Imagine there’s no cervical cancer. It’s easy, if we try.
Health care is an insatiable driver of provincial budgets.
In Ontario, health expenditures now exceed $87 billion per year and comprise over 40 per cent of overall spending. Such expenses are growing faster than our per capita productivity and show no signs of slowing down.
As a result, governments are rightly skeptical of too-readily adopting and funding new practices and innovations. That said, there are areas of health in which new technologies provide indisputable benefits to patients while actually reducing health spending.
A perfect example is cervical cancer screening for women. Modern testing methods for the virus that causes it, and enabling women to self-collect their test-samples are underused opportunities to vastly improve individual outcomes and reduce system costs.
Most men and women get HPV infections during their lives.
For women, it’s been proven that cervical cancers are the result of persistent infections with specific strains of the Human Papilloma Virus, referred to as high-risk HPVs.
Over years, such chronic HPV infections damage healthy cells and cause them to become cancerous. Screening for such cancers began in the 1950s with Pap tests — microscopic examination of cervical cells to look for signs that those cells have been transformed into cancer.
By catching cancers earlier, this has saved countless lives.
However, it has inherent limitations: the samples need to be collected and prepared by health-care professionals, and Pap tests detect cells that are becoming cancerous right now, in the present, not the HPV that will cause cancer years after infection.
The first problem with our current way of doing things is obvious to the many Ontarians who lack access to a family doctor, and for whom access to a specialist is even more remote.
Women who don’t have a doctor aren’t screened for cervical cancer under our current system, and those who are culturally, economically or geographically isolated are falling through the cracks.
Imagine there’s no wait-list — it isn’t hard to do.
Fortunately, there’s a solution.
Experts have created and validated self-swab kits that enable women to collect a sample at home for testing by a clinical lab — in a manner that is comfortable, convenient, easy, reliable and safe.
At a bare minimum, this innovation needs to be encouraged for women who aren’t now getting screening.
Imagine no appointments — I wonder if you can.
The solution to the second limitation of our Pap-based system is also ready and waiting. Modern molecular testing methods such as PCR can reliably detect the high-risk HPV types that cause cervical cancer and find it years before any cancer has had time to form.
This means it is now inexcusable to wait to detect an actual cancer — that may have already spread — when we can find and care for those at risk years earlier.
Imagine all the patients, living without disease.
Ontario does have plans to adopt a form of molecular testing for HPV, but seemingly without much urgency. Current plans suggest a tentative start later this year but without any timeline for encouraging self-collection.
Equally, there seem to be no plans to fully ensure the accuracy of molecular testing, which will help resolve the issues of false negatives (failing to detect high-risk HPV) and/or false positives (reporting the presence of HPV when it’s absent), which can have profound personal consequences for patients.
In recent years, health care in Ontario has seen multiple advancements, with a growing emphasis on patient-centred approaches. But when it comes to cervical cancer prevention, we are still not doing enough to protect the lives of women across the province.
Cervical cancer remains one of the most preventable forms of cancer, yet it continues to claim the lives of hundreds of women in Canada every year.
In addition to the human toll, caring for even one advanced cervical cancer patient costs more than screening tens of thousands of women to prevent it.
The introduction of at-home sample kit collection and properly controlled modern molecular HPV testing methods could provide a big leap forward, but our provincial government and its health leadership must ensure that all at-risk women have access to these life-saving and cost-effective technologies to give friends and fellow citizens the best possible care. We need these new practices and innovations today, not years from now.
You may say I’m a dreamer, but I hope you’ll join us and help get this done.
---
Cameron Groome is CEO & President of Microbix Biosystems Inc., an Ontario-based and TSX-listed company that employs 130 professionals and creates, manufactures and exports testing-related medical devices. He has worked in the Canadian life sciences industry for over 30 years.