Almost all cervical cancer is caused by the human papillomavirus (HPV), a viral infection that is the most common sexually transmitted infection. While HPV vaccination programs in schools can help prevent cervical cancer, vaccination rates across Canada vary widely—from 60 to 90 per cent.
“To eliminate cervical cancer, we need to aim for at least 90 per cent immunization rates right across the country,” said USask researcher Dr. Cory Neudorf, who is president of UPHN, which comprises the medical health officers of Canada’s largest urban centres.
With funding from the Canadian Partnership Against Cancer (CPAC) and in partnership with the Public Health Physicians of Canada and the Rural Remote and Northern Public Health Network, UPHN has been commissioned to collect data on vaccination rates across Canada and to assess barriers to vaccination in local regions of the provinces.
“This new national partnership will help move Canada closer towards the HPV immunization targets laid out in Canada’s action plan to eliminate cervical cancer,” said Neudorf, a faculty member in community health and epidemiology at the USask College of Medicine who is also a consulting medical health officer with the Saskatchewan Health Authority.
This week, USask signed a collaboration agreement to formally host UPHN projects, starting with the CPAC cervical cancer project which draws Health Canada funds.
“We aim to determine the various reasons people have for not being immunized against the virus, particularly among lower income groups, new immigrants, Indigenous populations or those living in remote areas where vaccination rates seem to be lower,” said Neudorf.
“We know there are challenges around access to vaccination, such as accessibility of clinics or school-based delivery and staff shortages, as well as misconceptions about vaccine safety, vaccine refusal, cultural beliefs, and health literacy. But we need to determine to what extent these factors are playing out across the country and also determine how certain regions have achieved better coverage than others so that we can learn from different approaches.”
At the end of the two-year project, the group will make specific recommendations to guide government funding and changes to program delivery.
The World Health Organization has set the goal of eliminating cervical cancer worldwide this century. Canada’s Minister of Health Patty Hadju has committed the country to doing its part through a national strategy led by CPAC.
Priorities of the action plan include vaccination of boys and girls against HPV, a shift to primary HPV screening in cervical screening programs (rather than Pap smears), and ensuring appropriate follow-up when abnormalities are identified. New technology to enable convenient HPV self-testing at home is also being explored. First Nations, Inuit and Métis peoples are collaborating to develop priorities and actions for their groups.
“A combination of higher vaccination rates and greater screening for HPV will get us to the target and help save lives,” said Neudorf.
Amanda Niebergall, a 32-year-old pre-school teacher, is a Regina cervical cancer survivor who underwent chemotherapy, radiation and brachytherapy (an internal form of radiation therapy) in 2018, and radiation and chemotherapy again in 2020. She now provides advice to CPAC as a member of the organization’s elimination of cervical cancer implementation group.
“The action plan focuses on HPV immunization, early screening and detection, and making sure you get your cervical screening tests,” she said. “If you feel something is wrong, push and get those tests. If you need a second opinion, get a second opinion.”
Thilina Bandara, a USask adjunct professor of community health and epidemiology and UPHN research scientist, and Charles Plante, USask post-doctoral fellow at the Johnson-Shoyama Graduate School of Public Policy, will work with graduate students on the UPHN-led project. Computer scientist Nate Osgood and a graduate student will analyze relevant social media. Nine staff will be hired to work on data analysis and collection in local health departments across Canada.
“USask is excited to host the UPHN network and research projects,” said USask Associate Vice-President Research Darcy Marciniuk. “This gives the university primary access to the UPHN network of public health practitioners for population health research, including student placements with UPHN member sites at public health units in major cities across Canada.”
UPHN (www.uphn.ca), a registered non-profit with an office in the College of Medicine, is currently applying for funding to set up a “national public health observatory” at USask where urban public health data can be accessed by researchers across the country.