A cervix self-screening kit is a part of the first self-screening cervical cancer plan in Canada, in Vancouver on Jan. 9.ETHAN CAIRNS/The Canadian Press
Canada plans to eliminate cervical cancer by 2040.
That bold plan received a big boost in recent weeks on a couple of fronts.
A new study out of Scotland showed that human papillomavirus (HPV) vaccines – first approved in the U.S. in 2006 – appear to be close to 100-per-cent effective at preventing cervical cancer. (Because the cancer develops slowly, after infection by HPV, it has taken a generation to start getting really good data.)
Meanwhile, B.C. has dramatically reformed its cervical cancer screening program, allowing women to do self-testing at home with a simple swab for HPV as an alternative to clinician-administered Pap tests.
It is getting markedly easier to screen for and prevent cervical cancer, the fourth most common cause of cancer in women worldwide.
In Canada, there are 1,550 cases and more than 400 deaths annually. While those numbers are relatively small compared to, say, lung cancer or breast cancer, cervical cancer kills women in their prime. It is the leading cause of cancer death in the 25-35 age group.
Of course, cervical cancer is a much bigger issue globally. Worldwide, more than 600,000 cases are detected annually, and there are 340,000 cervical cancer deaths recorded.
The World Health Organization believes it can become the first cancer relegated to the realms of historical diseases by the end of the century. But, as with other infectious diseases, that’s going to happen first in wealthy countries.
If Canada, Scotland and their counterparts in the developing world eliminate cervical cancer, that will set the stage for India, Nigeria and other developing countries to do so too.
The Scottish study, published in the Journal of the National Cancer Institute, examined the outcomes of 450,000 women born between 1988 and 1996, including 40,000 vaccinated at ages 12 and 13, 124,000 vaccinated at or after age 14, and 300,000 who did not receive an HPV vaccine.
To date, there have been zero cases of cervical cancer in the women who were vaccinated before they became sexually active. Zero. The incidence of cervical cancer was 3.2 cases per 100,000 population for those vaccinated between the ages of 14 and 22, and 8.4 per 100,000 among the unvaccinated – a 2.5-fold difference.
The results are astonishing. They also contain some important reminders: 1) Vaccination needs to be done early; 2) If girls/women are vaccinated later, additional doses are required; and 3) Screening is still necessary because the majority of women are not vaccinated.
In Canada, the HPV vaccine is largely administered in school-based programs, anywhere from Grades 4 to 9, with either two or three doses administered to both girls and boys. Vaccination is recommended up to age 26. If you’re not covered by public or private insurance, the shots are costly, around $600 for the series.
Canada has set a goal of vaccinating 90 per cent of 17-year-olds by 2025, and is well short of that goal. The rise in anti-vaccine sentiment is certainly not helping. Neither is the opposition of some parents and religious communities, who argue that vaccinating against a sexually transmitted infection will promote promiscuity.
That’s nonsense of course. This is a cancer-prevention vaccine, and an effective one. In addition to cervical cancer, the HPV vaccine protects against head, neck and anogenital (anal, penile) cancers.
On the screening front, Canadian provinces and territories are phasing out Pap smears in favour of HPV tests, and that should make it much easier to get tested.
Cervical cancer is treatable if detected early, but screening programs have poor participation rates, in the 25-to-40-per-cent range. There are a number of reasons why: A lot of women don’t have a family doctor; many doctors have stopped doing gynecological procedures and; the Pap test is often seen as uncomfortable.
While cervical cancer rates have fallen sharply over the decades, they are bouncing back. It’s actually the fastest-rising cancer in women.
Cervical cancer is, like many illnesses, a disease of inequality. Rates are three times higher in vulnerable populations like immigrants, the LGTBQ community, Indigenous people, and those who have experienced sexual trauma. All of these groups have far lower rates of screening and vaccination.
It’s a reminder that while we’ve made tremendous scientific progress, the science is the easy part. It’s the failure to act on evidence, including the need for education and promotion, that is the greatest barrier to the elimination of cervical cancer.
As Dr. Anu Rebbapragada, scientific director of microbiology at FH Health, said in a blog post recently: “Innovations are irrelevant if they are not implemented promptly, responsibly and equitably.”
Editor’s note: A previous version of this article incorrectly described Dr. Anu Rebbapragada's professional affiliation. She is the vice-president of diagnostic services at FH Health. This version has been updated.
André Picard