The Importance of Vaccines and Screening for Cervical Cancer
Last month, CBC’s White Coat, Black Art interviewed 42-year-old Karla Van Kessel from London, Ontario who had been diagnosed with late-stage cervical cancer. Van Kessel told CBC that she feels she was failed by the medical system, as her cervical cancer was not detected at an earlier stage. Although the number of cases in Canada has been steadily dropping, this type of cancer is still the fourth most common in women worldwide.
Dr. Joan Murphy, who was also interviewed by CBC, is the clinical lead of the Cancer Care Ontario Cervical Screening Program and Professor with the Department of Obstetrics and Gynaecology at UofT. Dr. Murphy said it can be difficult for family physicians or young clinicians to recognize cervical cancer, especially since some have never seen it. While screening is not always perfect, Dr. Murphy stresses that it is vital and saves many lives.
Dr. Amanda Selk, Assistant Professor with the Department of Obstetrics and Gynaecology, agrees with Dr. Murphy that screening is an important part of preventing cervical cancer.
“It is unfortunate to hear about this case of late-stage cervix cancer in Canada,” says Dr. Selk. “We are lucky to live in a country with organized provincial screening programs for pap tests and management with colposcopy, which results in Canada having some of the lowest rates of cervix cancer in the world. But even with the best screening programs, there are some cancers.”
Dr. Selk says that, unlike in this case, most cervix cancer in Canada occurs among those who are never screened with a Pap Test or who haven’t had a Pap Test for more than five years.
“There are rare cervix cancers that are not picked up with paps and not caused by HPV, and paps aren’t perfect. Therefore, if women have a normal pap, but new symptoms like bleeding after sex, bleeding between their periods, or someone sees a lesion on the cervix, then looking at the cervix with colposcopy can be helpful.”
Cancer Care Ontario has developed a program where women receive reminder letters to get paps, as well as follow up letters with results and further instructions. This is a reason why it is very important for Ontarians to keep their address up to date with OHIP. Dr. Selk states that patients having access to their results through this program and doctors’ office or hospital electronic health records also empowers them to ask about abnormal results and ensure appropriate follow up.
For physicians, Dr. Selk says tracking results is very important. Pap testing results can seem complicated with many different names, but an easy thing to remember is any abnormal Pap Test, other than ASCUS (where you need two ASCUS paps or a positive HPV test), needs a colposcopy referral. Dr. Selk says that HPV testing is the “new kid on the block” and it will help prevent more cancers, as most cervix cancer is caused by high-risk (cancer-causing) strains of HPV.
HPV is very common with more than an estimated 70 per cent of sexually active Canadian men and women being infected at some point in their lives. However, as Dr. Selk points out, most people who get HPV will not get cancer.
“Right now, in Ontario, if an HPV test is positive and the pap is normal, patients are supposed to have yearly paps as opposed to colposcopy,” says Dr. Selk. “Currently, colposcopy will have a hard time seeing all HPV positive patients with normal paps in a timely fashion and most will not need treatment. HPV testing is not used to screen women under age 30 and if a pap is anything other than ASCUS or LSIL, HPV testing should not be used.”
However, Dr. Selk points out that the HPV vaccine can help prevent acquiring the infection and the National Advisory Council on Immunization has no upper age limit regarding offering the vaccine.
“We need to work to get everyone vaccinated and into screening programs,” says Dr. Selk. “We need to have both clinicians and patients tracking results, and work to get HPV testing part of funded screening in the future, while centralizing and organizing colposcopy, so patients with abnormal screening results are automatically referred to colposcopy, ideally by Cancer Care Ontario, in order to try and eliminate cervix cancer in Canada.”
You can read more about Karla Van Kessel’s story at CBC’s White Coat, Black Art website.
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