Cervical Cancer Awareness: Spotlight on prevention

 

Did you know cervical cancer is one of the most preventable types of cancer? Read on to learn about what causes it, what “precancerous” cells means, and how Canada is working to eliminate cervical cancer by 2040.1



Cervical cancer in Canada

1 in 168 people are expected to develop cervical cancer in their lifetime, and 1 in 478 are expected to die from it.2 The mortality rate has improved over time, thanks to increased prevention and screening measures. Because so many cervical cancer diagnoses are preventable, the World Health Organization put out an elimination initiative, and Canada is working towards a goal of eliminating cervical cancer by 2040.1

What causes cervical cancer?

Almost all cases of cervical cancer are caused by a type of virus called the human papillomavirus, or HPV.

What is HPV?

HPV is the most common sexually transmitted infection (STI) in the world and can affect anyone who is sexually active. Although condoms help prevent HPV from being spread, HPV can also be passed through skin-to-skin or oral contact with the genital area, without having intercourse. Most people who get HPV will clear the virus within 6-12 months, however, if the body is not able to clear it, it can cause the development of precancerous cells, which can eventually become cancerous. There are many different strains of HPV. The “high-risk” types are the ones that can cause certain cancers, such as head and neck, throat, vaginal, vulvar, anal, and cervical cancer.

How do we detect cervical cancer?

A PAP test is a physical exam where a small sample of cells are taken from the cervix, to look for any abnormal changes. These abnormal changes can be precancerous cells, that are not yet cancerous. Regular PAP tests can help us catch precancerous cells and early stages of cervical cancer. The Canadian Task Force on Preventive Health Care (CTFPHC) recommends cervical cancer screening every three years for people ages 25-69. Some provinces and territories have changed their guidelines to align with the CTFPHC’s.3 In Ontario, cervical screening via a PAP test is recommended at age 21 for those who are or have been sexually active.

It is recommended that people with a cervix, continue to go for PAP tests every three years until the age of 70. Licensed naturopathic doctors (NDs) are trained to perform PAP tests. If you are uncomfortable receiving a PAP, talk with your healthcare provider about how they might be able to make the PAP test more comfortable for you.

Once the new “Action Plan for the Elimination of Cervical Cancer in Canada” is implemented in Ontario, most people will be screened through HPV testing (rather than a PAP test) beginning at age 25. Eventually, the goal is to be able to have people self-sample at home.

How can we prevent cervical cancer?

HPV vaccination has been recommended in Canada since 2006. A U.K. study published in the Lancet in 2021 found that rates of cervical cancer were reduced by 87% in those who were vaccinated at a young age (12-13 years old).4 In those who received the vaccine between ages 16 and 18, cancer rates were 34% lower than in unvaccinated groups. Getting vaccinated before sexual activity begins offers the best protection, since this prevents someone from ever getting HPV.

Gardasil-9 for example, has an effectiveness close to 100% when given before someone is exposed to the virus (before engaging in any sexual activity).

There are still major disparities in screening for cervical cancer.

Rates of cervical cancer are much higher, and survival much lower, among First Nations women compared to non-First Nations women in Ontario.5,6 Additionally, trans populations have a significantly lower screening rate than cis populations (56% vs. 72%).7

Of the deaths caused by cervical cancer worldwide, about 90% of them occur in low- and middle-income countries.8

To achieve the goal of eliminating cervical cancer, barriers to accessing preventive and screening measures need to be addressed.

Integrative support for HPV and cervical cancer.

Naturopathic doctors cannot treat cancer; however, they offer supportive care during cancer treatment, and afterwards. For example, NDs can help prevent weight loss during chemotherapy, help prepare for and heal from surgery, and work to maintain quality of life and prevent side effects from treatments like radiation.

If someone is positive for HPV, naturopathic doctors may recommend interventions to try to support the body in clearing it. Some treatments that have research suggesting a possible benefit to HPV clearance include Trametes versicolor (Coriolus or turkey tail mushroom)9 and Ganoderma lucidum (Reishi mushroom),10 AHCC,11 and other nutritional and nutraceutical interventions like EGCG, folic acid and vitamin B12.12,13

Sometimes, despite all our best efforts, cancer still develops. Fortunately, screening and treatment options are advancing, and survival rates are increasing for cervical cancer as a result.

Acronyms:

AHCC – Active Hexose Correlated Compound
CTFPHC – Canadian Task Force on Preventive Health Care
EGCG – Epigallocatechin Gallate
HPV – Human Papilloma Virus
PAP test – Papanicolaou test

Author: Dr. Erica Rizzolo, ND

Erica is a licensed naturopathic doctor at The Centre for Health Innovation, where she works with people affected by cancer, as well as other conditions such as anxiety, eating disorders, and Inflammatory Bowel Disease. Erica joined the team at The Patterson Institute for Integrative Oncology Research as a research assistant in 2022, and continues to support research initiatives. She is also a member of the research committee for the Oncology Association of Naturopathic Physicians.

 

 

 

References

1. Cancer CPA. Action Plan for the Elimination of Cervical Cancer in Canada 2020-2030. 2019-2020;

2. Canada PHAo. Cervical Cancer. Government of Canada. https://www.canada.ca/en/public-health/services/chronic-diseases/cancer/cervical-cancer.html

3. Care CTFoPH. Recommendations on screening for cervical cancer. Canadian Medical Association Journal. 2013;185(1):35-45. doi:10.1503/cmaj.121505

4. Falcaro M, Castañon A, Ndlela B, et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. The Lancet. 2021;398(10316):2084-2092. doi:10.1016/S0140-6736(21)02178-4

5. Marrett LD, Chaudhry M. Cancer incidence and mortality in Ontario First Nations, 1968-1991 (Canada). Cancer Causes Control. Apr 2003;14(3):259-68. doi:10.1023/a:1023632518568

6. Nishri ED, Sheppard AJ, Withrow DR, Marrett LD. Cancer survival among First Nations people of Ontario, Canada (1968-2007). Int J Cancer. Feb 1 2015;136(3):639-45. doi:10.1002/ijc.29024

7. Kiran T, Davie S, Singh D, et al. Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data. Can Fam Physician. Jan 2019;65(1):e30-e37.

8. Organization WH. Cervical cancer: overview. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

9. Serrano L, López AC, González SP, et al. Efficacy of a Coriolus versicolor-Based Vaginal Gel in Women With Human Papillomavirus-Dependent Cervical Lesions: The PALOMA Study. J Low Genit Tract Dis. Apr 1 2021;25(2):130-136. doi:10.1097/lgt.0000000000000596

10. Rokos T, Pribulova T, Kozubik E, Biringer K, Holubekova V, Kudela E. Exploring the Bioactive Mycocompounds (Fungal Compounds) of Selected Medicinal Mushrooms and Their Potentials against HPV Infection and Associated Cancer in Humans. Life (Basel). Jan 16 2023;13(1)doi:10.3390/life13010244

11. Smith JA, Gaikwad AA, Mathew L, et al. AHCC(®) Supplementation to Support Immune Function to Clear Persistent Human Papillomavirus Infections. Front Oncol. 2022;12:881902. doi:10.3389/fonc.2022.881902

12. Wang W, Yang A, Zhang H, et al. Associations of RBC and Serum Folate Concentrations with Cervical Intraepithelial Neoplasia and High-Risk Human Papillomavirus Genotypes in Female Chinese Adults. J Nutr. Feb 8 2022;152(2):466-474. doi:10.1093/jn/nxab396

13. Yang J, Yang A, Wang Z, et al. Interactions between serum folate and human papillomavirus with cervical intraepithelial neoplasia risk in a Chinese population-based study. Am J Clin Nutr. Nov 1 2018;108(5):1034-1042. doi:10.1093/ajcn/nqy160