hpv in canada: stats, impact and resources
health canada reports the lifetime cumulative incidence of hpv infection is estimated at more than 70 per cent for all hpv types combined, making hpv the most common sti.
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a study in the journal of infectious diseases found that the vaccination of young women in hpv catch-up programs is effective for improving herd immunity and reducing the risk of invasive cervical cancer.
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the human papillomavirus, or hpv, is highly contagious and the most common sexually transmitted infection. it’s spread by skin-to-skin contact in the genital area – penetration is not required – or during genital, anal or oral sex.
hpv is actually a range of more than 100 different types of viruses, with some strains leading to warts on your finger or more serious infections of the genital areas of women and men, including the cervix, vulva, vagina, anus and penis, as well as parts of the mouth and throat. these pathogens can affect reproductive and sexual health and newborn baby health.
unfortunately, what makes hpv difficult for physicians and people who are sexually active is that the major symptom is no symptom. people will be carriers but not aware that they’re infected and pass it on to somebody else. anyone who is sexually active is at risk.
typically, your body clears the virus without health issues within two years.
the compounding problem, though, is that some high-risk types of hpv can lead to cancer. it’s now recognized that hpv causes almost all cervical cancer, according to the canadian cancer society, which is the fastest increasing cancer in women. it can also lead to penile cancer, anal cancer in both women and men, and oropharyngeal cancer of the throat including the base of the tongue and tonsils.
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there’s no cure for hpv, but there’s a vaccine that prevents hpv-related cancers.
hpv vaccination launched in canada in 2007, and all provinces and territories have a school-based hpv immunization program starting in grades 4 to 7. as the canadian partnership against cancer notes, the vaccine is most effective when given during the pre-adolescent years prior to exposure to hpv.
there are also catch-up programs for immunization to people who didn’t get the vaccine through school programs or were in school before the programs were in place. a study in the journal of infectious diseases found that the vaccination of young women in catch-up programs is effective for improving herd immunity and reducing the risk of invasive cervical cancer.
hpv stats in canada
health canada reports the lifetime cumulative incidence of hpv infection is estimated at more than 70 per cent for all hpv types combined, making hpv the most common sti. the highest prevalence is found in people 20 to 24 years of age. rates of stis overall are on the rise: in 2019 the sti rate was 370.8 cases per 100,000 people, which is up 33.1 per cent from the rate in 2010 where numbers showed 278.5 cases per 100,000 people.
other key numbers include:
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- each year 3,800 new cancer cases in canada are attributed to hpv; by 2042, this number will increase to 6,600, notes the canadian partnership against cancer.
- an estimated 1,550 women in canada were diagnosed with cervical cancer in 2023 and an estimated 400 died from it, according to canadian cancer society data.
- hpv is also related to 80 to 90 per cent of anal cancers, 40 per cent of vaginal and vulvar cancers, 40 to 50 per cent of penile cancers, and 25 to 35 per cent of mouth and throat cancers – statistics validated by the canadian public health association. to help reduce the burden of hpv-related cancers, the national advisory committee on immunization has set a target of achieving 90 per cent hpv vaccination coverage of adolescents by 17 years of age, by 2025. as the association points out, “cervical cancer is almost exclusively caused by hpv and is preventable in a high number of cases.”
- in canada, 22 per cent of 15-year-old males have had sexual intercourse and 21 per cent of 15-year-old females have had sexual intercourse, according to the global hpv information centre.
- across all provinces, pre-pandemic rates for hpv vaccine completion in school-based programs ranged from 57 to 91 per cent, but covid-19 school closures impacted immunization delivery. now post-pandemic, there has been a decline in school-based hpv completion rates ranging from 15 to 81 per cent, writes mcgill university oncology scientist and clinical psychologist samara perez in the canadian medical association journal. “the importance of taking action to increase hpv vaccination is critical to mitigate hpv and its cancer consequences on future generations of canadians. there is a clear missed opportunity of hpv vaccine confidence, which has not been realized adequately by vaccine providers and in turn, receivers,” she notes.
- a canadian study published in sexually transmitted diseases examined hpv prevalence among 236 heterosexual university couples who had been dating for less than six months. researchers found that 56 per cent of couples tested positive for hpv (one or both partners) and 40 per cent of these cases were high-risk hpv types.
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impact of hpv on canadian society
alex mckay, executive director of the sexual information and education council of canada, has worked to promote sexual and reproductive health with the non-profit for more than 30 years. he’s seen approaches to hpv change dramatically, but it’s still not well understood by the public and many healthcare providers.
“hpv wasn’t considered an especially prominent sexually transmitted infection for a long time, and not of a lot of attention was paid to it, and it was thought of primarily as the cause of genital warts,” he says. “where awareness really started to change was around just how prevalent hpv is in the population with an estimated that 75 per cent of people in canada and elsewhere will be exposed to some form of hpv. more recently, there’s been a growing awareness that hpv is responsible for many different forms of cancer.”
mckay notes that one of the ways hpv gets confusing is that genital warts are a clear symptom of hpv infection, but the strains of hpv that cause genital warts are not the same strains that cause cancer. the primary strains of hpv that cause cervical cancer are entirely asymptomatic.
“there’s a common perception generally around sexually transmitted infections that if you had an sti, you would know it because there would be symptoms. more often than not there aren’t any visible symptoms, or if people do have symptoms, they brush them off,” he says, pointing to the stigma of stis and lack of open discussion.
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studies have shown that fear of shame and stigma of being “damaged goods” keeps people from reaching out for testing or treatment.
mckay also talks about the attitude that stis are a problem for younger people. “many people in their 30s and 40s who likely have had an hpv vaccine in their past but assume that this is not an issue for them because they have a low number of sexual partners or they’re serially monogamous. but we may move from one partner to another, people get married and then divorced, and then remarried or have new partners. and at any time in your life, it doesn’t matter how old you are, having a new sex partner is a risk factor for getting a new hpv infection.”
the prevalence of hpv and cancer rates in an aging population pose a burden on society.
as mckay adds, “for a small percentage of people with hpv, the virus sticks around and then develops into pre-cancer, and then eventually into cancer. in the big population picture, that translates into a high number of cases of cancer.”
a study in current oncology revealed that from a societal perspective, cancer-related costs were $26.2 billion (cad) in canada in 2021 with 30 per cent of costs borne by patients and their families. the economic burden was the highest in the first year after cancer was diagnosed.
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and a 2021 systematic literature review led by the canadian partnership against cancer highlighted that people in canada spend an average of $253 per month on out-of-pocket costs – anything from medications and caregiver expenses, to getting to appointments and other travel costs. these expenses come at a time when patients may be unable to work because of their sickness. adjusted to 2023, this amount is about $290 per month.
resources and support for hpv in canada
the main associations representing hpv are:
connecting with associations can help you find sexual health clinics for confidential testing, treatment, counselling and support.
screening is important. canada is moving away from pap tests for cervical cancer, which often miss abnormalities, in favour of an hpv test that can be done at home with a self-swab. studies have shown the hpv test identifies precancer cells earlier, and the at-home kit improves access to testing. pap smears are recommended once every three years while the hpv test can be done once every five years because of its accuracy and effectiveness, also helping to reduce healthcare costs.
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as advocates and experts agree, hpv vaccination is the surest way to protect the public. there’s discussion on ways to increase uptake for school-aged pre-adolescents and availability for adults.
perez at mcgill, for example, is calling on healthcare providers to take an active role in informing patients about hpv risks, vaccination and testing:
“with school rates declining, we must expand our efforts beyond publicly funded programs. hcps [healthcare providers] are frequently cited as canadians’ most trusted source of vaccination information, which makes a hcp recommendation the single most effective component impacting an individual’s decision to vaccinate. it is the collective role of all hcps to initiate a discussion about hpv vaccination with their patients. this includes allied hcps, including pharmacists, nurses, dentists who are well positioned to make an hpv vaccine recommendation.”
concern over access to services like hpv vaccination is also on the public health radar. while there are catch-up programs for children and young adults who have not completed the hpv vaccine series under the school-based immunization programs, vaccination needs to reach high-risk groups. the canadian partnership against cancer says that the provinces of british columbia, ontario, quebec and manitoba have extended eligibility criteria for the hpv vaccine to high-risk groups. the partnership also outlines the immunization schedules and recommendations.
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in the broader picture of hpv, eligibility for all individuals with known immunodeficiencies, those who are hiv-positive, and males who have sex with males (msm), “will avoid confusion and create equity for all canadians,” perez notes.
the future of hpv in canada
how do you instill hpv vaccination confidence? people urgently need to know that some cancers are preventable with hpv vaccination, especially when administered before people become sexually active.
task forces at the provincial and national levels are working toward policies and programs to address the issue. the federation of medical women of canada recently released its white paper written by a task force to address the crisis in the ontario school-based hpv immunization program. recommendations focus on expanded access to immunization by removing the barriers to access for unvaccinated populations, such as catch-up campaigns in high schools or mobile clinics. the recommendations also call for increased education about cancer prevention through vaccination and highlight the safety and efficacy of the hpv vaccine.
this speaks to mckay’s point about the critical need for awareness and understanding of hpv and all that it entails. “before we see a meaningful uptake by the public of hpv vaccine or self-testing, we need much greater awareness and knowledge within the public of hpv and other sexually transmitted infections. like the availability of the hpv vaccine and the necessity to pay attention to your sexual health. there’s still a taboo around that, particularly in relation to accessing healthcare related to sexual and reproductive health.”
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while there’s much work to be done, there is hope, mckay says.
“i think around issues like hpv-related cancer, that even though rates of some of those cancers are increasing, we have to be optimistic in the sense that we’ve got a vaccine to prevent those cancers. and that is not something we could say in the past.”
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