Ontario shifts to HPV test for cervical cancer screening, but no at-home kits yet

Ontario will replace its main method of cervical cancer screening next week to a more accurate and less frequent test, but the dreaded speculum exam is not in the rear-view just yet.

Human papillomavirus (HPV) tests in the province will replace Pap tests, also known as Pap smears or cervical cytology, on March 3, following similar moves in British Columbia and Prince Edward Island.

Both tests aim to detect cervical cancer and involve collecting a cell sample from the cervix. Ontario Health says the HPV test is more accurate at catching cervical cancer than the previous method, which will mean most patients can get tested less often and start their routine monitoring later.

But self-screening kits that have been adopted in British Columbia won't be a part of the upcoming rollout in Ontario, which means patients still need to visit the doctor to get tested.

Dr. Amanda Selk, an obstetrician gynecologist in Toronto, explains what you need to know ahead of the change.

Ontario doctors will pivot to testing for HPV first when screening for cervical cancer, rather than conducting a cytology test. The test will feel the same for the patient. It will still involve a doctor, nurse or midwife inserting a speculum into the patient's vagina to swab their cervix for a sample that will be sent to a lab. But starting next week, the lab will test for HPV, the primary cause of cervical cancer.

"Previously they would look at the cells taken — it's called cytology — and look for pre-cancer cells, and sometimes they would have slightly abnormal changes that weren't pre-cancer and you would end up with more testing and actually nothing was wrong," Selk said.

The new method tests for the virus that causes pre-cancer and cancer, catching it earlier, reducing false positives and identifying populations more at risk, Selk said.

Ontario Health guidelines sent to physicians over the last several weeks in preparation for the rollout say cervical cancer screening will be for people aged 25 to 69. That's several years later than the previous guideline of starting at age 21 for individuals who are or have been sexually active.

For those who test negative for HPV, the interval between tests will be extended to five years, from three.

For positive specimens, the sample taken for HPV testing will undergo a Pap test at the lab to identify if the infection caused cell changes in the cervix, and determine if it's high-risk and likely to cause cancer.

A provincial flow chart sent to doctors shows patients who test positive will be asked to screen again in two years.

After those two years, if the patient's HPV test comes back negative, they can return to the five-year screening protocol, the document says. Cancer Care Ontario says 80 per cent of HPV infections clear within three years.

Immunocompromised patients will be screened every three years.