One day Pap tests for cervical cancer will be replaced by less invasive and more accurate HPV tests.
But as countries around the world, and some provinces here domestically, begin the transition, doctors say Ontario is one of the jurisdictions lagging behind.
The commitment goes far beyond comfort.
“If we switch sooner, we could potentially save hundreds to thousands of lives each year,” said Michelle Halligan, director of prevention at the Canadian Partnership Against Cancer. “The longer we delay it, the longer we delay our benefits and put people at risk.” The nonprofit is mandated by the federal government to carry out Canada’s cancer prevention goals.
“There is tremendous momentum in the country to make that switch.”
Even more attractive is the HPV test, which you can take yourself, should only be done every five years.
Currently, Pap tests, which check for precancerous conditions, including abnormal cells in the cervix, are nearly 50 percent less sensitive than HPV tests, according to a 2007 study of 10,000 Canadian women published in the New England Journal of Medicine.
This means that about half of all abnormalities are missed with each Pap screening. So the tests are done every two to three years to limit damage, starting between ages 21 and 25, depending on the province, according to an article published in May in the Canadian Medical Association Journal.
The HPV test, which may involve: inserting a swab into the vagina is much more sensitive and accurate and is considered the gold standard in cervical cancer prevention.
“There’s the option of not using a speculum going in … there’s no need to scrape cells off your cervix,” Halligan says.
Ontario Health told the Star that switching to the HPV test is a “major undertaking” and said the Department of Health announced in its 2017 budget that the test would be funded through the Ontario Cervical Screening Program. Ontario Health did not provide further details on the timeline or specific costs in time for the deadline.
A 2019 report from the Canadian Agency for Drugs and Technologies in Health completed an economic review and found that switching to HPV testing would lower the cost of cervical cancer screening in Canada, as the more accurate test eliminates the need for multiple tests to confirm would reduce a cancerous HPV strain.
This analysis did not include implementation costs, which vary by jurisdiction, the report said. The cost of the switch could be “potentially significant,” so planning and financing are key, the agency said.
The agency also stressed that the public understands that the reason behind the switch is greater effectiveness, not cost. A public health education campaign is also needed so that women and people with female reproductive organs can understand the rationale for switching to HPV testing.
Cervical cancer is caused by the mutation of cells in the cervix; testing catches signs of precancerous cells before they evolve into cancer.
Most cervical cancers are caused by certain strains of HPV or human papillomavirus. HPV is a common sexually transmitted disease and most strains are not harmful and will resolve on their own.
The incidence of cervical cancer in Canada in 2022 is about 7.5 people per 100,000, according to an article in the Canadian Medical Association Journal. Those numbers have fallen from 20.05 per 100,000 in 1978, when screening efforts intensified, and from 12.6 per 100,000 in 2006, before the introduction of the HPV vaccine in schools.
But with HPV testing, those rates will further decline, with the goal of eliminating cervical cancer by 2040, Halligan says.
Other provinces that have continued HPV testing include Quebec, which announced the switch in June, and PEI, which is in the process of switching.
A 2012 report from the Ontario Cervical Cancer Screening Program—an Ontario Health initiative that informs people when it’s time to get tested—explained priorities for the coming years, including switching to HPV testing for women in their 30s. and older. Ontario’s 2017 budget also stated that the province would switch from Pap testing to HPV testing for women ages 30 to 69.
Now Ontario plans to launch HPV testing in the Ontario Cervical Cancer Screening Program in 2024-25, according to the province’s business plan for this year.
The delays are frustrating, said Dr. Amanda Selk, an obstetrician-gynecologist at Sinai Health and Women’s College Hospital, and an associate professor at the University of Toronto.
HPV screening “is a much better test and this is not new knowledge, but Canada is lagging behind,” she says.
There hasn’t been enough education for health care providers and the public for a change, she says.
“This is really the role of the provincial government and we don’t see a lot of them,” she says. Ontario was one of the first provinces to say it would switch to HPV testing, so it’s a shame that didn’t happen, she says.
A Pap test looks for signs of precancerous cells, but it’s not perfect, and false negatives can delay treatment, she says. Testing for HPV is at the root of cervical cancer, she says.
There are several options for how Ontario can move forward with HPV testing, including allowing patients to take a swab themselves by inserting a cotton swab into their vagina (similar to how PCR tests are done in the nose for COVID-19), or a health care provider does a Pap test and an HPV test, but doesn’t process the Pap test cytology unless the HPV test is positive, she says.
The home testing option would be especially important in rural areas and for Indigenous communities who don’t have access to frequent screenings, or face barriers in traveling for a Pap smear, Selk says.
Pap tests may be needed in Ontario for a few more years after the switch is made to determine who should be seen first, as the HPV test will detect even those with a low-risk strain, Selk says. As young people grow up who have received the HPV vaccination in schools, there will be fewer and fewer cases of HPV in the population and fewer people will test positive for HPV, so the system won’t get overwhelmed, she says.
The HPV vaccine has been offered free of charge in Ontario for 7th grade students beginning with the 2007-08 school year. Concerns have been raised about students who missed the shot due to COVID school disruptions.
The transition to a new system is complex and people need to be informed to make them feel comfortable taking the test, as well as addressing stigma as HPV is a sexually transmitted infection, said Dr Catherine Popadiuk, associate professor obstetrics and gynaecology and specialized in cervical cancer. cancer.
“We need to get rid of that stigma that there’s something negative about this,” she says, “so that’s part of the concern in having a good strategy for rolling this out.”
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