Is $1.5 million worth it for the risk of cancer?
That's the question being asked by hundreds of Ontario women, who are protesting the recent decision by the provincial government to change guidelines surrounding Pap tests, which screen for cervical cancer, to once every three years, as opposed to annual checks.
According to a petition on Change.org:
In the span of three years it is possible for a woman's cervix to develop abnormal and even cancerous cells. Further, our Government will not even allow a woman to PAY for a pap smear if the government still chooses to limit its funding. Our tests will be DENIED processing. That means that as Canadian women, we are being DENIED our right to healthcare.
As City News reports, the province has changed its Cancer Care policies with an eye toward cutting costs, with fewer tests initially saving $1.5 million for 2012/13 and $6.1 million for 2013/14.
For women who wish to pay for the test, however, those who created Change.org's petition may not be entirely incorrect in their statements — for example, LifeLabs, a laboratory testing service in Ontario, British Columbia and Quebec, offers an HPV test that looks for the potentially cancer-causing virus (versus a pap test, which looks for abnormal cells). This test can be obtained for a fee, or potentially covered by insurance.
Guidelines issued by the Canadian Task Force on Preventative Health in December 2012 are what sparked the switch, with the additional stipulation of changing the tests from occurring at age 21 to starting at age 25. As Dr. James Dickinson, a professor of family medicine at the University of Calgary, stated, "Doing it every year doesn't really add very much (protection) but it adds a lot of inconvenience and some harm," as reported in The Canadian Press.
The concern for over-testing revolves around finding cells or lesions that will not turn cancerous, but will require procedures that could permanently impact the cervix and potentially affect a woman's fertility and ability to carry a child, according to the CDC.
The Society of Obstetricians and Gynecologists of Canada (SOGC), meanwhile, has taken issue with waiting until age 25 for the test, with CEO Dr. Jennifer Blake noting that abnormal cells can be found in younger women, and therefore impacting "the natural history of the disease."
A Pap test can help detect cancerous cells early, and as with any cancer, the sooner it is found, the better the chances of survival, says the Canadian Cancer Society. The Human Papillomavirus (HPV) vaccine, which is approved for women between 9 and 45 years of age, and found to be most effective when given between 9 and 13 years of age, can also help prevent cervical cancer, and its prevalence in Canada is undoubtedly linked to these changes in policy.
As it currently stands, women in Ontario can expect a Pap test every three years, from the age of 25 to 69. But if a test shows abnormal results, says Cancer Care Ontario, her screening plan will change in order to monitor the cells for a short time after.