News  Inuit HPV rates soar

Lack of resources in the North makes screening sparse

As many as 30 per cent of Northern Quebec’s Inuit women could be infected with human papilloma virus (HPV), according to new findings presented Monday by Dr. Paul Brassard of the McGill Department of Epidemiology.

Of the 550 surveyed Inuit women from Nunavik, Quebec, about a quarter carried high-risk strains of HPV, a viral infection that accounts for most cases of cervical cancer and genital warts. The rates were especially high among girls aged 15-19, 60 per cent of whom carried some form of HPV, with some carrying high-risk strains responsible for dangerous reproductive cancers.

While cervical cancer was once one of the most common cancers in Canadian women, it has been in decline for the past 50 years, likely due to increased awareness and wider availability of the Pap test. According to the Society of Obstetricians and Gynaecologists, 1,500 new cases of cervical cancer are diagnosed in Canada every year, though the figures are likely much higher for under-screened lower socioeconomic groups, including immigrant, and First Nations women.

Brassard found that only about half of Nunavik women went for regular pap tests, well below the Quebec average, and that these low screening rates may explain the prevalence of HPV and cervical cancer in First Nations communities.

“Sixty per cent of cervical cancers appear in women who have not been screened in the past three years,” said Brassard, adding that low screening levels put middle-aged women particularly at risk.

“[There is] sub-optimal [Pap test] coverage in women over 40, when risk of cervical cancer reaches its peak,” he said.

Brassard noted that rates of HPV in First Nations women are between two and six times the national average, and that a systematic testing like that used for mammograms would be the best form of prevention – since early detection could make most cervical cancer avoidable.

But in order to implement such a substantive program, vast resources would be necessary. He explained that with a high turnover of nurses and doctors, many new medical professionals are unfamiliar with the procedures and require proper training. He also claimed the written pamphlets and educational brochures produced by the province were an inappropriate medium to reach Inuit communities, who have strong oral traditions.

While doing his fieldwork, Brassard worked on community awareness by speaking on the local radio show about HPV prevention and encouraging women to call in with questions. While local Inuit leaders were supportive during his eight-year study, Brassard noted that they were often constrained by their lack of resources and other community problems.

“The other big issue up North is ‘competing priorities,’” Brassard said, citing the environment, social issues, and more pressing primary care health issues as competiting for the resources and attention of local leaders.

“When you go in and try to improve these preventable diseases, it usually gets put on the back burner.”

Last fall, the Quebec government implemented a province-wide HPV vaccination program, offered free of charge to girls aged 9-16 through the school system. Girls who are younger than 18 but not attending school could be vaccinated for free while women over the age of 18 must pay for the vaccine, which costs up to $400, and lasts only six years.

The government of Canada allotted $300-million in its 2006 budget to provide HPV vaccinations until 2010, but Brassard estimates it will be 20 years before the results are measurable.

The Quebec government is currently working on a systematic Pap screening process, but has not implemented one yet. Systematic screening processes exist in other provinces and territories, such as the Northwest Territories, where up to 80 per cent of women are screened regularly.