• Vol. 50 No. 2, 135–140
  • 01 February 2021

Cervical screening in foreign domestic workers in Singapore

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ABSTRACT

Introduction: Globally, cervical cancer is the fourth most common cancer in women, with about 85% occurring in low-middle income countries (LMIC) and an age-standardised incidence rate of more than 15 per 100,000. It is largely preventable through HPV vaccination and cervical cancer screening. In Singapore, 18% of the foreign domestic workforce hail from Indonesia, the Philippines, Myanmar, and India. However, there is no data on preinvasive cervical disease and cervical cancer in foreign domestic workers (FDWs) and the aim of this pilot programme is to determine the baseline screen positive rate of high-grade intraepithelial in this population. Methods: A total of 322 FDWs were offered HPV screening through the Helping Our Helper (HOH) pilot programme. Data from this pilot programme were analysed and reported using simple descriptive statistics. Results: Out of the 322 FDWs who registered for HPV screening, 68.6% participated. There was a 22.2% screen-positive rate; 10% of those who screened positive for high-risk HPV had histologically confirmed high-grade cervical intraepithelial neoplasia. This result is similar to other data on cervical cancer screening in Singaporeans. This pilot project screened less than 1% of the eligible FDWs in Singapore. Discussion: The findings of this pilot programme suggest that there is public health value in providing cervical cancer screening to FDWs. Improving cervical cancer screening by increasing awareness and including routine cervical cancer screening as part of the employment medical examination should be studied.


Cervical cancer is the most common gynaecological cancer in many countries in Southeast Asia, with a cumulative age-standardised incidence rate (ASRI) of 17.2 per 100,000 and a corresponding mortality rate (ASMR) of 10 per 100,000. In Singapore, cervical cancer is the 10th most common cancer in women with an ASRI of 7.1 per 100,000 and ASRM of 2.3 per 100,000. However, in developing countries like Indonesia, Myanmar and the Philippines, cervical cancer remains high with ASRI of 14.9 to 23.4 per 100,000 and ASMR of 8.8 to 13.9 per 100,000. This is likely related to the lack of awareness, screening and cervical cancer prevention programmes in these countries. In Southeast Asia, the average screening coverage in developing countries is only 19%, with Myanmar at less than 1%. In another recent study by Anwar et al. on participation of screening among Indonesian women, it was found that only 14% of women had cervical screening and 20% were aware of a Pap smear. In Singapore, foreign domestic workers (FDWs) make up 18% of the non-resident workforce. The assumption is that these women have the same baseline risks as women in their home countries, but there is no published data that addresses this assumption and therefore the need for cervical cancer screening in this population.

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