Ontario is replacing the Pap test with a more reliable screening procedure for human papillomavirus as part of a push to reduce deaths from cervical cancer.
Starting Monday, the HPV test will become the primary screening tool in the province. It is similar to the Pap test but more effective in checking for HPV, which can cause cancer of the cervix – the fibromuscular organ that connects the uterus to the vagina. It can also be performed less frequently.
Most jurisdictions in Canada are either switching or plan to switch to the HPV test, and several European countries and Australia have already done so.
The incidence of cervical cancer has been growing in Canada, even though it is considered preventable.
Statistics included in a 2023 report from the Canadian Cancer Society show that, after a 30-year decline, the incidence rate for cervical cancer had increased 3.7 per cent a year since 2015.
Health care providers say Ontario’s decision to switch to the HPV test is taking place at a critical time.
“I think it’s a huge step forward for women’s health care or care for any individual who has a cervix,” said Amanda Black, a professor of obstetrics and gynecology at the University of Ottawa and a past president of the Society of Obstetricians and Gynaecologists of Canada.
While Pap tests can detect changes to cells in the cervix, HPV tests can detect the presence of high-risk types of the virus before such changes have occurred.
And because the new test is more accurate, Cancer Care Ontario, the government’s principal cancer adviser, says individuals will be able to go longer between procedures.
Patients will be eligible for the new screenings every five years, though some may need to undergo the procedure more frequently because of their medical history. The Pap test is currently done every three years.
“It really reduces the burden both on the individual as well as the health care system,” Dr. Black said.
The HPV test uses a small brush to take cells from the cervix, which are then tested in a lab. It will feel similar to the Pap and will require the use of a speculum, a device often likened to a duck bill, to open the vaginal walls and expose the cervix.
The Canadian Partnership Against Cancer points to modelling that shows Canada could eliminate cervical cancer by 2040 by transitioning to the HPV test as the primary screening tool and bolstering HPV vaccination efforts.
The non-profit organization says many provinces and territories are working toward moving from the Pap to the new test.
PEI introduced HPV screenings in May, 2023.
British Columbia announced in January of last year that it would transition to the new tests by phasing them in over three years, beginning with individuals 55 and older.
B.C. said the transition is part of its 10-year Cancer Care Action Plan and includes the option to test at home, billed as the first in Canada.
Quebec says it uses both the Pap and HPV tests for cervical cancer screening. The Pap was considered its primary test until 2023, but there has been a gradual transition to the new test.
Individuals who are eligible for the screenings in Ontario include women and gender diverse people with a cervix who do not have symptoms such as bleeding or discharge from the vagina.
The province is also changing the eligibility age for cervical screening, except for immunocompromised patients. The Pap test is currently recommended for sexually active individuals with a cervix who are 21 years old. HPV tests will be recommended for those 25 and older.
The rationale for the eligibility change includes the limited benefits of screening younger people, because it takes a number of years for cervical cancer to develop and the risk to individuals below the age of 25 is considered low.
Typically, doctors say cervical screenings can stop at age 70, though some individuals may have to be tested beyond that age because of medical history.
Testing is still recommended for individuals who have gone through menopause, have no family history of cervical cancer, have had one sexual partner for a prolonged period or have not had sexual contact in a long time.
