Sex and Gender-based Analysis of this topic
Definition
Cervical cancer starts in the cells of the cervix, which connects the uterus to the vagina. Precancerous changes to the cervix cells, known as dysplasia of the cervix, can develop into cancer if not treated, but most women with dysplasia do not develop cancer [1]. Dysplasia of the cervix is routinely screened with a Papanicolaou (Pap) test or smear. According to the Public Health Agency of Canada, it is estimated that approximately 1,300 women were diagnosed with cervical cancer in 2008 and that 380 women would die from cervical cancer [2].
Cervical cancer accounts for approximately 1.1% of all female cancer deaths [2]. Largely because of the widespread use of the Pap test detecting pre-malignant lesions, cervical cancer incidence and mortality rates have been declining (2.3% and 3.3%, respectively) for a number of years. For example, between 1996 and 2005, cervical cancer incidence declined 2% per year. This trend is anticipated to continue with regular Pap tests and the introduction of a human papillomavirus (HPV) vaccine.
There are two types of risk factors for developing cervical cancer: 1) factors associated with the development of HPV infection leading to cervical cancer (see Sex Issues) and 2) factors associated with the failure of pre-cancer or cancer detection and management (see Gender Issues) [3].
Sex Issues
The main risk factor for developing cervical cancer is infection of the cervix with HPV [1]. HPV encompasses a group of over 100 different viruses, some of which can be passed through sexual contact. Approximately 70-90% of women will clear high-risk infections of HPV without treatment within 12-30 months [4]. Certain types of HPV (HPV 16 or 18) can cause changes in the cervix that can lead to cancer. As such, risk factors for cervical cancer include becoming sexually active at a young age, having many sexual partners, and/or having a sexual partner who has had many sexual partners [2]. There are a number of risk factors that may contribute to developing cervical cancer including: a weakened immune system from taking transplant drugs or AIDS drugs; taking birth control for a long period of time; having many children; having taken diethylstilbestrol (DES) or being the daughter of a mother who took DES; tobacco use; and a history of sexually transmitted infection(s) (STIs).
Gender Issues
Canada approved the use of the HPV vaccine in 2006, which offers protection from four of the most common types of HPV (low-risk Types 6 and 11 linked to the development of genital warts and high-risk Types 16 and 18 linked to the development of cervical cancer) [3]. The vaccine is recommended for girls between the ages of 9 and 26 [2] and the National Advisory Committee on Immunization (NACI) recommends vaccination for girls specifically between the ages of 9 and 12 as this is before most girls become sexually active [5]. Currently, HPV vaccine is not recommended for prevention in males.
Diversity
According to data from the Canadian Cancer Registry Database, 67% of cervical cancer cases occur in women aged 30-59 [2]. Young women who are sexually active may be more susceptible to HPV and subsequently cervical cancer. HPV prevalence ranges from 10-29% depending on the age group; peak prevalence tends to occur in female adolescents and young adults (<25 years) [3]. Inuit women in Nunavut experience a high rate of HPV (86%) compared to the general Canadian population [6]. Another study found that Aboriginal women were more likely to have HPV Type 18 compared to non-Aboriginal women [7]. Based on data from the Canadian Community Health Survey 2003 and 2005, non-heterosexual women may be at a higher risk for contracting HPV due to lower PAP screening rates [8].
Critique
The Public Health Agency of Canada is working with federal and provincial governments to improve the quality of cervical screening programs to reach at-risk women, standardize screening procedures, monitor results, and provide follow-up procedures [9]. The Society of Obstetricians and Gynaecologists of Canada (SOGC) suggest that innovative and effective strategies are needed to increase screening rates among populations of women who are historically missed from screening programs, such as Aboriginal women, older women, new immigrants to Canada, and other marginalized women [10]. The SOGC suggest that improved screening programs could help identify women who are at risk for recurrent HPV infections. The SOGC also suggest a nationwide cervical cancer screening program to be integrated with a HPV vaccination database to assess the utility of the vaccination at a population level.