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hpv prevention week: experts work to turn around 'disturbing' trend of rising cervical cancer
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cervical cancer is almost entirely preventable and, if detected and treated early, highly curable. the human papillomavirus (hpv) infection causes nearly all cervical cancers and three in four unvaccinated canadians will get it.
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at a time when countries like australia and sweden are on track to eliminate cervical cancer, canada is going the opposite way. cervical cancer is the fastest-increasing cancer in women in canada as of 2023, more than double the target and rising by 3.7 per cent each year, current oncology reports. and the situation could get worse.
health experts say the trend is unnecessary because cervical cancer is almost entirely preventable and, if detected and treated early, highly curable. the human papillomavirus (hpv) infection causes nearly all cervical cancers, and three in four unvaccinated canadians will get it.
but we have a solution that works: vaccinating before age 17 can reduce cervical cancer risk by 90 per cent.
hpv vaccination and screening essential for eliminating cervical cancer
dr. shannon salvador, a gynecologic oncologist who treats patients at the jewish general hospital in montreal and president of the society of gynecologic oncology of canada, is speaking out for hpv prevention week so that people will get informed about vaccination, hpv screening and what they can do to protect themselves and their loved ones.
“the incidence of cervix cancer in canada is actually going up, not down. i find that incredibly disturbing,” she says. “i see it in my own practice. i see many more advanced-stage cervix cancers coming through than we did. there’s a lot going into the research of why is that happening and how?”
she says that the challenge with cervix cancer is that there is an excellent screening program that works “unbelievably well but only when we’re using it and when we’re active in it.”
when someone is appropriately screened, the odds are favourable. “we’re almost always going to catch this at a very early stage or even when it’s a pre-cancer because that’s the goal of screening. we catch it as a pre-cancer, so you never even get cancer. we can do the treatments before, and that’s why it’s so effective.”
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but if someone isn’t accessing the screening program, then by the time they get to her clinic, they likely have advanced disease that’s outside of the cervix, travelling in the lymphatic system. this is why cervical cancer is so lethal—it’s no longer a surgical disease.
cervical cancer can be lethal
“we can’t cut it out. we’re looking at very intensive treatments that often involve long-term radiation mixed with chemotherapy and immunotherapy,” salvador notes. “and quite frankly, if that fails in first line (of treatment), we are not going to be able to cure you in second line with the current knowledge that we have. so you have one shot at it, and if it’s already spread outside of what we call the radiation field, where we can radiate safely in the pelvis, we’re dealing with a stage 4 disease that is most likely not curable.”
she also chairs a national advisory committee on hpv screening and vaccination that is spearheading change and recently published a white paper with steps for governments to move canada toward the elimination of cervical cancer.
there are roadblocks to overcome. she acknowledges that the healthcare system is already strapped, trying to keep up with people who need care, and that doing preventative medicine is difficult. one of the important messages she comes back to is a call for individuals to be proactive, find out about screening recommendations in their province and get screened. and if you have a symptom that is not your normal, reach out for help.
call for women to be proactive about their health
“we tend to put things off ourselves because we’ve got little kids, we’ve got elderly parents, we’re the sandwich group, we’re taking care of both, and we’re always last. and we’ve been saying this to women for years. we need to be more proactive about our own health.”
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where are we at with hpv vaccine uptake? most provinces started in-school vaccination programs by 2010 for girls and by 2016 for boys. programs were disrupted during the covid-19 pandemic, so there’s a need for another educational push, salvador explains. while there was initial pushback about promoting promiscuity, the vaccine has nothing to do with sex. it’s a vaccine that prevents a vast majority of hpv-related cancers, including cervix, vulvar, vaginal and oral (the ears, nose and throat).
“vaccination rates are fluctuating between about 46 to 81 per cent, depending on the province, which means a national average around 65 per cent. that’s incredibly low. that’s not the herd immunity we need. we need our herd immunity to be upward over 80 into 90 per cent to really get adequate protection for everybody.”
health canada has approved the hpv vaccine for everyone up to age 45, but it is more effective for people under age 17 because their immune systems are robust, delivering a more aggressive immune response that’s going to be better and longer lasting. (as we get older, our immune systems aren’t quite as robust and functional.) the other reason is that vaccinating children before their first sexual debut is key because once you’ve been exposed to an hpv virus, the vaccine is not going to help fight off the hpv infection. it’s designed for prevention.
the first women to receive the hpv vaccine in canadian schools are now close to 30. “they’re just coming through where we would be screening them for developing pre-cancers and things like that. so that group is not old enough to be contributing to the cervix cancer rates that we’re seeing,” she says, pointing to the huge issue of accessing screening programs that have “fallen off the wayside.”
salvador raises access barriers, such as the lack of family doctors, so people are not being followed consistently and are left to stay informed about screenings on their own.
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however, when they are informed, the advancement of the hpv swab self-test instead of conventional pap smears has improved access to testing for rural and marginalized populations for people with a cervix aged 25 to 69. most provinces are in the process of switching to hpv screening, which is usually done every five years.
experts would like to see provincial databases created that follow who has been screened and who hasn’t been screened, so that reminders can be sent to people. british columbia is ahead of the game in canada with such a system in place, outlined by bc cancer.
“nobody goes to their doctors unless there is a problem. they’re not being reminded. you have to get your screening done and find the resources,” salvador says, noting that privacy laws for medical information in many provinces block the move forward for the databases needed to create an outreach program.
but there’s hope. she points to the progress in australia, which shares challenges similar to canada:
“they have very remote populations who do not have easy access to come into a centre, and they also have marginalized communities. we should look at what hpv self-collection has done for them. and what it did, especially during covid, is that it allowed people to continue to get screened because they could do self-collection at their home. they also have the same issues that canada did during the pandemic, where they lost family physicians, nurse practitioners and people who were monitoring. but with the addition of self-collection, their screening numbers have gone back up.”
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