Imagine a cancer that is almost 100-per-cent preventable. A cancer for which screening is readily available, that detects precancerous cells and can result in effective treatment, preventing cancer from even developing.
That’s cervical cancer.
Cervical cancer is a cancer of the cells lining the cervix — the lower part of the uterus that connects the vagina to the womb — and as recent research has shown, it is preventable.
That’s not to say that cervical cancer is not still life-threatening.
Dr. Erica Mantay, Central Local Health Integration Network (LHIN) cervical screening and colposcopy lead for the Central Regional Cancer Program, noted that cervical cancer affects 12 in 100,000 Canadian women. Annually in Ontario, about 750 women are diagnosed with cervical cancer — and 160 die of the disease.
That’s because cervical cancer may be symptom free in its early stages, but once it reaches Stage 4 and metastasizes to other organs, the five-year survival rate is only 15 per cent, said Mantay.
The five-year survival rate, when the cancer is detected early, at Stage 1 for example, is 93 per cent.
It is a statistic that highlights the importance of screening. The PAP smear test can detect pre-cancerous, abnormal cells, allowing for treatment that prevents cancer from developing — and that can detect the cancer in its earliest stages, when outcomes are most positive.
Pap tests are not available around the world, which is why “globally, it’s the second-most common cancer in women,” said Mantay.
The low rates of occurrence and high survivability in Canada are “a testament to the screening process,” she added.
There is a new advance that has made prevention even more possible: the discovery of the link between human papillomavirus (HPV) and cervical cancer.
“The HPV virus is what causes almost all cervical cancer,” Dr. Mantay explained, noting it is responsible for an estimated 99 per cent of cervical cancers.
As a result, the Ontario government has not only funded a vaccination program for Grade 7 students, as a key to preventing HPV infection and, ultimately, cervical cancer, “last year the Ontario government stated that it intended to screen for the virus first, and the PAP is used as a secondary test.”
The aim is to make “HPV high risk screening ... in the near future become the primary screening test for cervical cancer for women 30 years and older,” said Mantay, an obstetrician gynecologist at Southlake Regional Health Centre in Newmarket.
HPV can be transmitted by intimate skin-to-skin contact with someone infected with the disease.
“That doesn’t have to be intercourse,” said Mantay.
In fact, statistics suggest that 75 per cent of the population is infected with HPV at some time in their life.
Most people exposed to HPV will clear the virus from their systems without suffering any consequences. For some women, especially those who have certain risk factors, exposure increases the likelihood of developing cervical cancer, she said.
Those risk factors include smoking: “Smokers are less likely to have the appropriate immune response, to restore the cells,” said Mantay. Other co-factors include sexually transmitted diseases, and multiple sexual partners, increasing the risk of HPV exposure.
The link between HPV and cervical cancer opens up tremendous possibilities. It means, said Mantay, “the vaccine is the primary prevention, the screening is the secondary” and there is a possibility that cervical cancer can be eradicated in Canada.
Unfortunately, although the vaccine is offered free to Grade 7 students, both male and female – only women develop cervical cancer but men can spread HPV – the rate of participation in the vaccination program ranges from a high of 91 per cent in Newfoundland to a low of 40 per cent in the Northwest Territories, according to a 2016 report by the Canadian Cancer Society. The average vaccination rate in Ontario is 80 per cent.
Oct. 15-19 is Cervical Cancer Awareness Week. Doctors across the province, like Mantay, are taking the opportunity to urge women over the age of 21 be regularly screened for cervical cancer.
“We really would like to remind them that that is important until after the age of 70, unless you’ve had a hysterectomy,” she said.
Why 70? If screenings have been normal between the ages of 60 and 70, there is little likelihood that the slowly-developing cancer will impact lifespan, she explained.
Mantay acknowledged many women dread the test and fear the discovery of abnormal cells — but she was reassuring.
“When I see women with pre-cancerous cells, they are quite anxious. It’s not welcome news, but it’s good news that you’ve gone for screening,” she said, noting early detection and treatment have positive outcomes. “The ones who aren’t going for screening are the ones that should be anxious.”
Cervical cancer does not have the high profile of breast cancer, which will impact one in eight Canadian women during their lifetimes. But “it’s much more preventable,” said Mantay, encouraging women to get screened.
“Every case is unfortunate because it could have been prevented.”
This year, National Cervical Cancer Awareness Week is being celebrated with the PAP — Prevention and Awareness Program — campaign, urging women to get a PAP test, and help prevent cervical cancer.
Symptoms of cervical cancer:
- Early stages may be symptom free.
- Cervical cancer can cause nausea, fatigue and unexplained weight loss. Other symptoms include pale, watery pink, brown or bloody discharge between periods; unusually heavy or long periods; bleeding after sexual intercourse or after menopause; odour and pelvic pain.
- As the cancer advances, additional symptoms can include lower back pain, swelling in the legs due to fluid buildup, difficulty urinating and blood in urine, swollen abdomen, nausea, vomiting and constipation. See your health-care provider if you have any of these symptoms.