Cervical cancer screening in Canada: 2021/2022
HPV testing
Human Papillomavirus (HPV) testing is increasingly being recognized as the leading approach in cervical cancer screening. The link between the persistent presence of HPV and the risk of developing cervical cancer has been established, making HPV primary screening advantageous as it identifies cervical pre-cancer earlier, resulting in a significantly lower likelihood of cervical cancer compared with Pap test screening. Learn more about HPV testing in Canada.
HPV testing is not currently used for primary screening within organized screening programs in Canada. However, seven provinces and one territory have plans to implement HPV testing for primary screening. BC and NB are investigating implementing self-sampling to facilitate HPV primary screening. QC announced plans in May 2022 to implement a new cervical screening program using HPV screening as the primary test.
Provinces and territories are currently undergoing activities to support the implementation of HPV primary screening, including developing guidelines and business and operation plans.
Status of HPV primary screening implementation
| P/T | No current HPV primary screening activities | Planning for implementation | Piloting | Partially implemented | Jurisdiction-wide implemented | Plans to implement self-sampling to facilitate HPV primary screening implementation |
|---|---|---|---|---|---|---|
| YT | ✓ | |||||
| NT | ✓ | |||||
| NU | ✓ | |||||
| BC | ✓ | ✓ | ||||
| AB | ✓ | |||||
| SK | ✓ | |||||
| MB | ✓ | |||||
| ON | ✓ | |||||
| QC | ✓ | |||||
| NB | ✓ | ✓* | ||||
| NS | ✓ | |||||
| PE | ✓ | |||||
| NL | ✓ |
NB:* As of August 2021, the NBCN has initiated the project to assess the feasibility and provide recommendations towards implementation of HPV self-sampling for the New Brunswick Cervical Cancer Program.
Definitions:
- No current HPV primary screening activities: “Status Quo” cervical cancer screening activities.
- Planning for implementation: Conducting environmental scanning, gathering requirements to determine approach for implementation (i.e., preparing/submitting business cases, forming advisory committees) and/or planning for pilots/programs for HPV primary screening and/or self-sampling.
- Piloting: Pilot has been implemented to offer HPV primary screening. Pilots include time-bound screening activities that do not have confirmed sustainable funding.
- Partially implemented: Organized HPV primary screening has rolled out in certain sites or for certain populations across the jurisdiction. Partial implementation includes organized screening being phased-in over a time by gradually increasing capacity of screening sites or if plans are in place to implement organized screening at additional site locations. Partial implementation has secured sustained funding to offer long-term organized screening.
- Jurisdiction-wide implemented: A fully implemented organized HPV primary screening program, which is available jurisdiction-wide, with or without options for self-sampling and embeds a culturally safe approach to care. Note: An organized program would include elements such as eligibility criteria, quality assurance mechanisms, participant recall, abnormal follow-up, etc.
Activities to support the transition to HPV primary screening
| P/T | Description of activities to support the transition to HPV primary screening |
|---|---|
| YT | · Updating infrastructure to support implementation of program |
| NT | |
| NU | |
| BC | · Planning is underway for pilot |
| AB | |
| SK | · Data modelling to assess human and financial resource impact in process · Provincial Cervical Cancer Task Force working collaboratively to identify and assess steps needed for shift to HPV primary screening |
| MB | |
| ON | · Developing the future state cervical screening and colposcopy recommendations based on literature reviews, environmental scans, Ontario data analyses and input from an international expert panel that includes public representatives · Planning a stakeholder engagement and communication strategy to support provider (providers performing screening and providers performing colposcopy) and public change management · Working with regional cancer programs to support the regional implementation of the HPV test (e.g., preparing to strike regional implementation steering committees) · Planning for required changes to program infrastructure to support HPV test implementation (e.g., updating correspondence mailing campaigns) · Developing recommendations with Ontario’s Ministry of Health for updates to the physician and laboratory fee schedules to reflect the future state program · Preparing request for proposal materials for the procurement of laboratory services and the HPV test system platform |
| QC | · The Institut national d’excellence en santé et services sociaux (INESSS) has been commissioned to propose a screening pathway for cervical cancer using HPV as primary test (report expected in 2021) · The cervical cancer screening and investigation committee, bringing together clinical experts in this field, has been put in place to advise, assist, and make recommendations to the MSSS, particularly regarding the implementation of the incoming INESSS recommendations |
| NB | |
| NS | · Updating infrastructure to support implementation |
| PE | · 2021 identifying testing devices · Development of guidelines · Convening partners/stakeholders to support implementation |
| NL | · Work underway to include development of a business and operation plan · Work with involve stakeholder engagement, working group and consultation |
Currently, five provinces and two territories are using HPV testing in triage, with most specifying it is used in participants ≥ 30 years old with ASC-US. Some jurisdictions use HPV testing in post treatment, while others are researching its use for triage within their jurisdiction.
Current capacity in which HPV testing is being used
| P/T | Capacity in which HPV testing is being used |
|---|---|
| YT | Post treatment |
| NT | Triage in participants |
| NU | Triage in participants ≥ 30 with ASC-US |
| BC | Post treatment |
| AB | Triage in participants ≥30 with ASC-US or participants ≥ 50 with LSIL |
| SK | Currently working to implement revised cervical screening guidelines for the province, including transition to liquid based cytology and HPV reflex testing. Physician ordered HPV testing in place |
| MB | HPV Triage implementation planning in progress. Will support participants ≥ 30 with ASC-US and participants ≥ 50 with LSIL |
| ON | HPV testing is not currently funded by the Ontario Ministry of Health. However, it is available on a patient pay basis or in some hospital settings. Recognizing that it is available to everyone, the OSCP provides guidance to healthcare providers on when to consider its use (e.g., for people with a first time ASCUS result over age 30 or to discharge eligible patients from colposcopy). |
| QC | Triage in participants ≥ 30 with ASC-US |
| NB | Triage in participants ≥ 30 with ASC-US or participants ≥ 50 with LSIL |
| NS | Colposcopy clinic |
| PE | Triage in participants > 30 with ASC-US and no previous abnormal Pap HPV testing provided as a 12 month-follow-up test in treatment phase to confirm persistent or cleared HPV infection upon request by primary care provider, gynecologist |
| NL | Pilot trials/research Triage in participants > 30 with ASC-US |
Abbreviations: ASC-US: atypical squamous cells of undetermined significance; LSIL: low-grade squamous intraepithelial lesion
Five provinces and two territories who use Pap tests as the primary screening method also use HPV testing at the same time or after a Pap test. No jurisdiction is using HPV as the primary screening method. Five provinces include HPV genotyping when completing HPV testing to identify the presence of high-risk HPV strains to inform next steps.
Use of HPV testing after an abnormal cervical screening test result
| P/T | Pap primary screening with HPV triage/ reflex testing | Please describe when Pap primary screening with HPV triage/reflex testing is used | HPV testing includes HPV genotyping? | Please describe when HPV with genetic triage is used |
|---|---|---|---|---|
| YT | ||||
| NT | ✓ | · One year follow up for LSIL or ASC-US for 21-29 years · ASC-US ≥30 years · LSIL or ASC-US post-menopausal |
||
| NU | ✓ | Pap with HPV reflect testing for participants >30 years with ASCUS | ||
| BC | ||||
| AB | ✓ | Pap with HPV reflex testing for participants with ASC-US >30 and LSIL > 50 | ||
| SK | In process for 2021/22 | Proposed guidelines in development | ||
| MB | ✓ | In planning stages for Fall 2021 implementation | ✓ When implementation is complete | |
| ON | ✓* | HPV testing is not currently funded by the Ontario Ministry of Health. However, it is available on a patient pay basis or in some hospital settings. Recognizing that it is available to everyone, the OCSP provides guidance to healthcare providers on when to consider its use (e.g., for people with a first time ASCUS result over age 30 or to discharge eligible patients from colposcopy). | ✓^ | |
| QC | ✓ After an abnormal pap test screening, oncogenic HPV testing is used for participants > 30 before following with colposcopy if HPV test is positive. |
|||
| NB | ✓ | Recommended for participants aged >30 with an ASC-US or >50 with LSIL | ✓ Includes HPV genotyping |
|
| NS | ||||
| PE | ✓ | Triage in participants > 30 with ASC-US and no previous abnormal Pap. Further HPV testing on request by primary care provider for treatment/exit management, e.g. 12 months repeat testing to confirm persistent or cleared HPV infection | ✓ | Triage in participants > 30 with ASC-US and no previous abnormal Pap. Further HPV testing on request by primary care provider for treatment/exit management, e.g. 12 months repeat testing to confirm persistent or cleared HPV infection |
| NL | ✓ | Triage in participants >30 with ASC-US |
ON: *This is not the primary screening test recommended by the program at this time.
ON: ^The future state of cervical screening using HPV as the primary screening test are currently under development as part of planning for the implementation of HPV testing in Ontario.
Abbreviations: ASC-US: atypical squamous cells of undetermined significance; LSIL: low-grade squamous intraepithelial lesion; HSIL: high-grade squamous intraepithelial lesion; hrHPV: high-risk HPV