Cervical cancer cases on the rise because they are detected too late

THE CANADIAN PRESS/Nathan Denette

The most recent Canadian data show that cervical cancer is now the fastest growing incidence among women. Screening remains the best way to prevent this cancer, which is preventable when detected at the precancerous stage.

After declining for three decades, the incidence of cervical cancer increased by 3.7% per year between 2015 and 2019, according to the Canadian Cancer Society (CCS). This is the first significant increase since 1984.

The CCS estimates that 1,600 Canadian women will be diagnosed with cervical cancer in a year and 400 will die from it. “They are often found too late,” laments gynecologist Céline Bouchard.

“There are more and more cases and the cases are more advanced,” she notes. And it’s a shame when we know that it can be cured when it’s a precancer, it’s easily treated.”

With vaccination and screening, it would be possible to virtually eradicate cervical cancer.

It is the third most common cancer among women aged 40 to 44, said the gynecologist. “It’s a shame because it’s the only cancer that can be prevented. The others, they don’t prevent themselves,” she emphasizes, specifying that it is still possible to act on risk factors such as smoking for other cancers.

In addition, costs for society also increase when it is detected too late, among others for radiotherapy treatments, chemotherapy and invasive surgeries.

Several factors can explain the increase in cases of cervical cancer, according to Dr. Bouchard. Firstly because many Quebec women do not have access to a family doctor who will monitor the frequency of screening.

Also, there is no registry. “Women don’t receive a letter like they do for breast cancer,” laments Dr. Bouchard. Gynecologists have been asking the ministry for 40 years [de la Santé] to make a patient register and send letters. How do you expect people to remember when they had their screening test when it will be every five years? Already at the age of three, they almost never remember it. It’s not easy to remember all that.”

Unlike the Pap test, which must be done every two or three years, the new HPV test will be done every five years.

Abandoning the Pap test too slowly

In May 2022, the Minister of Health and Social Services, Christian Dubé, announced that the HPV test would be implemented as a primary screening test for cervical cancer following the recommendations of INESSS.

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The HPV test is much more precise than the Pap test, emphasizes Dr. Bouchard. It’s relatively the same procedure for the patient, that is to say the gynecologist passes over the cervix with an instrument to harvest cells.

With the HPV test, the sample is put into a liquid that will be analyzed. If the test is positive, the same sample can be used for follow-up cell testing.

This helps detect the presence of high-risk HPV which can lead to the development of precancerous lesions and, if left untreated, lead to cervical cancer.

According to the Ministry of Health website, Bas-Saint-Laurent, Gaspésie, Chaudière-Appalaches and Lanaudière are the only regions to offer the HPV test.

“The minister announced to us that in 2022 we were transferring [au test] HPV, but currently there are only four regions that have converted to [test] HPV. These are the least populated regions,” laments Dr. Bouchard.

With the HPV test, “we do not lose cases that would be positive and would not be detected [avec le Pap test]» and it can detect 14 precancerous types. “It’s the best test to have,” emphasizes the doctor.

In June 2024, the Ministry of Health indicated in a written response to The Canadian Press that the objective is still to replace the Pap test with the HPV test in all regions of Quebec by 2026.

He gave as an explanation for the deployment delay that the new test requires the acquisition and installation of specific equipment.

The Canadian Press’ health content receives funding through a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for editorial choices.

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