The Limits of Innovation: Lessons from Cervical Cancer Prevention Efforts

thehernetwork
Jul 29
5 min read

Written by: Kate Ross

Background:

Cervical cancer is one of the few types of cancer that is largely preventable. The potential to eliminate this disease is entirely within reach, with effective screening tools, implementation of screening programs, and a vaccine that protects against the primary cause (human papillomavirus (HPV)). And yet, cervical cancer has not been eliminated.

Globally, cervical cancer is the 4^th most common cause of cancer among women and resulted in nearly 350 000 deaths worldwide in 2022¹. The highest incidence and mortality rates occurred in low- and middle-income countries, where lack of access to primary healthcare drives higher rates of disease. In many of these settings, screening programs and access to treatment plans are extremely limited or unavailable^1–3. In Canada, although almost every province and territory has a population-wide screening program and offers publicly funded vaccination programs, an estimated 1700 women will be diagnosed with cervical cancer, and 450 will die from it in 2026 ^4,5.

In the Canadian context (and globally), this preventable gap reflects more than just individual health choices. Differences in access to healthcare, screening participation rates, vaccination uptake rates, and broader social determinants of health play a role in who benefits from prevention efforts. If the tools to predict and prevent cervical cancer already exist, then why do incidence and mortality rates remain so high? And why do these life-saving interventions fail to reach all populations equally?

What is Cervical Cancer?

Cervical cancer develops in the cells of the cervix and is almost entirely caused by a persistent infection with high-risk types of HPV. HPV is a common sexually transmitted infection (STI) that affects the skin, throat, and genital and anal areas³. Most sexually active individuals will be infected with HPV at some point in their lives, often without experiencing symptoms, and their immune system will often clear the virus naturally within 1-2 years^3,6.

Persistent infection of the cervix with certain carcinogenic strains of HPV can cause cells to become abnormal, called pre-cancerous lesions. If left untreated, these can progress and are the cause of almost 95% of cervical cancers^3,7.

The Evolution of Cervical Cancer Prevention

Early challenges and late diagnosis

Before the development of screening technologies, cervical cancer could typically only be diagnosed at advanced stages, when symptoms such as abnormal bleeding or pelvic pain had already appeared⁸. At this point, treatment options were limited and often ineffective. Without a clear understanding of the disease’s cause or a way to detect cellular changes, healthcare systems were forced to manage the cancer after it had already progressed. In the early 20^th century, cervical cancer was the leading cause of death for women in the United States, with a mortality rate of around 80%⁹.

The Pap smear: a turning point

The development of the Pap smear test in 1943 marked a major turning point in cervical cancer prevention. Developed by Dr. Georgios Papanikolaou, this test involved collecting a sample of a woman’s cervical cells and screening for cellular abnormalities, making it possible to ‘catch’ cells before they turned cancerous. It’s widely recognized as one of the most successful inventions of a cancer screening tool^9–12. In 1960, British Columbia introduced the first publicly funded cervical cancer screening program in Canada, leading to a decline in mortality rates of over 70%¹⁰.

HPV: Identifying the cause

Major scientific breakthroughs came in the 1970s and 80s with the discovery that HPV is the primary cause of cervical cancer. Research led by Dr. Harald zur Hausen isolated high-risk virus types, HPV 16 and 18, in cervical tumour tissue. This work later earned him the Nobel Prize in Medicine in 2008^13,14. For the first time, scientists could target the root cause of cervical cancer, allowing healthcare to expand beyond early detection.

The HPV vaccine: prevention becomes possible

The development of the HPV vaccine in the early 2000s marked another milestone in cancer prevention, introduced to the market after over 10 years of clinical development and testing. Officially approved in 2006 for females aged 9 to 26, the vaccine protects against the high-risk HPV types responsible for most cervical cancers. In 2007, Canada began implementing publicly funded vaccination programs, expanding access to prevention^13–15. Looking back, this vaccine made it possible to prevent cervical cancer before it began – bringing the possibility of elimination closer.

Cervical Cancer Remains a Burden

So, despite these breakthroughs, why does cervical cancer persist?

Despite decades of progress made, cervical cancer remains a public health burden. While many high-income countries have organized screening and vaccination initiatives, these services are not universally available. Almost 94% of cervical cancer deaths in 2022 occurred in low- and middle-income countries, where access to primary healthcare and screening programs remains limited¹.

It’s important to note that inequities still exist within Canada – we still have a long way to go! People living in remote communities, lower-income groups, and minority populations experience barriers to accessing screening and vaccination programs. Indigenous populations can face additional challenges in accessing care, partly because of the lasting and ongoing impacts of colonization on trust in healthcare systems. Recent Canadian data indicate that elimination progress has begun to plateau, with cervical cancer incidence rates rising and HPV vaccination rates falling below national targets^5,15.

Scientific breakthroughs and innovation alone aren’t enough.

What Comes Next

In 2020, the World Health Organization (WHO) launched a global strategy to accelerate cervical cancer elimination, highlighting it as a public health goal. Canada has pledged to eliminate cervical cancer by 2040³.

Cervical cancer prevention has come a long way, from being detected too late to prevention before it even develops. In many ways, it serves as a powerful public health success story. But it’s also a reminder that innovation has limits. Moving forward, the next phase needs to focus on more than new inventions and “Eureka” moments – it requires strengthening equitable access to healthcare and ensuring that the existing tools we have reach the populations that need them the most.

“This is what “global health” looks like in practice: the tools exist, the biology is understood, and the outcomes still diverge because systems differ. It’s not a mystery. It’s a map of who gets access.” ²

About the author:

Kate is originally from Prince Edward Island and is now based in Halifax, Nova Scotia, where she is completing her Master of Public Health from Brock University with a specialization in Infection Prevention and Control (IPAC). She currently works as a Research Assistant in psychiatric epidemiology at Dalhousie University, helping to manage a randomized controlled trial examining the risk of depressive episodes. She is passionate about women's health studies, mental health research, and global health equity. Kate is also a volunteer with the HER Network team. In her free time, she enjoys trying chai lattes around the city, taking spin classes, playing golf, traveling, and baking.

References:

Cervical Cancer Elimination Initiative. https://www.who.int/initiatives/cervical-cancer-elimination-initiative
Cervical Cancer Prevention: From Microscope Slides to Vaccine Victory. https://historyofvaccines.org/blog/cervical-cancer-prevention-microscope-slides-vaccine-victory/
Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
cancer CCS/ S canadienne du. Cervical cancer statistics. Canadian Cancer Society. April 2026. https://cancer.ca/en/cancer-information/cancer-types/cervical/statistics
Perez S. Progress and Challenges in Canada’s Path Toward the Elimination of Cervical Cancer. Curr Oncol. 2024;31(10):5850-5861. doi:10.3390/curroncol31100435
Canada PHA of. Reports - Progress against cancers in Canada — Canada.ca. January 16, 2024. https://health-infobase.canada.ca/cancer/progress-against-cancers/reports.html?type=1#Introduction
Human papillomavirus (HPV): Symptoms and treatment. February 14, 2025. https://www.canada.ca/en/public-health/services/diseases/human-papillomavirus-hpv.html
cancer CCS/ S canadienne du. Symptoms of cervical cancer. Canadian Cancer Society. https://cancer.ca/en/cancer-information/cancer-types/cervical/signs-and-symptoms
The “War Against Cancer” Started Earlier Than You Might Think. The Pap Test Launched It All. | Cancer Support Community. https://www.cancersupportcommunity.org/blog/the-war-against-cancer-started-earlier-than-you-might-think
Cervical Cancer. Gynecologic Cancer Initiative. https://gynecancerinitiative.ca/cervical-cancer/
Dugas A, Persaud NA, Ganti L. Dr. George Papanicolaou: Inventor of the Pap Smear and Father of Modern Cytology. Cureus. 16(12):e75106. doi:10.7759/cureus.75106
Szasz G, CM, MD. Origins of the Pap test. British Columbia Medical Journal. June 6, 2019. https://bcmj.org/blog/origins-pap-test
Some important things to know about HPV. Health e-News. March 1, 2018. https://healthenews.mcgill.ca/some-important-things-to-know-about-hpv/
Saraiya M, Steben M, Watson M, Markowitz L. Evolution of cervical cancer screening and prevention in United States and Canada: Implications for public health practitioners and clinicians. Prev Med. 2013;57(5):426-433. doi:10.1016/j.ypmed.2013.01.020
Goyette A, Yen GP, Racovitan V, Bhangu P, Kothari S, Franco EL. Evolution of Public Health Human Papillomavirus Immunization Programs in Canada. Curr Oncol. 2021;28(1):991-1007. doi:10.3390/curroncol28010097