There is a better way than Pap tests to prevent cervical cancer. Why is Ontario taking so long to implement HPV testing?

The day will come when Pap tests for cervical cancer are replaced by less intrusive and more accurate HPV tests.

But as countries around the world and some local provinces begin the transition, doctors say Ontario is among the jurisdictions left behind.

What is at stake goes far beyond comfort.

“If we switch sooner, we will potentially save hundreds to thousands of lives each year,” says Michelle Halligan, director of prevention for the Canadian Cancer Association. “The longer we put it off, the more we put off our benefits and put people at risk.” The non-profit organization is mandated by the federal government to implement Canada’s goals for cancer prevention.

“There is a lot of momentum in the country to make that change.”

Even more attractive, the HPV test, which can be self-administered, it would only have to happen every five years.

Currently, Pap tests, which check for precancerous conditions, including abnormal cells on the cervix, are almost 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 each Pap test misses about half of all abnormalities. So testing is done every two to three years to mitigate the damage, starting between ages 21 and 25, depending on the province, according to an article published in the Canadian Medical Association Journal in May.

HPV testing, which may involve inserting a Q-tip into the vagina is much more sensitive and precise, and is considered the gold standard in cervical cancer prevention.

“There’s the possibility of not having to use a speculum that’s inserted…you don’t have to scrape cells off the cervix,” says Halligan.

Ontario Health told the Star that switching to HPV testing is a “huge undertaking” and said the Ministry 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 Medicines and Health Technologies completed an economic evaluation and found that the switch to HPV testing reduce the cost of cervical cancer screening in general in Canada, as the more accurate test would reduce the need for multiple tests to confirm a cancerous strain of HPV.

This analysis did not include implementation costs, which differ between jurisdictions, the report said. The cost of the change could be “potentially significant,” so planning and funding are crucial, the agency said.

The agency also emphasized that the public understands that the reason behind the change is greater effectiveness, not cost. A public health information campaign is also needed so that women and people with female reproductive organs can understand the reason for the switch to HPV testing.

Cervical cancer is caused by the mutation of cells in the cervix; the tests detect signs of precancerous cells before they turn into cancer.

Most cervical cancers are caused by particular strains of HPV, or human papillomavirus. HPV is a common sexual transmission, and most strains are not harmful and 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 Journal of the Canadian Medical Association. Those numbers have dropped from 20.05 per 100,000 in 1978, as screening efforts became more important, and from 12.6 per 100,000 in 2006, before the introduction of the HPV vaccine in schools .

But HPV testing will drive those rates down even further, with the goal of eliminating cervical cancer by 2040, Halligan says.

Other provinces that have gone ahead with HPV testing include Quebec, which announced the change in June, and PEI, which is in the process of changing.

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 his priorities for the next several years included a switch to HPV testing for women age 30 and older. the 2017 Ontario Budget He also mentioned that the province would switch from Pap tests to HPV tests 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 report. business plan for this year.

The delays are frustrating, says Dr. Amanda Selk, an obstetrician and 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 falling behind,” he says.

There hasn’t been enough education for health care providers and the public before the change, she says.

“This is really the role of the provincial government and we’re not seeing too much of them,” she says. Ontario was one of the first provinces to say it would switch to HPV testing, so it’s unfortunate 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. HPV testing is getting to the root of cervical cancer, she says.

There are several possibilities for how Ontario can proceed with HPV testing, including having patients take a swab by inserting a Q-tip into their vagina (similar to how in-the-nose PCR testing is done for COVID-19 ), or have a doctor. doctor do a Pap smear and an HPV test, but don’t run the Pap smear unless the HPV test is positive, she says.

The at-home testing option would be especially important in rural areas and for indigenous communities that don’t have access to frequent screening or face barriers to traveling to get a Pap test, Selk says.

Pap tests may still be required in Ontario for a few years after the change happens to sort out who should be seen first, since the HPV test will pick up even those who have a low-risk strain, Selk says. As young people who received the HPV vaccine in schools get older, there will be fewer and fewer HPV cases in the population and fewer people will test positive for HPV, so the system won’t be overwhelmed, he says. she.

The HPV vaccine has been offered free of charge to students in grade 7 in Ontario beginning with the 2007-08 school year. There has been concern for students who have not received the vaccine due to school disruptions from COVID.

Moving to a new system is complex and people need to be educated to feel comfortable getting tested and to address stigma given that HPV is a sexually transmitted infection, says Dr. Catherine Popadiuk, associate professor of obstetrics and gynecology and specializing in the cervix. cancer.

“We have to remove that stigma that there’s something negative about this,” he says, “so that’s part of the concern of having a good strategy to implement this.”


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