depends on your results, so do check with your doctor!

When is it considered safe to stop getting a Pap smear?

The general recommendation is to get regular Pap smear screening up to the age of 65 years old. However, that is only if your previous 3 Pap smear results have been constantly normal for the past 10 years.

Women who have undergone a total hysterectomy to remove the whole womb and cervix for non-cancerous reasons can also stop getting a Pap test. This might not be the case if the hysterectomy is done for cancerous reasons, so do consult your doctor.

If you have had a history of cervical cell abnormalities in the past, you might have to continue getting Pap smears past the age of 65 years old [11].

It really depends on your medical history and condition, so be sure to check with your doctor first!

What happens during the Pap smear?

process-pap-smear

A PAP smear usually takes less than 5 minutes. The test itself is very safe and you should expect only very minimal discomfort.

That said, it is always best to understand what will happen during and after the procedure:

  1. First, you will be asked to lie down on the examination couch with your knees bent and legs apart.
  2. Your doctor will insert a small plastic device called a vaginal speculum into your vagina. This helps the doctor obtain direct visualisation of your cervix. Some patients may report discomfort and even slight pain during this procedure, but that is totally normal.
  3. Using a special Pap smear brush, your doctor will then obtain cells directly from the cervix.
  4. Lastly, the cell samples are sent to the laboratory for analysis. Usually, the results will be ready in 1 week. You can check with your doctor or clinic after the screening.

After the Pap smear, you might feel some vaginal discomfort or mild bleeding. Do not worry! This is quite common and will resolve itself within a few hours.

Some women may not be comfortable getting a Pap smear from a male doctor, which is actually a common concern in Singapore.

However, this should not affect and stop you from getting a routine Pap smear screening. You can always choose to see a female doctor that you are comfortable with.

Related: How can I reduce the pain of pap smear tests due to dryness and menopause?

Why should older women opt for a co-testing?

pap-smear-older-women

The risk of cervical cancer increases as you get older [13]. While a Pap smear is great, it does have its limitations in terms of screening ability.

For women aged 30 and above, I would recommend a different screening method.

There are two alternatives available in Singapore:

  • HPV DNA test
  • Pap / HPV co-testing

Research has found that an HPV DNA test and co-testing have greater sensitivity and specificity compared with a Pap test. They work by detecting high-risk viruses that might cause cervical cancer [11].

If your co-testing results are normal, you only need to repeat it once every 5 years.

How should I prepare for a Pap smear?

preparation-pap-test

There are a few things you should note before scheduling your Pap smear appointment:

  • Do not get testing during your menstrual period. Ideally, you should get a Pap smear at least 1 to 2 weeks after your menstrual period.
  • Avoid sexual intercourse for at least 48 hours before the test.
  • Do not apply creams, lubricants, or any medication in the vaginal area for at least 48 hours before the test.
  • Find a doctor you are comfortable with. Be as relaxed as possible! Being tensed up may cause even more discomfort during the test.
  • Do not do the test while you are pregnant. The general recommendation is to wait for at least 6 weeks after giving birth before getting a Pap smear. It should be okay as long as you do not experience any more vaginal bleeding. This might be different for every person, so do check with your doctor!

What should I do if my Pap smear shows abnormalities?

As mentioned earlier, a Pap smear may detect a few abnormalities in your cervix cells. They usually fall into 2 main categories: [15]

Inflammation

This is usually caused by a fungal or bacterial infection. For these cases, doctors would usually prescribe a course of antifungal medication or antibiotics. Depending on your case, you might need to get another Pap test in about 6 months. If your Pap smear results continue to show inflammation, you might need to get a more detailed examination, called colposcopy. Do consult your doctor regarding this!

Abnormal pre-cancer cells

It is important to figure out whether or not these abnormal cells are associated with a high-risk HPV infection. For that, doctors would generally recommend getting a HPV DNA test.

In certain cases, you might also be referred to get a colposcopy. Other than that, a biopsy may be needed for a more detailed confirmation regarding the diagnosis of precancerous or cancerous cells.

What is a colposcopy?

colposcopy

A colposcopy is a more detailed examination of the cervix. This helps determine the exact cause of abnormalities found in your Pap smear!

Colposcopy is done with an instrument called the colposcope. It is a medical instrument that consists of a magnifying lens and a light.

With a detailed examination, doctors can understand whether or not the abnormalities in your Pap test results are suspicious or related to cancer. If they are, your doctor can take a tissue sample from your cervix for a biopsy.

The procedure is generally very safe. There might be complications such as infection and bleeding, but they are usually resolved within a day.

That said, do consult your doctor before getting a colposcopy. There might be other possible complications, depending on your condition!

Where can I get Free Pap smears in Singapore?

The Singapore Cancer Society has been providing free PAP smears since 1969. You can get the test at:

Singapore Cancer Society Clinic @ Bishan

9 Bishan Place, Junction 8 Office Tower, #06-05, Singapore 579837

Clinic operating hours:

Mondays — Fridays, 9.00am — 6.00pm (last appointment at 5.15pm)

Saturdays, 9.00am — 4.00pm (last appointment at 3.15pm)

This free service is available for:

  • Singaporeans and permanent residents
  • Women aged 25 to 29 years old
  • Women who have engaged in sexual intercourse

To make an appointment, go to their website here.

How much is a Pap smear at the polyclinic?

The Health Promotion Board’s Screen for Life campaign offers subsidies for cervical cancer screening. This includes both the Pap smear and HPV test.

You can get the subsidised test at all polyclinics in Singapore, as well as at participating GP clinics.

Polyclinics

CHAS* GP clinics

Pap smear

$15 for Singaporeans

$22.50 for PRs

FREE for Pioneer Generation

$2 for CHAS cardholders

$5 for Singaporeans

Inclusive of consultation fee and first follow-up visit (if required)

HPV test

$22.50 for Singaporeans

$33.75 for PRs

$10.25 for PRs

NOT inclusive of consultation fee

Data from Health Hub

*CHAS is the Community Health Assist Scheme available for Singapore citizens. For more information regarding eligibility and application requirement, click here.


Also read: Should the throat require testing with pap smears or HPV testing since oral sex is common in practice?


Screening for a better future

With the technology and subsidies available, a Pap smear should be easily accessible to all women in Singapore. While there is still a lack of awareness on the importance of Pap smear screening for women, it is undoubtedly important.

I wrote this article to increase awareness and knowledge on why a Pap smear is so crucial for a woman's health. It is a very important test that can be life-saving. If you are sexually active and above 25 years old, do get a Pap smear screening as soon as possible!

Also read: The Ultimate Guide to Health Screening in Singapore (2021)


Dr Michelle Chia graduated from the National University of Singapore. She subsequently underwent her post-graduate training in Obstetrics and Gynaecology at KK Women's and Children's Hospital and the Singapore General Hospital.

She has extensive experience in managing a variety of women's health and general gynaecology issues, and antenatal care for pregnancy, and aims to provide holistic, well-rounded care for all women's health problems.

Read more of Michelle Chia's QnAs here.

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I hope that you've found this guide useful, and perhaps gained more insight into the application process. Most of the admissions-related information (admin and logistics wise) can be found on the official NUS Faculty of Dentistry website.

To help yourself out, you should take note of what people look for when they look for a dentist.

This article was written by Dr Michelle Chia and published on Wednesday, 25 January 2017. Human medically reviewed the article on Wednesday, 25 January 2017. The last update was made on Friday, 18 September 2020.

Disclaimer: Opinions belong to the author and not to the platform.

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