A cervix self-screening kit is a part of the first self-screening cervical cancer plan in Canada, in Vancouver, on Jan. 9.ETHAN CAIRNS/The Canadian Press
British Columbia is phasing out Pap tests as its primary screening method for cervical cancer and replacing it with a more reliable test that can be administered at home and less frequently.
The shift to human papillomavirus testing makes B.C. one of the first provinces in Canada to deliver cervical cancer screening this way. Last May, Prince Edward Island became the first to publicly fund HPV testing, though without the option to self-swab at home; Quebec and New Brunswick have announced plans to switch, and Alberta is piloting the at-home tests.
Gina Ogilvie, a Tier 1 Canada Research Chair in global control of HPV-related diseases and prevention at the University of British Columbia, described the transition to HPV testing as a primary cervical cancer screening mode as a “major leap forward,” and said the goal is not just reducing incidence of the preventable cancer but eliminating it altogether.
“It’s really exciting to be one of the first provinces in Canada to build on the solid standard of care offered by Pap smears to prevent cervical cancer toward an even better screening test with HPV,” she said at a news conference on Tuesday.
The conventional cytology test – or Pap test, named after its creator, Greek physician George Papanicolaou – involves a doctor or nurse scraping cells from the wall of the cervix and sending them to a lab, where they are examined for abnormal changes that can lead to cervical cancer. The HPV test, meanwhile, looks for the virus that causes these abnormal changes to occur.
Beginning Jan. 29, British Columbians can request a free HPV self-screening kit from BC Cancer to collect their own sample at home with a vaginal swab, then mail the kit back to the lab for testing. They can also self-swab at participating health care provider offices and clinics, or continue to have their screening samples collected by a doctor or nurse.
Because HPV tests have higher sensitivity, screening for average-risk patients with negative screens can shift to every five years, compared to every three years for conventional Pap tests. Patients are advised to continue going to health care providers to test for reproductive tract infections such as chlamydia and gonorrhea.
Dr. Ogilvie said randomized trials, including one involving more than 25,000 B.C. women, have found that HPV-based screening is more effective at identifying those with precancerous lesions compared to conventional Pap tests.
“And, globally, clinical trials have shown that HPV-based screening misses fewer cases of cervical precancer and cancer, and it also offers us greater assurance that a negative HPV test truly means someone doesn’t have HPV,” she said.
A person who chooses to self-swab, produces an abnormal test result and does not have a primary health care provider will receive a letter connecting them to a clinic in their community for next steps. That clinic will also receive a letter advising it to connect with the patient.
The net cost of the HPV testing program is expected to be about $12-million a year when fully activated.
The shift is part of B.C.’s 10-year cancer plan, aimed at bolstering an already strained system facing a surge in cases owing to the province’s growing and aging population.
The Globe and Mail has been reporting extensively on B.C.’s pressured cancer care system. In December, 2022, The Globe reported that there were just eight full-time gynecologic oncologists in the province – six in Vancouver and two in Victoria – a figure that remains the same today. This means that anyone on the mainland requiring such a specialist had to travel to Vancouver, where nearly all gynecologic cancer patients are being treated beyond benchmark wait times because of a shortage of staff and operating room time.
On Tuesday, BC Cancer executive vice-president and chief medical officer Kim Chi said there are efforts under way to improve program capacity, including expansions in the Fraser Valley and Interior.
Lily Proctor, medical director of BC Cancer’s cervical cancer screening program, called the shift to HPV testing “extremely significant,” noting it will engage a large population of previously unseen participants.
“Cervical cancer is essentially a disease of inequity; those who don’t have access to screening do not have the opportunity for early detection and prevention,” she said, adding she is hopeful about the expansion of gynecologic services elsewhere in B.C.
“As a gynecologic oncologist I can attest to the fact that patients are waiting too long for life-saving cancer surgery. It’s not acceptable, and it is not justifiable. There are only eight of us in the province and we need to almost double that.”
Sarah Finlayson, division head of gynecologic oncology at the University of British Columbia and the surgical gynecology representative at BC Cancer, called Tuesday “a landmark day in the history of cervical cancer screening.” She is similarly hopeful for an expansion in program capacity, noting the majority of patients still cannot access surgery within acceptable targets.
“Our data shows that many of our patients, particularly those from Interior Health and Northern Health, are travelling great distances for care and some of those patients choose not to make the long trip, which results in worse outcomes for their cancers,” she said.
Andrea Woo