Why uterine cervical cancer screening is not the same everywhere in Canada

The Question

I recently moved from Ontario to Alberta. At the first appointment with my new family doctor, I learned that Alberta does not begin to test for cervical cancer before the age of 25 years. I have already had one of these tests in Ontario. Why not try the same thing everywhere in Canada? My body did not suddenly change when I crossed a provincial border.

The Answer

We tend to view our health system as a national program. In reality, the provinces and territories are responsible for delivering health services. This means that local authorities are responsible for setting up health programs and sometimes opinions differ as to the best approach. As a result, cancer screening may differ from region to region.

But there is now a growing consensus within the medical community that Pap tests should start later – a move already made in Alberta and Britain Columbia. You will probably see more territories and provinces, including Ontario, in the same direction.

"We are looking at the evidence and we will see changes coming," says Dr. Joan Murphy Head of the Cervical Cancer Screening Program Cancer Care Ontario

The main concern is that surgical treatment can lead to unnecessary treatments that can do more harm than good.

Almost all cases of cervical cancer originate from the human papillomavirus. (HPV), which is transmitted mainly through badual activity.

There are actually many types or strains of HPV. Some produce mild warts that the immune system eventually clears. But others can trigger cellular changes that lead to cancer.

Screening of the cervix of the uterus has traditionally involved a Pap test. A doctor or nurse uses an instrument called a speculum to separate the walls of the bad in order to scrape off some cells from the surface of the cervix of the uterus. These cells are then examined under a microscope for alterations that may be cancer precursors.

The purpose of screening is to detect abnormal cells and remove them before they become cancerous.

"Early detection and often tracing the mantra," says Murphy, who is also program manager at Trillium Health Partners

Once the abnormal cells are found, follow-up tests are performed that represent significant precancerous changes, which can then be treated with excisional or laser ablation.

This treatment removes potentially harmful cells, but it can compromise the integrity of the cervix, which plays a crucial role during pregnancy, says Dr. James Dickinson, a professor of family medicine at the University of Toronto. University of Calgary

The cervix, says he, keeps the uterine cavity closed during a pregnancy until it is time r the woman to give birth. If the cervix of the uterus is weakened, the risk of premature birth increases.

The risk is considered relatively low and studies have shown that screening greatly reduces the chances of having cancer of the cervix of the uterus. Even so, doctors can not always say with certainty which abnormal cells will develop into invasive cancer and which ones will resolve themselves and will not be a problem. In order to minimize unnecessary treatments, Dickinson and others have insisted that screening begins when women are at least 25 years old, rather than 21 years old – the usual guideline in a large part of cases. Canada. (The test is repeated every two or three years until the age of 65 to 70 years.)

It points out that very few women develop cervical cancer or adolescence in the early twenties.