Campaign aims to make cervical cancer history

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This article was published 03/02/2020 (2414 days ago), so information in it may no longer be current.

It’s been a long and harrowing journey for Mary Schultz, one she would have preferred not to have taken.

Yet this past December she celebrated an important milestone for this unplanned path in her life: five years of being cancer-free.

“That’s a very good anniversary,” says the 56-year-old Winnipeg mom, who was diagnosed with cervical cancer in 2008 after feeling “a small, dull pain” in her pelvic area.

A Pap test confirmed abnormalities, and within days she was diagnosed with a cancer almost exclusively caused by the human papilloma virus, or HPV.

Schultz — a trim non-smoker who exercised regularly and did not drink alcohol — had no idea she carried the virus.

That’s fairly typical, despite about 80 per cent of sexually active adults carrying one or more variations of HPV.

She became all too aware of the virus and its consequences.

HPV is virtually the only cause of cervical cancer, as well as a common cause of penile, anal and other genital cancers. The virus is also a frequent culprit behind mouth and throat cancers.

A sexually transmitted virus, it as widespread as the common cold. And it’s generally as harmless as a cold, except for the risk of developing cancer.

And while these cancers are often curable when caught early, the consequences are often life-changing.

Consider Schultz’s experience, whose cancer kept returning, eventually leading to a pelvic exenteration.

“They clean out your whole area, so I have no bladder. They took the colon out. To get into the nitty-gritty, I now have urostomy (urine) and colostomy pouches,” she says.

Schultz is sharing her story because she wants to help younger Manitobans avoid the same fate. And indeed all cancers related to HPV are avoidable and preventable through vaccination, experts say.

It’s also why cervical cancer is a key focus of a global initiative, launching today on World Cancer Day. The campaign, which involves Canadian experts, including those in Manitoba, aims to eliminate the disease by 2040.

“Different studies have had different estimates, but somewhere between 40 to 50 per cent of all cancers can be prevented,” says Dr. Donna Turner, epidemiologist and director of population oncology at CancerCare Manitoba.

But cervical cancer is almost 100 per cent preventable, she adds, thanks to a vaccine available for free to children in Grade 6 in Manitoba. (Other at-risk groups are also eligible for the vaccine at no cost.)

As well, the province-wide program CervixCheck further ensures women between the ages of 21 and 69 receive a Pap test every three years. The procedure examines the cervix for pre-cancerous cells before they transform into cancer.

These efforts — and there are similar initiatives in every province — have limited the incidence of cervical cancer in Canada. The same can be said for other developed economies. That’s not so, however, in regions where people have poor access to preventative care.

Turner notes this disparity is illustrated in the difference between the top four cancers here versus the developing world. In Canada, lung, colorectal, breast and prostate are most common cancers, while in economically developing nations, breast, cervix, liver and prostate cancers are most common.

Still, she says, “just because cervical cancer isn’t among the top cancers in Canada, doesn’t means it’s not a major health concern here.”

Although preventable, the Canadian Partnership Against Cancer, which includes Manitoba-based cancer experts and is part of the new global initiative, is focused on ensuring access for all Canadians. That’s because not all us have equal access to care, Turner says.

“In Manitoba we still have between 40 and 50 women diagnosed with cervical cancer every year.”

She adds among the challenges for health-care providers is a general lack of awareness about HPV, which can be transmitted to a sexual partner. As well, underserved populations, such as remotely located Indigenous communities, cannot always easily access preventative care.

Dr. Erin Dean, gynecologic oncologist at CancerCare Manitoba and a clinical expert in cervical cancer, says anyone who isn’t vaccinated and sexually active is at risk.

“About 20 per cent of women who get HPV will eventually get Pap tests with abnormal cells on their cervix,” she says. “That’s a pre-cancer phase, but not all of those women will have pre-malignant changes that need treatment.”

While public awareness about the connection between HPV and cancer is growing, misconceptions persist.

Many people are more likely to associate HPV with genital warts, which involve — like a lot of sexually transmitted infections — a fair amount of social stigma. But wart-causing virus subtypes — and more than 100 subtypes of HPV exist — are not linked to cancer.

Rather a handful of others — most notably subtype 16 — can cause cancer and are often asymptomatic.

As a result people can pass the virus unknowingly even when taking precautions (i.e. using condoms) during sexual contact.

Given how easily HPV can spread, vaccination is the best means to fight it and the cancers it causes. Yet vaccination rates among eligible girls is about 62 cent in Manitoba (no data exists for boys), Dean says. One reason for these low numbers is that parents must sign an opt-in consent form.

“How many times have you found a letter in your kid’s backpack that has been there for two weeks?” she says, adding others may be ignorantly ambivalent, and “might not bother.”

Some also fear vaccination will prompt children to become sexually active earlier, even though research demonstrates this is not the case, she says.

Dean says she would like the province to adopt an opt-out policy, which would likely see more children are vaccinated.

Given how common HPV is, vaccination is “nothing to sneeze at,” Dean says, adding the virus’s long-term consequences can be deadly.

The five-year survival rate for cervical cancer is 72 per cent, less than that of breast cancer (87 per cent). Although often curable when caught early, “even early-stage treatments can have long-term consequences,” she says.

Indeed Schultz lives a very different life today than prior to diagnosis. She has endured chemo and radiation therapy, and a hysterectomy as well as the removal of most of the organs in her lower abdomen.

“The challenges are ongoing.” She frequently battles kidney and other infections. “On the plus side, I’m still breathing.”

All the “big inconveniences,” she says, are worth seeing her daughter Elaine — 12 at the time of her diagnosis — grow up to attend university, and pursue a career in medicine.

Schultz also saw to it her daughter was vaccinated against HPV.

“I didn’t want her to go through what I’ve been through.”

She urges others to do the same, as well as get the recommended regular Pap tests.

After all, Schultz adds, “a little preventative maintenance” can go a long way.

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