Gender, Health, and Popular Culture: Historical Perspectives

The Challenge of Developing and Publicizing Cervical Cancer Screening Programs: A Canadian Perspective

The Challenge of Developing and Publicizing Cervical Cancer Screening Programs: A Canadian Perspective Mandy Hadenko C ervical cancer is one of the few cancers that with early detection, can have a 100 per cent cure rate. By the mid-twentieth century, medical communities in Canada, the United States, and the United Kingdom understood cervical cancer as a potentially preventable disease, if properly organized screening programs were in place. Once knowledge about the disease was established, a prompt response on the part of health and government officials in the development of screening programs might have been expected. This was not the case in several Canadian provinces, even with a screening model in British Columbia (B.C.) as early as the 1950s. As Gardner demonstrates in the previous chapter, the Canadian experience with cervical cancer screening was very different from the American experience. Gardner argues that early in the twentieth century, women actively sought screening for this disease and “worked conscientiously to inform one another about the risk of cancer.”1 This chapter focuses on early Canadian responses to cervical cancer screening, with particular attention given to Ontario and B.C. Within these provinces, there was a greater increase in knowledge on a more public level, both via print and film, than in other provinces, and in this chapter, I argue that print and film were integral places for women to seek knowledge about this disease. As Barbara Clow argues in Negotiating Disease: Power and Cancer Care, 1900–1950, in the early twentieth century, the Canadian public and medical professionals were largely invested in dealing with cancer treatment options rather than prevention. While science and technology 127 The Transmission of Health Information 128 took a powerful hold of Canadian society in the 1950s and 1960s, there was little focus on prevention. Even though scientists wanted to prove they could “cure” any disease, cervical cancer was still not on the radar of concern for the Department of Health in Ontario, Canada’s most populous province.2 Furthermore, prior to the mid-1960s and the advent of medicare, Canadian women had to pay for preventive health care. It was extremely difficult for health officials to convince women who felt perfectly healthy to pay for cancer screening. For centuries, women had been held responsible for the health of their households, but women resisted seeking screening, attempting to avoid a diagnosis of cancer even though it usually ended in death.3 Once a fully funded health care system was in place in the 1960s, the prevention of cervical cancer seemed easier and more financially feasible for all Canadian women. Yet women were still reluctant to be screened, physicians were not active in educating and encouraging their female patients to be screened, and follow-ups were difficult to obtain. In Ontario, without governmentfunded and -monitored programs specifically devoted to screening, quality laboratory screen readings could not be guaranteed. The founding of the Canadian Cancer Society in 1938 and the National Cancer Institute of Canada in 1947 increased cancer research and public awareness of both cancer and the lack of screening-program funding. Both the United Kingdom and the United States showed real initiative in funding and focusing on cancer research. In Canada, national conferences were held as early as the 1940s to discuss cancer research, mortality and morbidity rates, and, eventually, the prevention of cancer. However, as will be shown in this chapter, there was very little focus on cervical cancer until as late as the 1960s, except for the particularly early development of a central cytology laboratory and screening program in B.C.in the late 1940s and 1950s.Various discoveries, such as the understanding of the human papilloma virus (HPV) in the early 1980s, eventually moved cervical cancer awareness in the right direction. In 2007 both the medical community and the general public alike were openly discussing a “cancer vaccine,” Gardasil, which purported to eliminate HPV from the cervical cancer equation completely. However, this type of vaccine has not come without criticism, as issues of sexuality, religious morality, and political motive surrounded its release. The postwar transition of focus from a curative to a more preventive approach proved that prevention was on the minds of medical officials and researchers, but effective screening would require recall/follow-up systems, the monitoring of laboratory technicians and screening techniques, and increasing public awareness of the disease. In the 1990s, Ontario released The Challenge of Cervical Cancer...