Cervical smears (also known as Pap smears) are cervical cytology tests that are one of the most effective, fast and easy ways to screen for cervical cancer. Regular Pap smears can detect abnormal cervical cells. 90% of the test results are normal. If abnormal cells are found in the cervix, the doctor will arrange further examinations to rule out serious cervical problems.

Cervical cancer screening in Macao is mainly for asymptomatic women aged 21-65 years who have had sexual intercourse.

• A. General Cases:

  Age of women	Recommendation
  Ages 21-29 years	Receiving cervical cancer screening once every three years after having normal Pap test results for two consecutive years
  Ages 30-65 years	Cervical cancer co-testing every five years

• B. Special Cases:
  
  • Those over 65 years who have never been screened for cervical cancer should be screened.
  • Women with other specific risks, such as persistent HPV infection, HIV positive, and existing cervical cell lesions, should be assessed by a doctor and may be required to undergo screening more frequently.

For more information, please check “Recommendations for Screening Subjects”.

A.Women over 65 years of age who have had regular cervical cancer screening in the past ten years may discontinue screening if the results are normal;
B.Those who have had their uterus removed (including cervical resection) for reasons other than cervical cancer may discontinue screening.

Cervical cancer co-testing is a combination of cervical smears and HPV-DNA testing. And it is another effective, quick and easy way to screen for cervical cancer.

Yes. Cervical cancer may develop in a woman who has not had sex for a long time. In fact, the risk of cervical cancer increases with age. Therefore, you should have regular cervical screening even if you have had sexual activity only once before or a long time ago.

Yes. Menopause does not protect a woman from cervical cancer. As long as you have had past sexual experience, you should have regular cervical screening.

Yes. The HPV vaccine does not protect against all types of HPV, nor against existing HPV infections, but only protects against high-risk HPV types associated with cervical cancer (e.g. HPV 16 and HPV 18). Therefore, women still need to have regular cervical smears after vaccination.

HPV is a group of viruses that can cause cervical pre-cancerous lesions and cervical cancer, especially the high-risk HPV types, such as HPV 16 and HPV 18. HPV includes more than 150 types of viruses, of which about 40 can infect human reproductive organs. HPV is mainly transmitted through sexual contact. Most infected patients are asymptomatic, and normally the infected populations can eventually clear the infection. However, persistent infection with high-risk HPV can lead to pre-cancerous cervical lesions. Most of these lesions are usually reversible, while a few of them may develop into cervical cancer in a few years.
For more information, please check “HPV and Cervical Cancer”.

Since 1 September 2013, the HPV vaccine (commonly known as the cervical cancer vaccine) has been included in the “Macao Vaccination Programme”, providing free vaccination to female Macao residents aged between 10-18 years.
- Since 1 September 2017, the 4-valent vaccine has been replaced with the 9-valent one.
For information about the HPV vaccine, please refer to the relevant leaflet.
Women over 18 years old can consult their doctors and arrange for vaccination, at their own expense, outside of the Health Bureau medical system.

Cervical cancer can be completely asymptomatic in its early stages and only detected during a medical examination. The most common symptom is irregular vaginal bleeding, including bleeding between periods, after sexual intercourse or after menopause.

Risk factors for cervical cancer:

1. Persistent HPV infection is the most critical factor, especially with the high-risk HPV types 16 or 18.
2. Smoking: Smoking increases the risk of cervical cancer in women, with the risk of cervical cancer being twice as high in women who smoke as in women who do not smoke.
3. Sexual intercourse at an early age: Sexual experience at younger than 18 years of age is associated with a 5 times higher risk of HPV infection.
4. Multiple sexual partners: Studies have shown that those who have had two to five sexual partners exhibit 1.6 times higher risk of HPV infection than those who have had only one sexual partner, and up to 2.2 times higher risk for those who have had six or more partners.
5. Unsafe sex: Unsafe sex increases the risk of recurrent HPV infection and other sexually transmitted diseases.
6. Weakened immunity: Increased risk of HPV infection.
7. Frequent use of oral contraceptives: Long-term use of oral contraceptives (more than five years) increases the risk of cervical cancer by 4 times compared to non-users. It also increases the risk of HPV infection.
8. High number of childbirths or young age at first pregnancy: Increased risk of cervical damage or HPV infection.

(1) Regular Pap smears: It usually takes a long time for abnormal cervical cells to develop into cancer cells. Therefore, regular cervical cancer screening can detect abnormal cervical cells at an early stage for early follow-up and intervention.
(2) Prevention of HPV infection: HPV is the most critical cause of cervical cancer, and it is mainly transmitted through sexual contact. Preventive methods:

• Vaccination against HPV.
• Avoid multiple sexual partners (the more partners you have, the higher the chance of infection).
• Use condoms during sex: Condom use has been shown to be associated with a lower incidence of cervical cancer, as well as preventing other sexually transmitted diseases such as gonorrhoea, syphilis and AIDS.
• Avoid early sexual activity: An immature cervix is more susceptible to HPV infection and other carcinogens.

(3) Avoid smoking.
(4) Keep a regular routine.