Cervical Cancer

The leading cause of cervical cancer is infection with the Human papillomavirus (HPV). In fact, HPV is responsible for roughly 99% of all cervical cancers and is one of the most common sexually transmitted infections.  In most people, HPV will go away on its own and won’t lead to cancer; however, in some people, HPV infection persists and does not go away. This persistent infection can lead to cervical cell changes (abnormal cells) that over time can lead to cervical cancer.

There is no way to know if you have an HPV infection that will lead to cervical cancer, but regular cervical cancer screening will help detect cell changes early. If cell changes are found, you will either be closely monitored or referred to a specialist.   

Screening

Who should be screened for cervical cancer? 

Get screened if you: 

• Are 25 years or older AND
• Have had sexual contact^{Footnote 1}  AND
• Have a cervix (or had your cervix removed for high-grade cervical cell changes) 

If you have a cervix and have had one or more sexual partners, it’s recommended to get screened regardless of your gender or sexual orientation.

Start talking to your healthcare provider about screening for cervical cancer before you turn 21 years of age to ensure you are booked for cervical cancer screening when appropriate for you.

People who received the HPV vaccine should still be screened. This is because the vaccine protects against only some of the high-risk strains that cause cervical cancer, not all strains.  

How do they screen for cervical cancer? 

There are two ways to screen for cervical cancer: 

• A Papanicoloau (Pap) test looks for cell changes or abnormal cell growth in the cervix. This is done when a healthcare provider collects some cells from the cervix during a speculum exam and the cells are then examined in a lab. The Pap test does not look for other cancers or sexually transmitted infections. 
• A Human Papillomavirus (HPV) test looks for the presence of HPV in the cervix or vagina. This can be done like the Pap test by a healthcare provider collecting a sample during a speculum exam, but it can also be done by a self-swab (if available). The HPV test does not look for cervical cell changes or for sexually transmitted infections. HPV screening is available to some CAF members in specific provinces in Canada (British Columbia, Prince Edward Island) based on provincial programs.

How often should I be screened? 

Generally, regular screening is every three years for a Pap test or every five years for the HPV test. Always follow your clinicians’ guidance on the recommended interval.

If your last Pap test was abnormal or HPV test was positive, you will require a follow-up appointment to determine the next steps in testing and/or treatment. 

Results 

Your healthcare provider will be given your results. If there are any abnormalities with your Pap test or your HPV test is positive, you will be contacted to discuss these results and the next steps in your care. Having an abnormal Pap or a positive HPV test doesn’t mean you have cervical cancer, only that cervical cell changes or an HPV infection were detected. Further testing and/or follow-up care will usually be necessary, so it is important to attend these appointments.   

Some people may get a Pap test or HPV test during other external health appointments, such as an Intrauterine Device insertion or perinatal care visits. If you do get a Pap or HPV test done by an external healthcare provider, it will be important to ensure the results are sent to your primary healthcare provider at your CDU. This way, your provider will be able to follow-up on any abnormal or positive results with you. 

What are the signs and symptoms of cervical cancer? 

There are often no signs or symptoms of cervical cancer in its early stages. However, as it progresses some signs and symptoms can include:

• Spotting or bleeding between periods  
• Spotting or bleeding after vaginal intercourse  
• Spotting or bleeding after menopause  
• Menstrual bleeding that becomes unusually long or heavy 
• Pain during vaginal intercourse 
• A change in vaginal discharge or odour  
• Pelvic pain that may travel to the back or down the legs  
• Swelling in one or both legs 
• Difficulty urinating or having a bowel movement  
• Leaking urine or feces from the vagina  
• Unusual weight loss, loss of appetite, or fatigue

Prevention through HPV vaccination 

There is no treatment for an HPV infection, but vaccination can protect against some high-risk strains of HPV that cause cervical cancer as well as some strains that cause genital warts. The best time to get vaccinated is before becoming sexually active; but, it's still beneficial afterward because the vaccine can protect against infections from HPV strains you weren’t exposed to before.

You can access the HPV vaccine through your local CFHS immunization department. 

Who is at risk of developing cervical cancer? 

Some factors that increase the risk of developing cervical cancer include: 

• Persistent infection with human papillomavirus (HPV)
• Being immunosuppressed, such as living with HIV 
• Smoking

Reducing your risk 

There are things you can do to reduce your overall risk of developing cervical cancer. These include: 

• Get the HPV vaccine – it can prevent infections from strains you have not been exposed to before
• Quit smoking – smoking reduces your ability to clear an HPV infection
• Use barrier protection – condoms and dental dams can help reduce HPV transmission
• Attend follow-up appointments if you have an abnormal Pap test or tested positive for HPV – most of the time abnormal cells can be removed before cancer develops

For more information please visit the Canadian Cancer Society.