# Towards Cervical Cancer Elimination: Insights from an In-Depth Regional Review of Patients with Cervical Cancer

## TL;DR

This study examines cervical cancer cases in Eastern Ontario to identify preventable factors and system failures that contribute to rising cancer rates.

## Contribution

The study categorizes cervical cancer cases by screening status and system issues, revealing gaps in access and screening quality that hinder elimination efforts.

## Key findings

- Only 16.7% of cervical cancer cases were detected through screening, while 55.3% occurred in inadequately screened individuals.
- System failures, such as false-negative Pap tests and misapplied guidelines, contributed to 28% of cases.
- Rural residence, deprivation, and lack of primary care were linked to inadequate screening.

## Abstract

Cervical cancer is largely preventable, yet rates in Canada continue to rise. This study explores cervical cancer cases that were diagnosed in a two-year period in Eastern Ontario to better understand the factors leading to their development and identify opportunities to improve prevention. Cervical cancers were partitioned into three categories: cancers found through screening, cancers in people who were not adequately screened, and cancers linked to failures in the health care system. Of the 132 cervical cancers diagnosed during this two-year period, only about one in six were detected through screening. Nearly one quarter of the cases were incurable, and more than 13% of individuals died within two and a half years of diagnosis. Over half of the cases occurred in individuals who were inadequately screened. Lack of screening was more common among people living in rural areas, those experiencing social or economic disadvantage, and those without a regular primary care provider. System issues included false-negative Pap tests, loss to follow-up, and misapplication of screening guidelines. Overall, this study shows that gaps in access, follow-up, and screening quality continue to drive preventable cervical cancer in Canada and highlights clear opportunities to improve prevention and care.

Cervical cancer is a largely preventable disease, with over 90% of cases caused by persistent infection with human papillomavirus (HPV). Despite the availability of HPV vaccination and cervical screening, incidence rates in Canada have been rising since 2015, particularly among underserved populations. This study investigates contributing factors behind cervical cancer diagnoses in Eastern Ontario over a two-year period to identify gaps leading to failures in prevention and screening. A retrospective chart review was conducted for cervical cancer cases diagnosed between January 2022 and December 2023 at two regional cancer centres in Eastern Ontario. Cases were categorized as screen-detected, inadequately screened, or system failure, based on prior screening history and care processes. Data was collected on patient, screening, and cancer characteristics. Of 132 cases, 22 (16.7%) were screen-detected, 73 (55.3%) were inadequately screened, and 37 (28.0%) were attributed to healthcare system failure. Later-stage disease was significantly more common in the latter two groups. Thirty-one (23.5%) cases presented with palliative diagnoses, and 18 (13.6%) individuals died within 2.5 years. Inadequate screening was associated with rurality, deprivation, and lack of a primary care provider. System failures included false-negative Pap tests, loss to follow-up, and misapplication of screening guidelines. This study evaluated failures in cervical cancer prevention, which led to cervical cancer diagnoses in Eastern Ontario. Gaps included suboptimal screening participation, lack of access to care, health care system breakdowns, and limitations of the Pap test. Findings provide concrete suggestions for eliminating cervical cancer in Canada.