how hpv turned into cervical cancer years later for a b.c. woman

corinne schelle considers herself one of the lucky ones. the 43-year-old kamloops, b.c. woman has now been cancer-free for five years. weeks before her son’s first birthday, schelle was told she had cervical cancer related to the human papillomavirus (hpv).

the virus, which is a sexually transmitted infection, is behind almost every case of cervical cancer in women, and can cause a variety of cancers like head, neck and anal cancer in both women and men. and although the incidence rates of cervical cancer are declining, according to the canadian partnership against cancer (cpac), roughly 1,300 women are diagnosed with the disease each year, and an estimated 400 will die from it.

“i knew that i had hpv, but it didn’t actually occur to me at all. it was so many years ago,” schelle, who says that the virus was detected in her 20s after an abnormal pap test, but subsequent tests were normal, even into her pregnancy.

then came the heavy bleeding. “i was dealing with all the things that a first-time mom deals with, the lack of sleep, the stress, the hormones,” she says. “but i had this prolonged new bleeding that my doctor thought was my first postpartum period.”

‘i had to give up a part of my body’

her doctor’s exam revealed a possible tumour in the cervix, the lower part of the uterus that connects to the vagina. this led to an urgent referral to a cancer clinic — and an emergency radical hysterectomy to remove her cervix, fallopian tubes and uterus.

“they take all of that, but they leave your ovaries in the hopes that you will still be able to produce your own estrogen,” she says. “i had to give up a part of my body and that was really crushing for me; i also had to face that this meant i couldn’t have any more children.”

when a pathology report following the surgery showed there were some cancerous cells remaining close to the uterus, the next course of action was radiation and chemotherapy. this caused schelle to lose her hair, and forced her to give up breastfeeding her son — something she describes as the hardest part of the diagnosis.

“i just remember rocking him and telling him that this would be the last time,” she says.

to help herself move forward, schelle found resources and support at inspirehealth, a b.c.-based non-profit organization that offers counselling and self-care workshops to cancer patients.

hpv vaccination: a proven tool for prevention

one of the challenges of hpv is that there often are no obvious signs of infection — even though genital warts are one symptom, these can be small (they resemble a cauliflower) or be hidden inside the body, out of sight. and while for women, the warts may be spotted on the vulva, thigh, anus, rectum, or inside the vagina or urethra, men can find the warts on the penis, scrotum, thigh, anus, rectum or in the urethra.

perhaps most important for schelle, though, as a cervical cancer survivor, is to advocate for hpv vaccination: after all, it’s a proven tool for prevention.

beginning in the 2000s, many countries, including canadaand the u.k., started vaccinating school-aged girls (too late for schelle herself), and later boys. and though results have shown a decrease in the high-grade lesions that can lead to cervical cancer, it’s difficult to show a decrease in actual cervical cancer diagnoses because it takes so long for the disease to develop, and the numbers are relatively small.

however, a breakthrough study from scientists in the u.k.looking at the effectiveness of the hpv vaccine, recently discovered a nearly 90 per cent reduction in cervical cancer in women who were first vaccinated when they were 12 or 13 years old.

“my parents would’ve never been able to predict, and nor would i, what my sexual activity was going to look like years down the road,” says schelle. “it only takes sleeping with one person to get it. if you can get a vaccine to prevent something as serious and life-altering as cancer, it makes sense.”

it’s a sentiment shared by experts in the cervical care community.

“[discovering] the role of the human papillomavirus as being responsible for the majority of cervical cancers has been a game-changer,” says cpac’s vice-president of cancer control erika nicholson. “we’re seeing the positive impact that immunization has on preventing this cancer. it’s safe, it’s effective, and we’re fortunate in canada that we do have publicly-funded vaccine programs targeted to school-based children.”

in fact, the canadian population attributable risk of cancer (compare) study, funded by the canadian cancer society, found that we could prevent about 5,300 cervical cancer cases by 2042 if more canadian children were vaccinated against hpv.

hpv vaccine is most effective in pre-adolescent years

school-based immunization schedules for the hpv vaccine start in grades 4 to 7. notably, the vaccine is most effective when it is given during the pre-adolescent years, says a 2017 review of the canadian data by researchers at the university of saskatchewan’s school of public health:

“to prevent infections and reduce the burden of hpv-related diseases (including cervical cancer), communities should be made aware and encouraged to vaccinate their children,” researchers conclude. “there is a documented need to direct effort and focus interventions toward improving hpv vaccination uptake in canada.”

a key part of cpac’s action plan is to see 90 per cent of adolescents who are 17 years of age immunized with the hpv vaccine by 2025. based on 2017 to 2018 data, the uptake rates among school-based programs are almost 70 per cent, with numbers ranging across the country. ontario, the most populated province, comes in at just over 62 per cent.

while hpv vaccination programs are now publicly funded for both girls and boys across canada, this was not the case in 2016, when researchers saw a correlation between vaccine uptake and whether or not provincial funding was available. in fact, a study published by researchers at the princess margaret cancer centre, mcgill university, université de montréal, and the jewish general hospitalfound that provinces where the vaccine was available to boys in schools — alberta, nova scotia and prince edward island — saw higher vaccination rates than in british columbia, new brunswick, newfoundland and labrador, and saskatchewan, where vaccinations were not publicly funded.

why wouldn’t you want your child vaccinated?

some of the barriers to increasing the rates of hpv vaccination include parental concerns about their child’s sexuality, limited awareness of hpv and the link to cancer, and worry over vaccine safety — something that the covid-19 pandemic has amplified.

“people have a lot of uncertainty, especially now with covid and the concern that vaccines don’t work,” says dr. cathy popadiuk, chair of the canadian foundation for women’s health, canada’s national not-for-profit fundraising foundation for women’s sexual and reproductive health. “vaccines work for antibodies and for other parts of the immune system, like t cells and other things that we don’t measure.”

she adds that the hpv vaccine is a good example of how well vaccinations work.

“if you got vaccinated in 2007, it’s still working,” she says. “that should be very reassuring to the population that vaccinations also have longer-term benefits.”

popadiuk has been a practicing gynecologic oncologist in newfoundland since 1998 and teaches in the faculty of medicine at memorial university. she has a special interest in cervical cancer and is also working with the national microbiology lab in winnipeg to study hpv incidence in young women.

the timing, she says, is right. it’s been 15 years since the hpv vaccines came into play and she’s excited about the results of immunization coming to light, both in research and in the results she is seeing in her own patients.

‘you can actually see less cancer happening’

popadiuk says the first abnormality the vaccine helped to address was low-grade warts. then, as the vaccinated cohort matured through high school and sexual activity, there were fewer high-grade lesions found.

“pre-cancerous cells can usually become cancer in 10 or more years, and we’ve been seeing less high-grade abnormalities among younger women who have been in that vaccinated cohort,” she says. “that’s really exciting. you can actually see less cancer happening in 25 to 29-year-olds.”

looking back, schelle says that cancer made her re-evaluate what’s important. she not only adopted healthier eating habits, but she also decided to trade city life in for life closer to nature.

“for us, it was moving out of vancouver to give our son a lifestyle that wasn’t the hustle and bustle of a big city,” she says. “having a backyard and being in nature is really important.”

karen hawthorne is a toronto-based freelancer.