A message from Dr. Unjali Malhotra, Medical Officer, Women's Health
January is Cervical Cancer Awareness Month. The cervix, as part of the female reproductive system, is out of sight, but it shouldn't be out of mind, because cervical cancer – which is usually preventable – is the leading cause of cancer death in women - including First Nations women - across the globe.
This fact is just one of the reasons to celebrate the great news that Canada's first female First Nations general surgeon, Dr. Nadine Caron, was named the inaugural First Nations Health Authority Chair in Cancer and Wellness at the University of British Columbia on Jan. 6. Dr. Caron's focus will be on improving cancer outcomes and wellness among Indigenous peoples. She says she regularly hears difficult stories from Indigenous patients in rural BC – stories about lack of or barriers to access and how the historical mistreatment of Indigenous peoples has led many to distrust the system and hesitate to go for screening or even treatment and surgery.
“For example, after I strongly recommended surgery to one Indigenous woman with cancer, she eventually disclosed that she had had such horrific experiences that she felt she could not face going into a hospital," says Dr. Caron, who provides surgical cancer care to rural populations, while also serving as co-director of UBC's Centre for Excellence in Indigenous Health.
First Nations women and cervical cancer
First Nations women in BC are 92 per cent more likely to be diagnosed with cervical cancer than non-First Nations women, and survival rates are generally lower.
“Many of us put off screening due to past trauma or unsafe care," says Dr. Shannon McDonald, Deputy Chief Medical Officer of the FNHA. “There is also the issue of lack of access in remote areas. It is so important that we turn this story around for the next generation, that we encourage screening and create safe spaces and care for First Nations clients."
It's very important that Indigenous women feel safe and comfortable to go in for screening, as Pap tests have drastically reduced the number of people who die from cervical cancer, and this reduction is the best proof that prevention is the key to fighting cervical cancer. Read on to learn what cervical cancer is and what causes it, and most importantly, what can be done to prevent cervical cancer. Also check out this video about one First Nations woman's journey.
What cervical cancer is and what causes it
Cervical cancer starts in the cells of the cervix, which is the lower part of the uterus (womb). Sometimes, cells in the cervix change and no longer grow normally; these changes can cause cancerous, pre-cancerous or non-cancerous tumours.
The main cause of cervical cancer is the Human Papilloma Virus (HPV), the most common sexually transmitted infection (STI), which infects three of four sexually active adults. HPV causes various forms of cancers, not just cervical cancer. Although often an HPV infection is not serious and will go away on its own without treatment, when it doesn't go away, certain strains can result in the development of cancer.
Reducing our chances of getting cervical cancer
The good news is that we can reduce our chances of getting cervical cancer by:
a) getting vaccinated/immunized against HPV, ideally between the ages of nine and 26;
b) getting regular screening / Pap smear tests to detect, as early as possible, any precancerous or cancerous conditions of the cervix;
c) practising safe sex, especially using condoms and dental dams;
d) avoiding commercial tobacco; and;
e) getting any treatment that may be needed.
Vaccination builds immunity against HPV infection that causes cervical cancer; it is safe and it works. People who are eligible for this vaccine include females and males in school-based programs, females aged nine to 45, and males nine to 26. For more information about the British Columbia HPV immunization program, visit HealthLink BC.
The HPV vaccine is available free of charge for girls in Grade 6 as well as Grade 9 during the school year. The vaccine is given in a series of two or three shots and may be obtained through doctors, pharmacists, youth and sexual health clinics, student health centres and public health units. Girls and women who want to receive the vaccine but do not fall into the eligible age range can ask their physician or pharmacist about purchasing the vaccine for their physician or pharmacist to administer.
Regular screening for cervical cancer (via Pap tests) saves lives by detecting cancers or pre-cancerous conditions early, often before they have spread. Screening is provided by healthcare providers and women should start getting Pap tests at either the age of 21 or three years after becoming sexually active, whichever comes later. This includes women in same-sex relationships and transgender and two-spirit people with a cervix.
To find a nearby clinic with a screening program, visit the BC Cancer Agency. The test is free and can be done by a healthcare provider at their office or clinic. If you have a cervix and are age 25 to 69 you should be screened every three years. For information about the program for young people, visit the BC Centre for Disease Control. You can also call 8-1-1 toll free in BC, or for the hearing impaired, call 7-1-1.
Pap tests can be challenging for those who have endured sexual abuse or trauma. If you or anyone you know is putting off screening for this reason, please read our previous message at https://www.fnha.ca/about/news-and-events/news/sexual-health-and-trauma-honouring-our-mind-body-connection.
If it happens that a Pap is abnormal it is important to know that treatment is available and will usually treat the abnormality. This can also be stressful but it is vital to preventing spread of cancerous cells. There are excellent treatments available to further prevent cervical cancer.
Find out more online:
The FNHA, BC Cancer Society, BC Association of Aboriginal Friendship Centres, and Métis Nation BC released an Indigenous Cancer Strategy in December 2017. One of the strategy's recommendations is to increase access to relevant cancer screening services for Indigenous peoples, with specific focus on cervical cancer screening.