Karla Van Kessel had always gone for regular Pap tests and felt that she was well-informed about her reproductive health.
That’s why it came as a shock for the London, Ont., woman, who’s in her early 40s, when she was diagnosed with Stage 4 cervical cancer in 2018.
“I thought it was impossible for me to be diagnosed with this type of disease, because I was so compliant with Pap smears,” she said. “I did everything right and still ended up in a really terrible situation.”
In Canada, 1,350 women were diagnosed with cervical cancer in 2019 and an estimated 410 will die from it, according to the Canadian Cancer Society.
Cervical cancer is the most preventable cancer in Canada, according to Shawn Chirrey, a senior analyst at the organization.
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Their data shows that routine screenings can catch precancerous lesions and treat them before they turn into cervical cancer.
Incidents of cervical cancer decreased by 3.3 per cent per year from 2010 to 2015, which the organization attributes to increased cancer screenings and the HPV vaccine, which lowers the risk of cervical cancer, as the virus can cause it.
But there are gaps in accessing these tests and understanding how frequently to get them, along with issues like practitioner error, which is what impacted Van Kessel’s diagnosis, she told Global News. She also spoke to the CBC last year about why doctors missed cancer signs in her Pap tests.
A Pap test she had was abnormal and she should have been referred to a doctor, but she wasn’t, which delayed her diagnosis by six to eight months, she said.
“It was quite a lot because it had spread quite a bit in that time,” she said, adding she was able to review her own records to see that it been noted that she needed a biopsy immediately, but she was never sent for one.
In the months prior to her diagnosis, she had what are known symptoms of cervical cancer like abnormal bleeding between periods and pain during intercourse. Signs also include pelvic pain, painful urination and bleeding after menopause. But Van Kessel was unaware those symptoms were associated with cancer, and she thought her Pap tests were fine.
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She advises those with female reproductive organs to keep up to date with their Pap tests, ensure they have gotten the HPV vaccination, and access their test results.
“Women have always had a challenge being heard in health care and have even more challenges advocating for themselves, because women tend to be quite compliant and don’t want to raise a fuss,” she said. “I would tell women to take charge of their health.”
Karla Van Kessel pictured with her family. Photo by Lindsay Davis.
Lindsay Davis
Work closely with your family doctor and get your hands on your results, she explained.
Van Kessel is now undergoing experimental treatment in the U.S. and is hopeful it will allow her to beat the disease and continue life with her husband and two young sons.
0:41 Black woman at higher risk of dying from cervical cancer
Black woman at higher risk of dying from cervical cancer
More than 70 per cent of cervical cancer cases for women aged 18-39 in Canada were caught at Stage 1 due to detection from cancer screening programs and tests like Pap smears, according to the Canadian Cancer Society.
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But in addition to access to information about screenings and tests, access to doctors and cost can also be factors. In Ontario, HPV tests cost around $100 and groups like Cancer Care Ontario are working to have the test covered by OHIP.
For those who didn’t receive the HPV vaccine in school, it can cost between $300 and $500 depending on if you have private health care coverage.
Access to cancer screenings for marginalized people, including Indigenous people, is also an issue. Cancer Care Ontario is working to address issueslike lack of access to care, culturally competent health care providers and providers in general.
Black women may be under-screened for cervical and breast cancer and there is a lack of health research on this issue, according to a literature review from the University of Toronto. This could lead to worse outcomes from these diseases, according to a previous report by Global News.
Another barrier to receiving care around cervical cancer prevention is the stigma associated with this form of cancer, as it’s related to women’s sexual health, said Denise Corbin, an early detection co-ordinator at the Saskatchewan Cancer Agency.
Corbin’s role involves engaging with the public in Saskatchewan to better inform them about cervical cancer screenings and early detection.
“It’s a topic that is touchy to talk about because what causes cervical cancer in nearly all cases is the HPV virus,” she said. “So seeing as HPV is a sexually transmitted infection, there’s not a lot of people that want to talk about it.”
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Most people who are sexually active will have an HPV infection at some point in their life. In most cases, it will go away, but sometimes it will not, which can lead to cancer, according to the Canadian Cancer Society.
0:56 HPV test should replace Pap tests for cervical cancer screening: study
HPV test should replace Pap tests for cervical cancer screening: study
Two strains of HPV, HPV16 and HPV18, can cause cells to change or become abnormal, which causes 70 per cent of all cervical cancers, according to the organization. But men are also encouraged to receive the vaccine as HPV also causes anal, penile, mouth and throat cancers.
There is shame associated with women talking about being sexually active and their bodies, and many aren’t comfortable doing so with a male doctor, said Corbin.
“You’ve got stigmas of, ‘I’m not supposed to talk about it’ or ‘I’m afraid to talk about it,’” said Corbin. “And a lot of people think, ‘Oh, I had a Pap test, I’m good.’”
Getting the HPV vaccine along with cancer screenings is important to do along with a Pap test and monitoring your body for unusual symptoms, she said.
Recommendations for when to get a Pap test, which screens for cervical cancer, are to start at age 21 and get one every three years after that. However, in 2013, the Canadian Medical Association Journal published new guidelines that recommend tests start at age 25.
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The main goal of the Saskatchewan Cancer Agency’s outreach program is to help women be comfortable with their own bodies and talk about their health, so they feel more inclined to get tested, said Corbin.
“We just sit down and talk about some of the fears … what they’re feeling anxious about,” she said, adding that the Pap test is invasive and uncomfortable, which can also be a deterrent.
Free HPV vaccination in schools has made a big difference in tackling cervical cancer rates, said Dr. Sarah Ferguson, a gynecologic-oncologist at the Princess Margaret Cancer Centre in Toronto.
But accessibility continues to be an issue in health care, as costs continue to be barriers to care, said Ferguson.
“We need to make sure that women are being screened and to maximize our HPV vaccinations,” she said, adding she is pleased to see rates of cervical cancer decrease in the country.
“We can’t be complacent, but it is a success story,” she said. “It’s important to… advocate for ourselves to make sure our screenings are done every three years to prevent cancer.”
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
