National Health and Morbidity Survey 2019
Technical Report − Volume I
134
8.3 Cervical Cancer
Pap Smear Examination
The total number of respondents was 5,509. The prevalence
of pap smear practice in the last three years among women
age 20 years and above was 36.6% (95% CI: 34.53, 38.77).
The prevalence of ever done a pap smear examination among
eligible women was 26% in NHMS II (1996) and 43.7% in
NHMS III (2006) [5]. Only 12.8% of eligible women had a pap
smear examination done in the past 12 months, according to
NHMS 2011 survey.
Perlis recorded the highest prevalence of pap smear
examination with 51.3% (95% CI: 43.48, 59.00). The prevalence
was highest among women in the age group of 40 to 44 years
old, Bumiputera Sarawak, married women, those with at least
secondary education, government employee, and in the T20
household income group, compared to the other categories
in their respective group.
Awareness of Self-Sampling for Cervical Cancer Screening
(HPV Screening)
Awareness of the availability of the Human Papilloma Virus
(HPV) self-sampling test as a cervical cancer screening tool
in Malaysia was 24.7% (95% CI: 22.58, 26.98). Women in WP
Kuala Lumpur had the highest awareness level, with 44.7%
(95% CI: 34.09, 55.86). The awareness was highest among
women in the age group of 40 to 44-year-old, Bumiputera
Sabah ethnicity, married women, those with at least tertiary
education, government employee, and in the T20 household
income group, compared to the other categories in their
respective group.
Interest to Use Self-Sampling Screening for Cervical
Cancer (HPV Screening)
Interest to use the Human Papilloma Virus (HPV) self-
sampling test as a cervical cancer screening tool was among
41.7% (95% CI: 39.24, 44.13) of women aged 20 years old and
above. Women in WP Kuala Lumpur had the most interest
level, with 55.4% (95% CI: 43.32, 66.80). The interest was
highest among women in the age group of 40 to 44-year-old,
Bumiputera Sabah ethnicity, married women, those with at
least tertiary education, government employee, and in T20
household income group, compared to the other variables in
their respective categories.
8.4 Faecal Occult Blood Test for Colorectal
Cancer Screening
In total, 4,351 respondents aged 50 years and above
responded to this submodule. The prevalence of colorectal
cancer screening using faecal occult blood tests (FOBT)
in the last 12 months was 10.8% (95% CI: 9.47, 12.39). The
prevalence was highest among adults in the age group of 65
to 69-year-old and retirees.
Conclusion
Though many are aware of health screening or periodic
medical check-ups, the uptake in Malaysia is relatively
low. Elder age groups utilize the available health screening
programs in Malaysia more, compared to the younger
eligible age groups. Some respondents imbibe certain
healthy lifestyle, thinking that it can be substituted for health
screening or routine medical check-up. Efforts are needed to
make sure that health screening or periodic medical check-
up is continuously encouraged especially among younger
adults.
Non-Communicable Diseases:
Risk Factors and other Health Problems
135
Recommendations
Health screening programmes, such as health screening
roadshows or mobile health screenings, are essential in
ensuring that the community is being screened enough. Local
champions at the community level are crucial to make such
programs a success. Many countries have adopted organized
screening programs that have been remarkably successful in
reducing the incidence and mortality of diseases, especially
cancers. Sit-and-screen is bygone; now is the era of search-
and-screen.
Colorectal cancer
The prevalence of colorectal cancer screening using the
faecal occult blood test is still low. The finding from this
survey can be used as a baseline towards strengthening the
current program.
Breast cancer
The way forward is to improve access and quality of
mammography among women in rural areas. At the same
time, women should be empowered to perform breast-
self-examination and to seek advice once they find any
abnormalities. Coordinated activities with the related
agencies are vital in ensuring functional data integration.
Cervical cancer
Not all women have the level of acceptable awareness
regarding cervical cancer prevention and early detection,
which could influence the rate of screening uptake. Lack of
screening registry results in difficulty in tracking the women
who went for screening and their subsequent follow-ups.
Therefore, implementing the Transformation of Cervical
Cancer Prevention Programme that integrates the HPV test
as a primary screening tool is the solution to this dilemma.
It is also a strategy towards the World Health Organization’s
global cervical cancer elimination goal.
References
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Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L, et al.
Screening for breast cancer: an update for the US Preventive Services
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2.
Al-Naggar RA, Bobryshev YV. Practice and barriers of mammography
among Malaysian women in the general population. Asian Pac J Cancer
Prev. 2012;13(8):3595-600.
3.
Saber Azami-Aghdash, Morteza Ghojazadeh, Sepideh Gareh Sheyklo
et al. Breast Cancer Screening Barriers from the Womans Perspective: a
Meta-synthesis. Asian Pac J Cancer Prev, 16 (8), 3463-3471. DOI: http://
dx.doi.org/10.7314/APJCP.2015.16.8.
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Azizah AM., Hashimah B., Nirmal K., et al. Malaysia National Cancer
Registry Report 2012-2016. National Cancer Institute, Ministry of Health
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National Health and Morbidity Survey III (Women Health).2006. Institut
Kesihatan Umum, Ministry of Health.
National Health and Morbidity Survey 2019 Technical Report − Volume I 136 Table 8.1: Prevalence of Undergoing Any Health Screening / Medical Check Up in The Past 12 Months Among Adults Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=10,472) Sociodemographic Characteristics Health Screening / Medical Check Up Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 5,966 10,427,479 49.0 47.03 50.94 State Johor 460 1,148,345 47.3 41.39 53.23 Kedah 359 747,878 58.2 51.03 65.04 Kelantan 267 432,390 38.5 35.15 41.98 Melaka 381 321,517 53.9 47.08 60.55 Negeri Sembilan 344 374,996 53.2 44.01 62.17 Pahang 359 526,489 51.7 45.27 58.04 Pulau Pinang 345 630,141 50.2 40.37 60.05 Perak 320 755,654 48.9 42.71 55.06 Perlis 356 90,055 56.2 49.26 62.86 Selangor 632 2,179,173 47.6 42.26 52.89 Terengganu 364 380,779 51.4 45.52 57.30 Sabah 490 1,298,635 50.5 44.11 56.84 Sarawak 375 829,989 44.8 39.04 50.66 WP Kuala Lumpur 287 639,507 49.3 42.92 55.60 WP Labuan 337 39,698 62.7 57.51 67.53 WP Putrajaya 290 32,233 56.3 50.36 62.09 Location Urban 3,626 8,141,361 49.0 46.60 51.38 Rural 2,340 2,286,118 49.0 46.28 51.68 Sex Male 2,592 5,043,230 46.1 43.44 48.75 Female 3,374 5,384,249 52.1 49.89 54.20 Age Group (Years) 18-19 76 141,888 15.8 11.52 21.17 20-24 263 786,681 27.4 23.06 32.20 25-29 387 1,109,172 37.0 32.71 41.55 30-34 479 1,146,533 43.1 37.85 48.49 35-39 527 1,121,832 47.3 42.54 52.14 40-44 479 911,157 49.7 45.29 54.16 45-49 546 911,170 54.8 49.96 59.54 50-54 619 960,708 62.6 58.00 66.94 55-59 676 928,457 69.4 64.98 73.44 60-64 633 798,713 72.2 67.20 76.71 65-69 503 628,666 78.2 73.17 82.50 70-74 365 446,737 81.2 75.58 85.72 75 & above 413 535,765 81.4 76.62 85.43 Ethnicity Malaya 3,790 5,316,594 48.8 46.61 51.03 Chinese 806 2,260,992 49.5 44.57 54.34 Indian 455 775,940 62.5 56.29 68.33 Sociodemographic Characteristics Health Screening / Medical Check Up Count Estimated Population Prevalence (%) 95% CI Lower Upper Bumiputera Sabah 382 721,873 52.6 45.18 59.94 Bumiputera Sarawak 228 424,741 44.3 37.29 51.55 Others 305 927,339 41.2 33.81 48.96 Marital Status Single 737 1,892,768 31.3 28.13 34.65 Married 4,406 7,488,584 54.6 52.04 57.05 Widow(er)/Divorcee 823 1,046,127 69.1 64.62 73.32 Education Level No Formal Education 423 605,003 55.6 47.44 63.47 Primary Education 1,528 2,226,500 54.3 50.25 58.27 Secondary Education 2,655 4,807,537 46.4 43.93 48.89 Tertiary Education 1,334 2,736,529 48.8 45.20 52.38 Occupation Government Employee 687 987,832 63.1 57.43 68.48 Private Employee 1,438 3,539,675 43.1 39.83 46.48 Self Employed 944 1,554,259 42.0 37.88 46.27 Unpaid Worker/ Homemaker 1,276 1,947,359 54.7 50.92 58.33 Retiree 408 615,855 77.4 71.61 82.33 Student 81 216,050 28.8 22.65 35.83 Not Workingb 1,126 1,557,177 57.8 53.88 61.62 Household Income Group Less than RM 1,000 670 1,022,683 59.6 54.76 64.26 RM 1,000 - RM 1,999 1,127 1,851,345 45.3 41.11 49.51 RM 2,000 - RM 3,999 1,684 2,918,697 45.6 42.36 48.90 RM 4,000 - RM 5,999 864 1,631,343 49.0 45.09 52.83 RM 6,000 - RM 7,999 491 909,947 46.4 40.93 51.95 RM 8,000 - RM 9,999 239 468,925 52.2 44.33 60.00 RM 10,000 and above 441 839,774 52.2 42.71 61.50 Household Income Quintile Quintile 1 1,270 1,952,220 51.4 47.41 55.27 Quintile 2 1,058 1,786,734 44.0 39.77 48.25 Quintile 3 1,054 1,873,534 46.9 43.18 50.72 Quintile 4 963 1,811,580 49.2 45.51 52.97 Quintile 5 1,171 2,218,646 49.7 45.19 54.11 Household Income Category Bottom 40% 3,757 6,233,168 47.9 45.50 50.26 Middle 40% 1,271 2,446,179 47.4 43.94 50.90 Top 20% 488 963,367 52.8 45.37 60.01 a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age
Non-Communicable Diseases: Risk Factors and other Health Problems 137 Table 8.2: Prevalence of Breast Self-Examination in The Past 12 Months Among Females Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=5,687) Sociodemographic Characteristics Breast self-examination Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 2,971 5,028,665 49.0 46.00 51.00 State Johor 206 474,483 41.0 32.80 49.64 Kedah 130 279,184 44.4 37.38 51.61 Kelantan 203 344,383 60.2 54.50 65.65 Melaka 222 192,128 61.5 49.27 72.39 Negeri Sembilan 182 203,749 58.4 45.55 70.19 Pahang 122 190,456 39.2 33.74 45.02 Pulau Pinang 151 241,085 39.3 30.76 48.48 Perak 188 406,898 53.7 45.24 61.95 Perlis 171 49,097 59.7 51.95 66.94 Selangor 318 1,090,027 49.9 43.62 56.20 Terengganu 163 165,819 45.2 37.91 52.60 Sabah 219 614,783 50.7 44.00 57.31 Sarawak 196 420,505 46.3 40.48 52.12 WP Kuala Lumpur 128 313,155 48.5 42.37 54.61 WP Labuan 175 21,106 66.2 58.42 73.16 WP Putrajaya 197 21,807 68.4 60.90 74.97 Location Urban 1,830 3,927,760 48.5 45.80 51.25 Rural 1,141 1,100,905 49.0 45.56 52.35 Sex Female 2,971 5,028,665 48.6 46.36 50.87 Age Group (Years) 18-19 43 84,999 21.1 14.49 29.70 20-24 166 431,713 31.4 24.96 38.61 25-29 264 726,260 51.5 44.91 58.01 30-34 353 718,016 57.5 50.31 64.42 35-39 358 704,656 61.3 55.36 66.91 40-44 314 501,929 57.9 51.53 63.99 45-49 327 502,733 60.0 54.41 65.24 50-54 310 420,639 54.2 48.13 60.07 55-59 326 371,289 55.8 49.63 61.75 60-64 208 230,677 41.4 35.31 47.83 65-69 152 162,796 39.6 31.75 48.07 70-74 95 118,543 40.6 32.14 49.72 75 & above 55 54,415 15.5 10.98 21.55 Ethnicity Malaya 2,047 2,925,641 53.5 50.96 56.06 Chinese 294 898,717 40.5 34.31 47.02 Indian 181 285,532 44.1 38.12 50.36 Sociodemographic Characteristics Breast self-examination Count Estimated Population Prevalence (%) 95% CI Lower Upper Bumiputera Sabah 192 370,923 53.7 46.07 61.24 Bumiputera Sarawak 133 231,956 49.0 41.20 56.77 Others 124 315,897 37.2 27.92 47.64 Marital Status Single 336 730,262 31.2 27.29 35.46 Married 2,247 3,830,629 56.2 53.56 58.89 Widow(er)/Divorcee 388 467,774 39.1 34.52 43.96 Education Level No Formal Education 140 174,325 25.7 21.12 30.97 Primary Education 581 735,935 39.6 35.44 43.92 Secondary Education 1,403 2,473,419 50.7 47.62 53.84 Tertiary Education 840 1,631,865 56.4 52.11 60.67 Occupation Government Employee 401 513,821 71.5 64.88 77.33 Private Employee 583 1,395,279 47.4 42.93 51.85 Self Employed 401 614,559 55.0 49.69 60.19 Unpaid Worker/ Homemaker 1,110 1,785,492 52.6 48.83 56.27 Retiree 81 105,158 48.9 38.53 59.29 Student 48 99,907 23.4 16.29 32.42 Not Workingb 346 513,917 33.8 28.99 38.90 Household Income Group Less than RM 1,000 308 459,340 44.5 38.66 50.49 RM 1,000 - RM 1,999 548 913,005 48.3 43.68 52.84 RM 2,000 - RM 3,999 821 1,369,127 47.2 43.40 51.02 RM 4,000 - RM 5,999 463 784,614 51.1 45.71 56.46 RM 6,000 - RM 7,999 272 486,659 53.0 45.87 59.94 RM 8,000 - RM 9,999 122 231,646 52.4 40.74 63.74 RM 10,000 and above 217 367,599 51.9 43.41 60.22 Household Income Quintile Quintile 1 599 938,098 45.6 41.40 49.85 Quintile 2 520 821,022 46.8 42.09 51.50 Quintile 3 502 884,651 47.6 43.05 52.20 Quintile 4 519 882,316 52.2 47.07 57.31 Quintile 5 611 1,085,904 52.5 47.17 57.69 Household Income Category Bottom 40% 1,846 2,926,001 47.1 44.43 49.74 Middle 40% 670 1,248,556 51.6 46.65 56.49 Top 20% 235 437,433 55.0 48.22 61.57 a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age