After decades of decline, rates of cervical cancer within Canada have plateaued, according to the Canadian Cancer Society — a troubling trend for some experts, given that the type of cancer is preventable.
Between 1984 and 2005, rates of cervical cancer had been dropping steadily. But a report published Monday by the Canadian Cancer Statistics Advisory Committee shows a plateau in the annual percentage change for cervical cancer rates, which is just under zero for the period from 2005 to 2021.
“Cervical cancer is not one of the most common causes of cancer death for females in Canada, but each one of the 430 deaths expected in 2025 due to this cancer was potentially preventable,” the report said.
Cervical cancer is widely preventable through vaccinating against and screening for human papillomavirus (HPV), a sexually transmitted infection which causes this type of cancer, as well as some head and neck cancers.
The World Health Organization has pledged to virtually eliminate cervical cancer within the century by reducing rates to fewer than four cases diagnosed per 100,000 females, while Canada has set a goal to eliminate it within the country by 2040.
“If things continue as they are now, we’re not going to make that timeline,” said Brandon Purcell, advocacy manager of prevention and early detection with the Canadian Cancer Society.
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The data shows a “concerning plateau” according to the news release for the report. The Canadian Cancer Society’s director of surveillance Jennifer Gillis says it’s likely due to lower HPV vaccination rates, a decline in the rate of people getting screened, and gaps in follow-up care.
It’s disappointing news to Shannon Pethick, who was diagnosed with cervical cancer at the age of 32 and went through extensive radiation and chemotherapy treatments to fight it.
“It’s one of the hardest things I’ve ever gone through, and I’m grateful that I came out the other side … but I wouldn’t wish what I went through on anybody,” Pethick said.
Despite the discomfort that comes with a pap smear — a test that’s widely used to test for abnormal, possibly cancerous cells in the cervix — Pethick urges women not to put screenings or other prevention methods off, given the possibly dire consequences.
“I think if people understood the consequences of not having those tests, of not having those vaccines … I don’t think we would be here,” Pethick said. “The minor inconvenience … of that pap is just so minuscule compared to what you could be going through if you’re not checking that.”
She also hopes that more education might make women more aware of the options they have for prevention and testing.
Doctors in Ontario will now test for HPV, the human papillomavirus, a more accurate test to screen for cervical cancer than the pap test that had been used. Many say it’s a step in the right direction, though it still requires an intrusive pelvic exam.
More screening, vaccination could turn things around
Purcell says Canada could get back on track to meet its 2040 elimination goals if it adopted policies to boost vaccination, increase access screening and adopt HPV testing rather than pap testing for cervical cancer.
Dr. Amanda Selk, an obstetrician gynecologist at Women’s College Hospital in Toronto, says she’s not surprised by the report’s findings as she’s seen screening decrease in recent years as people have had less access to their doctors during the COVID-19 pandemic, and more Canadians find themselves without a family doctor. She says we need to find “new ways to get people screened that don’t involve a family doctor,” be it through nurse-run clinics or at-home testing.
At-home testing — which involves taking a vaginal swab yourself and mailing it off for screening — has only been adopted in B.C. so far. That option has proven effective in other countries, including Sweden, which saw population test coverage for the Stockholm region increase from 75 per cent to 85 per cent in just one year when they first introduced the option to test at home during the pandemic.
A new report in the Canadian Medical Association Journal recommends self-screening for certain medical issues like cervical cancer to help reduce inequity among certain groups that avoid getting tested. Experts say the measure could help catch more cases of cervical cancer and might potentially eliminate it altogether.
Selk says she would like to see the option to test at-home adopted countrywide. “I think that’s what women in Canada want … they want options,” Selk said. “We have the technology, we just don’t have the access.”
Replacing the pap smear, which involves taking a vaginal swab and testing for abnormal cells in the cervix that are or could turn into cervical cancer, with a test for HPV is another measure the Canadian Cancer Society recommends.
While a pap smear only detects already abnormal cells, testing for the HPV virus gives doctors an idea of whether a patient might develop cancer in the future. Ontario, B.C., Quebec and P.E.I. have all replaced pap testing with HPV tests so far — a step Selk calls “amazing.”
The HPV vaccine has also proven very effective at preventing cervical cancer — a 2024 study in Scotland found there were zero cases of cervical cancer among young women who were fully vaccinated for HPV.
The shot is free for school-aged children across Canada, and Selk encourages parents to have their kids vaccinated against HPV. Adults who missed out on the shot while they were in school are still able to catch up, according to experts, though often have to pay out of pocket for it, which can cost hundreds of dollars.
Purcell says switching to a “once eligible, always eligible” policy that would allow Canadians to get the shot for free regardless of their age would help more people get protected against HPV and the cancers it causes.
Out-of-the-box vaccination campaigns in other countries like Sweden, where their public health department teamed up with movie theatres to give away movie tickets and HPV shots at the same time, have also helped increase vaccination. Sweden also has program allowing some women who previously received an older version of the vaccine to get caught up on the most effective dose for free.
Other findings
Outside of the findings for cervical cancer, there were silver linings in the data, which assessed the impact of all types of cancer within Canada broadly.
More Canadians are surviving battles with cancer overall — in the 1990s, the five-year net survival rate for all kinds of cancer was 55 per cent, but that figure is now 64 per cent, according to estimates.
The incidence and amount of deaths resulting from lung cancer and colorectal cancer in particular have also decreased in recent years.
