Canada is moving away from Pap tests. Here's what you need to know
At-home HPV tests are accurate, effective and will increase access, experts say
Getting a Pap test can be an uncomfortable experience.
For people who have undergone sexual trauma or experienced discrimination in a doctor's office, putting their feet into stirrups for a pelvic exam is likely even worse.
Some relief could be coming as Canada moves away from Pap smears for cervical cancer screening in favour of testing for the human papillomavirus (HPV), which causes the vast majority of cervical cancers. The HPV test has been shown to be safe and effective — plus, people can do the swab test at home.
It's a small but mighty change that experts say will help Canada meet its goal to eliminate cervical cancer by 2040.
"HPV testing is well-proven to be an enormous improvement in terms of detection of pre-cancers over Pap testing," said Dr. Kim Alexander, a gynecologist in Brampton, Ont., whose expertise is in cervical cancer screening.
"Screening with Pap testing misses almost half of existing abnormalities on the cervix," Alexander told Dr. Brian Goldman, host of CBC's The Dose.
The HPV test, however, identifies pre-cancer cells earlier, studies have shown. That means a negative result can be trusted, Alexander said.
"If you have a single negative HPV test, the probability of finding a pre-cancer 10 years later is less than one per cent."
Benefits of the HPV test
Most jurisdictions across Canada are moving to HPV testing as primary screening.
One of the biggest advantages to the switch is the improved efficacy of the test. Because it detects cervical precancers earlier and more accurately, the test only needs to be done every five years.
In comparison, it's recommended that women aged 30 to 69 get a Pap test at least every three years.
If an HPV test is positive, a Pap smear is done to collect a specimen from the cervix for further testing.
If you're going to a medical office for HPV screening, the doctor or nurse practitioner may still do a pelvic exam with a speculum, said Alexander.
"If we can collect that primary HPV sample in the doctor's office with a speculum, then if your HPV test shows up positive in the lab, they can automatically run the Pap test from the same specimen," she said.
However, a benefit of HPV testing is being able to do it at home yourself, said Dr. Gina Ogilvie, an expert in HPV screening who ran a pilot project rolling out at-home tests in regions across British Columbia.
"I think some of us don't realize how difficult pelvic exams are for many folks," said Ogilvie, a UBC professor and Canada Research Chair in Global Control of HPV-Related Disease and Cancer.
With a testing kit, patients can "have dignity, privacy, do it in their own home, be under their control," she said.
How effective is the at-home test?
Data has shown that self-testing is just as precise as a test in a health-care provider's office.
This is "great news, especially for our under-serviced populations," Alexander said.
People who could benefit from the self-testing option include those who live in remote areas, are low income or have precarious employment, don't feel comfortable in a doctor's office, or don't have a family care provider.
"That has huge advantages in terms of equity," said Dr. Craig Earle, CEO of the Canadian Partnership Against Cancer (CPAC), a federally funded group that works with provincial cancer agencies.
"People from certain cultural groups for whom speculum examination is problematic or people who have suffered sexual trauma, this is a test that's much more acceptable to them," said Earle.
What does the at-home test look like?
There are two types of HPV self-testing kits approved in Canada, which work in similar ways.
The swab being used in B.C. looks like a long Q-Tip, said Ogilvie. You insert it into your vagina and turn it for 15 to 20 seconds to get a good sample.
"It's not aiming anywhere in particular. It's not like you have to touch the cervix or anything. It just has to get a good vaginal sample," said Ogilvie.
The swab is placed into a vial, sealed in an envelope and mailed to the lab.
Change rolling out across Canada
The at-home test costs around $100 but may be free in some provinces doing pilot programs, so it's best to check with your health-care provider.
So far, Prince Edward Island is the only place in Canada using HPV testing as primary screening for the entire province.
CPAC's website has information on the status of provinces and territories in adopting HPV testing as the primary screening for cervical cancer.
"P.E.I., I think, is the leader, having actually implemented this as the main test in their province," said Earle.
"British Columbia has also done it quite widely within the province, but I think it's not quite a full provincial program yet. And then there are pilots we know going on in places like Ontario."
In the 2021 B.C. self-testing pilot, 10,000 kits were sent to regions across the province, said Ogilvie.
B.C. is hoping to roll out self-collection across the province in the near future, she said.
What if you don't have a family doctor?
There are challenges to having people do their own test at home. One of the biggest is not having a family practitioner, experts said.
With self-testing, it's "much easier to get the test, but more complex in terms of figuring out the next steps, especially for unattached patients," said Earle.
In the case of a positive test, follow-up care is critical, said Earle.
"There needs to be a plan and support for helping people navigate to the next test, which can either be then having a Pap or colposcopy," he said.
Colposcopy is a procedure to visually examine the cervix and vagina for signs of disease.
"You don't want people falling through the cracks," said Earle.
During its self-collection pilot project, B.C. Cancer identified family doctors and nurse practitioners who follow up with people who have abnormal results and don't have a primary care provider, said Ogilvie.
"A screening test is only as good as people getting the follow-up they need to be treated," she said.
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