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2023-03-02

Cervical Cancer: Screening, Challenges, and Remedies for Healthcare Professionals

While cervical cancer was once a leading cause of cancer death, the combined efforts of increased education, screening, research, and prevention methods have significantly reduced its impact among women worldwide.

Still, according to theĀ Canadian Cancer Society (CCS), an estimated 1,450 women were diagnosed with cervical cancer in 2022, with 380 deaths among them.

In Canada, cervical cancer accounts for approximately 2 percent of new cancers in women, with 67 percent of these occurring in women between 30 and59. Over the last few decades, the incidence rates of cervical cancerĀ have decreased steadily, with increased awareness, screening, and testing the likely reason.

Cervical Cancer Research Update

Cervical cancer research has already led to several breakthroughs in prevention and treatment.

The American Association for Cancer ResearchĀ reports that various new immunotherapeutic strategies (for example, the recentlyĀ approved checkpoint inhibitor pembrolizumab [Keytruda]) are being used in the successful treatment of cervical cancer.

AĀ Lancet OncologyĀ modeling study also indicates that the continued spread of cervical cancer screening and availability of HPV vaccines could prevent approximately 13 million global cases of cervical cancer by 2069.

Screening for Cervical Cancer

Regular cervical cancer screenings are paramount for early detection, leading to the best preventative and treatment efforts. According to theĀ Canadian Cancer Society, there are two screening options patients should be aware of:

  • The pap test:Ā Pap tests (pap smears) screen for precancers, cells that might become cancers if left untreated. The CCS recommends that women receive a pap test every one to three years, starting at age 21.Ā 
  • The human papillomavirus (HPV) test:Ā HPV is one of theĀ most common sexually transmitted infections in Canada and aĀ leading cause of various cancers, including anal, vaginal, vulvar, laryngeal, and oropharyngeal. AroundĀ 3 out of 4 sexually active Canadians are likely to contract HPV once in their lifetime. Nearly all cases of cervical cancer are believed to be linked to the HPV virus. HPV screening starts around 30, and women should speak to their gynecologists to determine the recommended testing frequency.

Prevention and Remedies

The best preventative remedy for cervical cancer is the HPV vaccine.

Health Canada recommends that girls and women between the ages of 9 and 27 receive the vaccine. It may also be administered to those 27 and older who have an ongoing risk of exposure.

The Canadian governmentĀ has approved three HPV vaccines:

  • Gardasil, 4vHPV
  • Gardasil 9, 9vHPV
  • Cervarix, 2vHPV

It is also important to remind patients to continue getting regular screenings, even if they have received the vaccine.

Barriers and Challenges

Despite increased awareness and access to screening in recent years, various barriers to testing continue to prevent thousands of women from being screened for cervical cancer.

A recentĀ systematic review of various studies revealed three primary categories of barriers and challenges to cervical cancer screening (CCS):

1. Awareness Barriers

72.2 percent of reviewed studies reported that lack of knowledge or awareness of cervical cancer screening/prevention was a leading barrier to women opting for regular tests. Lack of physician recommendation and participantsā€™ health literacy gaps are contributing factors.

2. Socio-Cultural and Psychological Barriers

Another common set of barriers to regular CCS is socio-cultural and psychological. A large number of young people appear resistant to testing due to factors like:

  • Anxiety
  • Fear of pain
  • Embarrassment
  • Sexual stigmas
  • General discomfort around visiting a gynecologist

Additionally, “the fear of finding cancer” is anotherĀ major psychological barrier in this group.

3. Systemic/Practical Barriers

Systemic, economic, and practical barriers are the final category of reasons why young women ignore or delay testing.

The cost of testing is a significant factor, especially among women without healthcare insurance. Other factors preventing regular CCS are:

  • Language barriers
  • Forgetting to make an appointment
  • Lack of time or transportation
  • Lack of access to female gynecologists

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