Look Before You Leap:
New HPV Screening Program in BC: Promotional Pomp and Deadly Circumstance
On January 9th, 2024 with much hullabaloo, the BC Ministry of Health announced a new self-test HPV screening program. This is supposedly to “eliminate deadly cervical cancer in B.C. in the next decade,” according to the government’s press release .
As a person who spent several years drilling into the evidence and claims around medical screening programs, resulting in a CBC radio documentary, a book, and a TedX talk, I have grown to be pretty skeptical of most claims made by screening advocates. Let’s just say when you screen the screeners—and apply a little bit of critical thinking or research to these programs— their claims are almost always overblown and unfounded.
When you look closely at medical screening programs, designed to tease out early signs of disease in healthy people, you often have to screen out the fluff, the pomposity, the fearmongering and the arrogance to arrive at some nuggets of truth. Often you’re left with a big nothingburger out of a pronouncement that breathlessly promises to prevent death itself. Such is the case with BC’s latest press announcement, that has received glowing reports but no critical examinations as far as I can tell, from the typists down at the Globe and Mail or the CBC.
If there was a soundtrack to this new program it would feature the flapping of the virtue signalling flag from the top mainstay, indicating that BC, (and our province’s NDP leadership) is the first, fastest and most virtuous and caring jurisdiction in Canada.
When it comes to invasive screening of healthy people I’d prefer it if BC was almost last, less fast, and less virtuous.
Proponents of medical screening often aggressively assert that their screening tool is going to save lives and the presumption of any screening test is clear: why would any normal person avoid breast or prostate cancer screening if it could save their lives? Only an idiot would avoid them, right? Well, as perhaps the least-screened person on the planet, who favours the axiom “look before you leap,” you might want to know the immortal words of Jerry Lewis: “I’ve had great success being a total idiot.”
Let’s look at some of the more pompous and hubris-laden aspects of the government’s press release. This proposed test, by the way, is not for everyone. It’s only for women and “individuals from 25 to 69 with a cervix.” Hmmm. Ok….
With the overblown rhetoric of a carnival barker, Premier David Eby is quoted in the press release that “It’s not every day that a province can set an achievable goal of eliminating a deadly cancer,” to which I would add, what kind of planet is Eby orbiting? If this screening test proves to be as good as claimed, then no BC woman would ever die of cervical cancer in this province. Ever? Well this is a claim you cannot make for ANY of the other cancer screening programs in existence on the planet some which have been in place for decades. None. Screening—which is about finding disease early— does not make a deadly disease disappear, Mr. Eby. If I were you I’d be having a few words with the communications people who put such absurd words into your mouth.
Here are a few other gems (in bold are quotes from the press release):
“Cancer screening programs are an important component of preventative health care and are intended for people with no identifiable symptoms as an effort to detect cancer sooner.”
My second opinion: No, no and, ultimately no.
Cancer screening programs are a very minor part of preventive health care. Trying to identify disease in healthy people, when done properly, severely restricts screening to certain age groups and small subsets of generally higher-risk people. When used in widespread programs (such as for breast or prostate cancer) it results in high numbers of overdiagnosed patients, because it detects more anomalies sooner without resulting in longer lives in those screened. And don’t get me going about high cholesterol, probably the biggest screening scam on the planet.
You see, detecting cancer is no big deal if it is the kind that will never go on to hurt you. You can be seriously harmed—and even die from— being treated for something that will never otherwise harm you. It is for this reason many screening programs have been banned or cancelled in other countries because of the low-yield and considerable adverse effects of screening healthy people. Screening for prostate cancer, which we call the Poster Child for Overdiagnosis finds many men being treated unnecessarily, invasively and sometimes fatally, with no overall saving in lives. Just the simple act of doing a biopsy to evaluate the possibility of prostate cancer in healthy men can result in sepsis, hospitalizations and deaths in a small percentage of those screened such as this study found.
“Cervical cancer is the fourth most common cancer in women globally. Rates of cervical cancer are among the fastest increasing among females in Canada but it is preventable through immunization and screening programs. Ninety-nine per cent of cervical cancers are caused by high-risk HPV.”
This is fearmongering, pure and simple. And mostly untrue to boot.
According to the Canadian Cancer society in 2022 an estimated 1,450 Canadian women were diagnosed with cervical cancer and 380 died from it. With 19,570,000 women in Canada in 2022, the chance a Canadian woman dying of cervical cancer was 0.002 %. or one in 50,000. Hmmm. In BC, if you look at statistics on cervical cancer death put out by BC Cancer, the incidence of cervical cancer in 2018 was about 2.2 per 100,000. Again, chances about one in 50,000. You should note, that these deaths are mostly in older women, where death is, well, more common.
And the “among the fasted increasing” types of cancer? Wrong again. Data from the US and Canada show that cervix-related cancers have enjoyed a 30 year downward trend, due to a number of factors. The comment about the HPV vaccine preventing cervical cancer? That’s a stretch too far, and worthy of another column by me, but suffice to say the HPV vaccine is highly contested in terms of its actual impact on cancers and is linked to a range of autoimmune disorders experienced by those getting the HPV vaccine. HPV vaccination rates vary a lot by province but what you CAN’T say is that provinces with lower HPV vaccination rates have more cervical cancer deaths. The vaccines make so little difference the effect is undetectable between provinces.
The best way to evaluate the value of a new drug or test, is through a randomized trial. I found one such trial, in Finland, testing HPV testing against the usual Pap smear which is currently used. The difference? Nothing.
One of the authors of that study wrote me to say that Pap smear testing works well and that “there is still the continuous challenge with overdiagnosis with HPV screening and a high proportion of screen-positives even if the cancer prevention effect is as good as with Pap smear based screening.” What is the problem with a false diagnosis? Clearly the harm, both psychological and physical, by being told you could have a fatal disease when you don’t is not good for your health. The bottom line for the Fins: Such a program —ie: HPV testing —might be able to increase screening but it wouldn’t lead to any fewer cancer deaths. Therefore doing so in BC would be wasteful, possibly harmful (more screening means more medical interventions) and have a very small effect because cervical cancer incidence and mortality is already very low.
“British Columbia will be the first jurisdiction in Canada to launch this new accessible self-screening test province wide and one of the first to fully implement HPV testing as its primary screening method.”
This is a true statement but not exactly something we should be flying from the virtue-signalling flagpole. Every screening program has problems, adverse effects, costs, impacts on mental health and serious downsides that any jurisdiction needs to understand before they spread it and promote it widely.
I asked a few Canadian researchers who evaluate screening why they thought BC was so aggressively pursuing a test that likely had little chance of doing much of anything.
One of them told me that this fits a pattern of BC often taking the lead on promoting some kind of unproven or minimally-important, possibly wasteful and harmful screening test before other provinces. We saw this with other types of screening but what is most noticeable is the lack of follow up and evaluation. No one is going back and examining whether the screening tools had the impact they were promised.
My final word: Medical interventions don’t save lives. When they work at their best, they might delay death. And what they generally can’t do is improve the interval. Remember that when someone is coming at you with a screening program promising to save your life.