Cervical cancer screening guidelines change

Recently the government made a decision to change its guidelines on Pap tests, which screen for cervical cancer, from every year to every 3 years. The projected saving in Ontario is $1.5m per year, but is it worth it?

Screening is an essential part of beating cervical cancer – if it’s caught early, it is treatable but if not, it can be a killer. A report published in 2012 by the Canadian Cancer Society had this to say about cervical cancer:

“Incidence and mortality rates have continued declining for cervical cancer, by 1.4% and 2.9% per year, respectively, since 1998. This is largely due to widespread, regular screening with the Papanicolaou (Pap) test, which detects pre-malignant and malignant lesions early so that they can be treated.”

Mortality rates have been declining by 2.9% per year? Surely that means that annual screening is working, so why change it? Some would say that the declining mortality rate is due to the HPV vaccine, but Health Canada only approved the vaccine in 2006 and it’s used on women who are too young to develop the cancer so clearly, the vaccine has not had any effect on the statistics yet.

The decrease is all down to screening. In fact, some say that the vaccine program is overkill, as there are only 400 deaths per year in Canada from this particular cancer. But most of those women didn’t have a routine Pap test. As with most cancers, by the time it’s symptomatic it’s too late. Three years is a long time in the world of cancer, in a gap like that a lot can change.

There is still the option of paying for an annual test, but the worrying thing is that this will deter women who would have happily gone for a free one. It’s not about being out of pocket, it’s about whether women will bother going if they have to pay for it themselves. As far as I’m concerned we should be encouraging women to get screened, not putting them off.

One argument for reducing the frequency of testing is put forward by Philip Castle of the American Society for Clinical Pathology:

 “If you test every year you find a lot of benign infections that would go away on their own… You end up overscreening, overmanaging and overtreating women who are not actually at risk of getting cervical cancer.”

That may be true, but I would take the risk of overtreating over the risk of cancer. Another argument is that it brings Canada in line with other countries, which only test once every 3 years.  Doing something just because other people are doing it has never been a great argument as far as I’m concerned.

In short, I’m apprehensive about these changes. Are you?

Until next time,

Peace, love and vitamin C!