Fighting for Women’s Health

09 October 2017

With cervical cancer being the second most common cancer among Malaysian women, University of Malaysia’s clinician-scientist Professor Dr Woo Yin Ling is working to implement a new method of self-testing

Professor Dr Woo Yin Ling juggles two demanding roles: as a gynaecological oncologist in University Malaya Medical Centre (UMMC), where she cares for patients in advanced stages of cancers, and as a research lead in many different cancer projects at University of Malaya (UM).

While doing her housemanship in Dublin’s St James’s Hospital, Woo’s interest in gynaecological oncology was inspired by her mentor, Dr Noreen Gleeson who took care of patients with gynaecological cancer. According to Woo, Gleeson treated everybody the same, whether they were rich or poor.

“After she left the room, everyone would continue talking about her compassion,” she recalls. “The experience left a powerful impact on me. Even today, I always tell my students they must have a genuine interest in people in order to do well as a doctor.”

Woo went on to specialise in gynaecological oncology, and even scored the highest marks in the world in her professional exams. This achievement secured her Cancer Research UK’s prestigious Gordon Hamilton Fairley Fellowship, a million-ringgit grant that funded her PhD in Cambridge.

After getting her full training overseas, she returned to Malaysia in 2010 as a fully qualified science researcher and doctor. In technical terms, Woo is a clinician-scientist – a dual-career path that’s rare even in developed countries (the demands of the two professions make it difficult to remain active as both simultaneously).

For Woo, the value of synergising both her scientific work and clinical practice was simply too good to resist. “My interactions with patients produce invaluable insights for areas of research that are relevant to patient care,” she says.

One of these insights is the importance of localising treatments and methods. “You should not and must not take a system en blocke and apply it here. We shouldn’t be saying, ‘just because it works for Australia and UK, let’s do it here’,” she asserts.

An example of how there is no one-size-fits-all solution is the varying prevalence of cervical cancer.

Coming back to Malaysia, Woo was alarmed that cervical cancer is among the top three cancers in Malaysia, despite the availability of scientific tools to prevent and detect it.

Woo separating the different components of a research blood sample.

In the West, cervical cancer rates dropped dramatically, a fact widely attributed to the practice of organised pap smear programmes (the physical examination of a woman’s reproductive organs typically performed by a gynaecologist. A woman is recommended to have one every three years).

In sharp contrast, cervical cancer has remained the second most common cancer among Malaysian women since the 1980s.

Woo realised one of the key problems was the simple fact that Malaysian women were not getting themselves screened. “The takeup rate is still extremely low although pap smears are offered free of charge at community clinics,” she explains.

“As it turns out, culturally, women are too shy to have a gynaecological examination.”

This problem is not exclusive to Malaysia. “Pap smear works in countries where it is centrally organised and the general practitioners are incentivised to carry it out. However, the same results have never been reproduced in the developing world because of cultural factors. In countries like Bangladesh, Laos and India, 50 to 70 percent of women have never had a pelvic examination in their lives.”

Lab samples for testing.

Given the cultural backdrop, she believes a more practical solution is to design a method that suits the local context. “Health systems in developed and developing worlds are different. Solutions must be adapted to the setting,” says Woo.

These solutions may not be technologically inferior to their western counterparts either, just different.

 There are now self-sampling methods to screen cervical cancers which are more sensitive than the traditional pap smears. Women can do a HPV-DNA test, which involves a vaginal self-swab. The swab is then sent for testing and the results can be obtained in an hour. No embarrassing pelvic examinations by doctors necessary.

“The technology is already available,” Woo says. “It’s just a question of systemic implementation [in Malaysia].”

A centrifuge where biological specimens are separated based on their densities.

A common excuse cited for avoiding pap smears is the pain factor, but the self-sampling method aims to reduce that discomfort. According to a study published by Woo and her colleagues where more than 1,000 women were surveyed before and after self-sampling, more than 90 percent of those sampled felt that the test was “highly acceptable”.

Woo shares, “In countries where there are published papers showing only a 20 percent uptake when women do pap smears, the percentage goes up to 86 percent when they do a self-swab.”

What does this mean for Malaysians moving forward? That is the question Woo and her collaborators aim to answer through a two-year Malaysian-centric pilot study that investigates the financial viability of HPV-DNA testing as a first-line alternative to pap smears. The results could have enormous implications for the management of cervical cancers in the country.

“By empowering women to do the tests themselves, we hope to motivate them to take ownership of their own health,” Woo says.

Woo (centre) with her research team.

Speaking to Woo, one gets the sense that there’s a mine of activity in Malaysian healthcare that the public may not be aware of.  She shares, “Malaysia has the first Asian school-based vaccination programme against cervical cancer. Since 2010, our Form One students are vaccinated under this programme. It is not compulsory yet uptake is 95 percent!”

“When you go for international conferences, this is cited as one of the areas where Malaysia has done so well, and people ask me, how do you do it?” she beams.

Given her time spent in the most prestigious hospitals overseas, has she ever felt that she would do better elsewhere?

Woo using a colposcope, a special instrument to inspect the cervix magnified.

Woo says she has always wanted to come back to Malaysia. “I was lucky to have engaged with mentors who had a global view of healthcare when I was overseas. But even when I was doing my training, the question at the back of my mind was, how can I tailor this to fit Malaysia?”

“When I did my student attachment in UM during my summer holidays, I always regarded it as a centre of excellence that I wanted to contribute to in future.”

For Woo, she sees her future in the place she calls home. “Since coming back six years ago, I’ve been involved in a host of rewarding work, from studying BRCA genes in ovarian cancer, to my HPV and vaccine work. I have achieved a lot in Malaysia which I could not have done anywhere else.”

By Alexandra Wong
Photos by Teoh Eng Hooi

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