HPV screening and follow-up pathway

Supporting partner and community engagement

network of five people: patient, loved one, three healthcare workersRecommendation: Throughout planning and implementation of HPV primary screening, build and maintain ongoing, meaningful partnerships with equity-deserving communities who are underserved by the healthcare system and partners involved in cervical screening.  

Key evidence and implementation considerations:

  • Engaging community partners to understand their specific needs will advance equity and promote community-driven strategies that foster screening uptake and participation. For example, communities can be engaged to understand acceptability and feasibility of self-sampling and options for implementation.
  • Jurisdictions can engage with community partners by forming advisory committees or working groups comprised of key community representatives to oversee and direct decisions made at every step of HPV primary screening implementation.
  • Community engagement should take place during the planning stages and continue throughout the implementation, evaluation and monitoring stages to embed the experiences, priorities and values of communities experiencing marginalization throughout the co-development process.
  • Determine who within regions/jurisdictions experience inequities in cervical cancer screening and collaborate with these groups to identify barriers and co-develop educational resources and approaches to promote access to screening.
  • Work with and engage sexual and gender minority groups (e.g., transgender, gender-diverse and non-binary populations) to co-develop specific resources that can support participation in cervical cancer screening.
    • Evidence shows that transgender populations are less likely to be screened for various cancers, including cervical.1,2 Working with transgender and other gender-diverse populations to develop specific resources can improve their participation rates in cervical cancer screening.
  • Work with and engage equity-deserving populations and communities who are often underserved by the healthcare system to ensure their concerns, values and preferences are considered throughout the implementation process.

Examples of communities and populations underserved by the healthcare system3

  • People living on low income
  • Recent immigrants and refugees
  • Racial or ethnic minorities
  • Sexual and gender minorities
  • Specific cultural groups
  • People with co-morbidities or chronic illness
  • People with mental illness
  • People with physical disabilities
  • People living in rural/remote communities
  • People experiencing food or housing insecurity
  • People without a primary care provider
  • People whose first language is neither English nor French

Recommendation: First Nations, Inuit and Métis communities and organizations must be engaged throughout every stage of implementation.4  

Key evidence and implementation considerations:

  • Establish trusting relationships with First Nations, Inuit and Métis communities and organizations where opportunities for engagement occur across each stage of implementation and partners understand how their feedback is being used.4
  • To maximize screening uptake, work with partners to create Peoples-specific approaches to implementing HPV primary screening and education resources that are grounded in reconciliation.5

Recommendation: Establish strong links among all healthcare levels to ensure continuity and completeness of care.6  

Key evidence and implementation considerations:

  • While strategy may vary by jurisdiction, every jurisdiction should develop a clear communication strategy between healthcare levels.
  • Multidisciplinary care (where professionals at all levels work alongside screening participants) has multiple benefits, including improving patient care, providing best practice, enhancing patient well-being and satisfaction, increasing the timeliness of appropriate consultations and surgery, and reducing service duplication7
  • Groups within the healthcare sector to consider engaging include screening programs; provincial/territorial ministries or government departments; healthcare providers such as family physicians, nurse practitioners, gynecologists, pathologists and their professional organizations (Society of Obstetricians and Gynaecologists of Canada, Canadian Association of Pathologists, medical societies, etc.); laboratories and staff; provincial HPV vaccination representatives; public health; cancer-related interest groups (i.e., Canadian Cancer Society), community groups/organizations; and public representation.8
  1. Lofters A, Kiran T. A tool for healthcare professionals: Improving cancer screening rates in your practice and reducing related disparities. Available from: https://maphealth.ca/wp-content/uploads/2019/11/MAP-toolkit-for-health-care-professionals-Improving-cancer-screening-rates-in-your-practice-and-reducing-related-disparities.pdf
  2. Cancer Care Ontario. Cancer fact: New policy addresses cancer screening inequities in transgender people. 2019. Accessed April 25, 2022. Available from: https://www.cancercareontario.ca/en/cancer-facts
  3. Canadian Partnership Against Cancer. Cervical Screening in Canada: 2019/2020 Environmental Scan. Toronto, ON: Canadian Partnership Against Cancer; 2020.
  4. Henderson RI, Shea-Budgell M, Healy C, et al. First Nations People’s perspectives on barriers and supports for enhancing HPV vaccination: Foundations for sustainable, community-driven strategies. Gynecologic Oncology. 2018; 149(1):93–100. https://doi.org/10.1016/j.ygyno.2017.12.024 
  5. Canadian Partnership Against Cancer. Equity-focused interventions to increase colorectal cancer screening: Program Pack. Toronto: Canadian Partnership Against Cancer; 2021. https://stg.partnershipagainstcancer.ca/topics/ equity-colorectal-cancer-screening/.
  6. World Health Organization. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. 2021.
  7. Government of Australia. Optimal care pathway for women with cervical cancer. https://www.cancer.org.au/assets/pdf/cervical-cancer-optimal-cancer-care-pathway 
  8. Canadian Partnership Against Cancer. National guidance document on HPV testing for primary screening of cervical cancer. 2016.