Canada can prevent cervical cancer, but isn’t

Across Canada, women are being diagnosed with cervical cancer after receiving “normal” pap test screening results. Some die. And this is happening because Canada’s health system continues to use a cervical screening test it knows can miss cancer.

Our recent study found that in just two years, 132 women in Eastern Ontario were diagnosed with cervical cancer. Eighteen of them died. They did not have to.

While several provinces have shifted to more accurate Human Papillomavirus (HPV)-based screening, Pap-based testing is still widespread across much of the country. Those 18 deaths are not a regional phenomenon.

This should be unacceptable. 

Cervical cancer is caused by infection with certain HPV strains. Because the disease develops slowly, effective screening can create a window of opportunity for intervention, years before cancer develops.

For many decades, cervical screening in Canada relied on the Pap test, which looks for abnormal cells after cancerous or pre-cancerous changes have already happened. 

Modern testing takes a different approach, detecting the HPV virus that causes cervical cancer in the first place. This approach identifies risk much earlier and more reliably. Evidence consistently shows HPV testing to be more accurate than Pap testing.

In our own work, the Pap test was falsely negative in a fifth of women who ultimately were diagnosed with cervical cancer.

Despite this, Canada has been slow and uneven in implementing HPV-based screening, even as cervical cancer rates continue to rise.

Our study also highlights how cervical cancer continues to slip through the growing cracks of Canada’s healthcare system. More than half of cases we found in Eastern Ontario were women who weren’t adequately screened, often because they didn’t have a primary care provider.

Australia, which has access to the same tools and evidence as Canada, is now on track to eliminate cervical cancer by 2035. They’ve achieved this through widespread HPV vaccination, full adoption of HPV-based screening, and national support for self-testing. This is the roadmap.

Our own findings point to a clear path forward. First, HPV-based cervical screening must be implemented consistently across Canada, rather than adopted unevenly.

Second, screening programs must be designed around the realities that keep people from participating. HPV self-collection is a proven way to reduce barriers related to trauma, discomfort, access to care, and geography. Each of these factors is a known barrier to screening, but self-testing, which addresses all of them, is still not recommended nationally.

Finally, we still use mailed paper reminders for screening. We need to move beyond snail mail to reminders through text or email alerts, which are more effective at translating awareness into completed tests. 

Canada has the evidence, the technology, and the clinical experience needed to eliminate cervical cancer. What is missing is consistent, timely implementation, and public and political will. Until this changes, women will continue to die from a disease we know how to prevent.

Anna N Wilkinson, MD, MSC, CCFP is a Family Physician and GP Oncologist at the Ottawa Hospital and an Associate Professor in the Department of Family Medicine, University of Ottawa.

Tara Baetz, MD, FRCPC is a Medical Oncologist at BC Cancer Victoria and is a Clinical Associate Professor of Medicine at the University of British Columbia.