Understanding the impact of cervical cancer

Cervical cancer is a leading cause of death in women worldwide. In Canada, the number of deaths from cervical cancer has decreased by 75 per cent since introducing regular Papanicolaou (Pap) smear screening in the 1960s. Following international guidelines, Pap tests are recommended every three years for women with normal test results.

In a new study from Lawson Health Research Institute, researchers looked at women who were diagnosed with locally advanced cervical cancer (LACC) who were screened within two years of their diagnosis, and studied their experiences. The research team found a number of misconceptions around cervical cancer screening and diagnosis. 

Researchers looked at health records of women under the age of 50 who were treated for LACC between September 2010 and December 2012 at London Health Sciences Centre (LHSC). Thirty-four per cent of these women had a normal Pap test before their diagnosis. Ten women participated in face-to-face interviews with the research team. 

“We wanted to give a voice to these patients and understand their experiences,” says Dr. David D’Souza, Scientist at Lawson and Radiation Oncologist at LHSC. “Interviews allow researchers to hear how the disease and treatment affects these patients’ lives.”

From these interviews, six important themes emerged, showing a need to educate patients and physicians. 

Several women expressed feelings of shock when receiving their diagnosis of cervical cancer. They believed a normal Pap test meant they were cancer free. Patients did not know the symptoms of cervical cancer and often related them to other factors like stress or stopping an oral contraceptive. The women were also unaware of how cervical cancer is diagnosed and treated. When a diagnosis was made, they did not realize how serious the type and stage of cancer was until they were advised that radiation and chemotherapy were needed. 

“For women, it’s important to understand the HPV vaccine and regular screening are the best chance for lowering the risk of developing cervical cancer,” says Dr. Jacob McGee, Gynecologic Oncologist at LHSC. “If you have any concerning symptoms, you should see a doctor and have them investigate further even if your last Pap smear was negative.”

Treatment for LACC has significant impacts on quality of life, including loss of fertility, changes in sexual function and bowel and bladder problems, stressing the importance of early diagnosis and treatment.

“For physicians, it’s essential to know the symptoms and diagnosis of cervical cancer,” adds Dr. McGee. “You need to ask, does this patient have symptoms or is there a lesion on the face of the cervix? If yes, the Pap smear may not be the best test for that patient and they should be referred to a specialist for more testing.”

The researchers add “the Pap smear is an excellent screening tool and is shown to have greatly lowered the rate of cervical cancers in Canada. It is, however, a screening tool. The Pap smear is not a diagnostic test for invasive cancer and should not be relied upon to rule out disease. A pelvic exam with direct visualization and assessment of the cervix should be the initial step in the evaluation of women with symptoms.” 

This is one example of how Lawson is contributing to making Ontario Healthier, Wealthier and Smarter.

The study, “When pap testing fails to prevent cervix cancer: a qualitative study of the experience of screened women under 50 with advanced cervix cancer in Canada,” is published in Cureus.