By Dr Ang Peng Tiam

The cheerful young woman was in a wheelchair, accompanied by her mum and two aunts, when we first met two months ago. She had been diagnosed with cervical cancer earlier last year, but in that short span of time, the disease had ravaged her body. She was in severe pain - the cancer had attacked the left side of her pelvis, causing her left leg to swell to twice the size of the right.

Despite our best efforts, Shandy Sim died, aged 30, on Boxing Day, surrounded by close friends and family. Although I knew her only during the last two months of her life, I could tell that she had lived a life filled with love. It was only after The New Paper wrote about her on Jan 4 that I realised she had been an avid blogger about her journey with cancer and had attracted many readers.

Every morning that I visited her during my ward rounds, her mum and one of her aunts would always be around. Everyone, not least Shandy herself, knew that her time was limited. She accepted her fate calmly and without bitterness.

Yet it would be easy to feel bitter on her behalf, to feel that her tragedy was that she had been born too soon. If she had been born today, she would have a powerful weapon against cervical cancer.

Up to 80 per cent of all cervical cancers are associated with Human Papilloma Virus (HPV) infection. This virus is transmitted through sexual intercourse and carried by both males and females.

In 2006, a vaccine against the virus was released. Targeted at girls between the ages of 10 and 26, preferably before they become sexually active, the vaccine has the potential to dramatically slice HPV infection and cervical cancer rates.

The vaccine comes in three injected doses over six months. So far, studies have shown minimal side effects, such as some girls fainting just after receiving the vaccine. Although long-term or exceptional effects of the vaccine cannot be known yet, early results are certainly promising.

If Shandy had been born today and if she availed herself of the full benefit of medical science, cervical cancer would have no power over her.

Cancer of the cervix is the sixth most common cancer among women in Singapore. However, it is one that few, if any, should die of, even without the dramatic appearance of the vaccine.

The cervix is in a unique position - it can be felt and seen. By inserting a speculum (a medical instrument that looks a little like a duck's beak) into the vagina, the doctor can have a good look at the shape and appearance of the cervix.

Decades ago, George Papanikolaou discovered that it was possible to detect cancer of the cervix simply be scraping some of the surface cells from the cervix and examining these under the microscope. He helped to identify what the normal cells should look like and how the cells looked different as cancer of the cervix developed.

This simple diagnostic test was named after him and is often referred to as the Pap smear or Pap test. Doctors tell women to undergo a Pap smear at the age of 21, or within three years of having had sex. The test should be done annually for the first three years. If everything is normal, it should be done once every three years. A Pap smear takes no longer than five minutes.

The discovery and use of the Pap smear has helped to save hundreds of thousand of lives. The procedure is safe, simple and inexpensive, yet many women have either not gone for one or do not go for it as regularly as they should. It could be plain inertia, the attitude that 'cancer cannot happen to me', the embarrassment of having a vaginal examination or fear of discomfort.

Up until recently, the best defence against developing cancer of the cervix was early detection through a Pap smear. By early intervention before the cancer has developed, we can cure almost 100 per cent of patients in the pre-cancerous stage. If women screened themselves regularly, if they take advantage of medical breakthroughs such as vaccinations, I am confident that cervical cancer, which has taken so many like Shandy, so young and promising, will become a far less potent enemy very soon.

This has come too late for Shandy. But would she have wished to be born later, to swop her life for another? This young woman, who lived life to the fullest, who saw humour where there was fear, joy where there was pain, who displayed true courage in the face of death and despair? I cannot think so.

We cannot regret the time in which we were born. We can only take full advantage of what science has to offer at the moment. Today, too many do not.

angpt@parkwaycancercentre.com

Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.

This article was first published in Mind Your Body, The Straits Times on Jan 15, 2009.