Sex and Gender-based Analysis of this topic
Definition
Cervical cancer screening has been shown to reduce morbidity and mortality from cervical cancer. The Papanicolaou (Pap) smear test is used to detect changes to cervical cells and women are recommended to have regular Pap tests in order to detect cell changes while treatment can be effective (before they become cancerous). While cervical cancer is the tenth most common cancer among Canadian women of all ages, it is the third most common among women aged 20 to 49[1]. The BC Cancer Agency’s Cervical Cancer Screening Program (CCSP) has succeeded in reducing cervical cancer incidence rates by over 70 percent[2].
Sex Issues
Health Canada states that some of the important risk factors for women developing cervical cancer include: contracting Human papillomavirus (HPV) as a result of having multiple sexual partners or becoming sexually active at an early age (as cervical tissue undergoes many changes that might make the area more vulnerable to damage), smoking, having a lowered immune system, and long-term use of oral contraceptives[3]. In order for cervical cancer to develop from HPV, one of the approximately 15 oncogenic types must be present long enough to cause changes to the cervical cells. It is estimated that as many as 75% of sexually active men and women will have at least one infection in their lifetime[4]; however, the virus usually clears up on its own within 24 months without treatment[5]. HPV infection can often be asymptomatic so it is important for women to have regular Pap tests in order to detect changes to cervical cells.
Gender Issues
There are a number of issues that may prevent women from accessing regular cervical screening. Some social/system barriers include poverty, transportation to services, and lack of child care. Some important individual barriers include lack of knowledge about tests and feelings of shame and embarrassment, especially if a female health care provider is not available. Young women may not feel comfortable admitting they are sexually active and may avoid Pap tests, which may be why the Public Health Agency of Canada suggests that increasing numbers of young women are not being screened[6].Women who have been sexually assaulted or are in violent relationships may not be screened regularly because they feel they are not in control of their body. All of these barriers may be further compounded if services are not provided in the woman’s first language.
Diversity
According to Health Canada, most women who develop cervical cancer have not been screened in the three years prior to their diagnosis. A large majority of these women are either older, lesbian, new immigrants, live with a disability, come from the Aboriginal community, do not live within closer proximity to health services, or those from a lower socio-economic status. Specifically, based on data from the 2003 and 2005 Canadian Community Health Survey, less than two-thirds of lesbians reported having had a Pap test within 3 years of the survey.
Health care providers have started to incorporate culturally sensitive procedures in an effort to address some of these barriers. For example, BC Women’s Hospital hosts both an Asian Women’s Health clinic where services are offered in Chinese and Korean[7] and cervical screening clinics that travel to Aboriginal communities throughout British Columbia.
Critique
BC and Nova Scotia have had long-running, established programs for cervical screening, while Alberta, Manitoba, Ontario, and Prince Edward Island more recently launched programs. However, there is no central information system to monitor screening activity or cytology outcomes, which makes it difficult to compare incidence and mortality across the different provinces[8].