Cervical Neoplasia Among Canadian Armed Forces Regular Force Members, 2012-2024: A Descriptive Case Series
Yanfang Guo, Chrissi Galanakis, Nourhan Shehata, Natalia Abraham, Barbara StraussAbstract
Introduction
Cervical cancer is preventable through human papillomavirus (HPV) vaccination, routine screening, and timely follow up of abnormal results. However, limited evidence is available regarding cervical cancer burden and screening patterns and barriers within the Canadian Armed Forces (CAF). This study describes the demographic, military, clinical, and screening characteristics of cervical neoplasia cases diagnosed among CAF Regular Force members between 2012 and 2024.
Materials and Methods
A retrospective descriptive case series was conducted using electronic medical records from the Canadian Forces Health Information System. The International Classification of Diseases, 10th Revision (ICD-10) codes in the clinical extract were used to identify any cervical neoplasia diagnoses from January 1, 2012 to December 31, 2024. Incident cases were confirmed based on colposcopy‑directed biopsy results. Demographic and military-specific data at diagnosis were obtained from the Master Patient Index. Variables extracted from the health record included age at diagnosis, rank, screening history, HPV vaccination status, diagnostic pathways, stage at diagnosis, referral timelines, and follow-up outcomes. Descriptive statistics were used to summarize case characteristics and identify gaps in screening participation and follow-up adherence.
Results
A total of 23 incident cervical neoplasia cases were confirmed during the study period. The median age at diagnosis was 37 years (range: 24-52), and 47.8% were officers. 21.8% reported smoking at diagnosis. 43.5% of cases had missed (n = 7) or delayed (n = 3) at least 1 routine cervical cancer screening before diagnosis. 39.1% experienced delayed or missed follow-up after abnormal Pap results. Reported barriers to routine screening and follow-up included pandemic-related service interruptions, deployment or domestic posting, pregnancy, and childcare challenges. 39.1% (n = 9) had an abnormal result at the first recorded Pap test in the system. HPV vaccination completion was recorded for 52.2% of cases, and among those tested for HPV (n = 19), 31.6% were positive for types 16 or 18. Invasive cancer accounted for 56.5% of diagnoses, with 92.3% of invasive cases presenting at International Federation of Gynecology and Obstetrics (FIGO) stage I. Histology included squamous cell carcinoma (69.2%) and adenocarcinoma (30.8%). The median interval from abnormal screening result to diagnosis was 3.1 months (range: 0.7-61.9). No cervical cancer–related deaths were identified.
Conclusion
This case series provides the first comprehensive description of cervical neoplasia among CAF Regular Force members over more than a decade. Findings highlight important opportunities to strengthen CAF prevention efforts, including improving screening participation and reducing delays in follow-up of abnormal tests. Enhanced reminder systems, reduced barriers to screening including self-testing, and targeted health promotion may reduce cervical cancer incidence and support the health and operational readiness of CAF personnel.