Halifax doctor working on 'game-changer' urine test to detect cancer-causing HPV

A Halifax doctor is leading research to develop a urine test to detect human papillomavirus, or HPV — a common sexually transmitted infection that's the biggest cause of cervical cancer.

"If we can do a urine test for HPV that is cheap and effective, that would be a great step forward," Dr. James Bentley, head of gynecologic oncology at Dalhousie University, told CBC Radio's Maritime Noon.

The new test could be used to screen people for the virus, so they could then be provided treatment to prevent cervical cancer, he said. It could also decrease the need for Pap tests, the current screening method for cervical cancer that Bentley said has "lots of limitations," including the significant technology needed.

Bentley is working with a team of international scientists to develop the urine test, which he describes as a "point of care" test, meaning it can be easily transported to places like remote communities where standard testing isn't as easily available.

The test would be affordable and could produce results instantly, making it a valuable tool in cervical cancer prevention, he said.

The Canadian Cancer Society estimates 1,350 Canadians would have been diagnosed with cervical cancer in 2020, and an estimated 410 would have died from it.

"We know it does kill women in the prime of their lives, and it also does affect marginalized communities, First Nations, Inuit and Métis women at disproportionately high rates as well," said Bentley.

He said currently, only about 70 per cent of eligible Canadians get regular cervical cancer screenings.

Barriers to testing

Abbey Ferguson, the health promotion co-ordinator and medical office administrator for the Halifax Sexual Health Centre, estimates the clinic does 25 to 30 Pap tests per week.

She said there are many barriers when it comes to getting a Pap test. Even just getting an appointment can be a challenge — one that's been exacerbated by COVID-19.

"We're wildly backed up," said Ferguson. "We simply do not have enough primary care providers for our population."

Another issue is the invasive nature of a Pap test. Many people may be uncomfortable to put their feet into the stirrups.

It can be especially challenging for patients who have trauma related to sexual assault, or transgender or non-binary people seeking gender-inclusive care. Others may not trust the medical professional or feel heard by them during the examination.

"Every step of getting a Pap, for a lot of people, is a struggle. It's a struggle to get through on the phones, it's a struggle to get an appointment in a timely manner that works for you," said Ferguson.

"And then when you get there, it is very personal to get up in the stirrups and to have a speculum inserted, and that's hard for folks."

While Ferguson said pelvic exams will always be important in some capacity, a urine test to catch HPV would be "awesome." 

"We don't currently have any sort of front-line screening for HPV, because a Pap test is a test for cells that may show up as abnormal, which then may be determined to be HPV, but it's not an HPV yes-or-no test," she said.

"So, a urine test that actually is an HPV yes-or-no? I'm all for it. Sounds great."

World-wide implications

Having a simple urine test to detect the cancer-causing virus could have huge implications, said Bentley — not just in Canada, but worldwide.

"This is going to be a real advantage and a game-changer for rural remote communities, places in sub-Saharan Africa, India, Nepal," he said.

While cervical cancer is an issue in Canada, it is a much bigger problem elsewhere, especially in developing countries.

In November 2020, the World Health Organization launched a global strategy to eliminate the "preventable" disease through increased vaccinations, screenings and treatment.

"Without taking additional action, the annual number of new cases of cervical cancer is expected to increase from 570,000 to 700,000 between 2018 and 2030, while the annual number of deaths is projected to rise from 311,000 to 400,000," the WHO said in a release. 

"In low- and middle-income countries, its incidence is nearly twice as high and its death rates three times as high as those in high-income countries."

Early days of research

Bentley's research is being funded through the Canadian Cancer Society's Spark Grants. The full value for Bentley's grant is $140,483.

Stuart Edmonds, executive vice-president of mission at the Canadian Cancer Society, said "it's fantastic" to be involved in a project with such far-reaching impacts.

"We're living in an environment now where information, wherever it's gathered, is now being made available to people around the world. The whole COVID vaccine is a good example of that, where it doesn't really matter where the study is conducted, the implications and the impact can be much broader," he said.

"We want positive outcomes for all people that may be affected by cancer."

Bentley said it could take years to actually get the urine test in use, but he said they hope to finish their research within a year or so.

"Early days for research, but this will be very interesting research, and really help with the elimination of cervical cancer," he said.

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