Cervical screening in Canada, 2023-24

Innovations in cervical screening

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In response to the World Health Organization’s call for the elimination of cervical cancer this century, Canada has an Action Plan for the Elimination of Cervical Cancer in Canada and is committed to achieving elimination by 2040. As part of this, the Partnership made funding available in 2021 to support jurisdictions through the Accelerating Innovations to Build Resilience in Cancer Screening during COVID-19 initiative, with the goal of creating equitable access to cervical screening and care and further momentum on the elimination goals. Projects were designed to be focused on well-defined activities and be completed over 1-2 years. These projects will help accelerate the uptake of evidence-based innovation which will increase resiliency of screening services.

Seven jurisdictions developed projects focused on cervical screening, and one jurisdiction developed a project to improve screening across multiple cancer sites. Many jurisdictions continue to develop innovative solutions to ongoing challenges.

Results of projects to improve cervical screening

Northwest Territories

The Northwest Territories project focused on creating a database to facilitate ongoing territorial screening programs for breast, colorectal, and cervical cancer. A functional database will allow shifting away from opportunistic testing towards inclusive methods that will more reliably serve under-screened populations, and experience less disruptions to local healthcare provision like those that have resulted from COVID-19.

British Columbia

British Columbia developed provider and patient materials for cervix self-screening, adjusted the IT systems to accept incoming HPV test results, and implemented results handling within the IT system for HPV screening and follow-up.

Saskatchewan

Key goals:

  • Engage with key stakeholders in the development and implementation of Liquid Based Cytology (LBC) and HPV reflex testing
  • Support the development and implementation of revised provincial screening guidelines
  • Develop and deliver a strategic, comprehensive, and equity-oriented knowledge translation plan for healthcare providers and the public

Key deliverables:

  • Revised screening guidelines
  • Updated screening program for cervical cancer materials and website (multiple healthcare provider resources in varied formats and an accredited Continuing Medical Education course)

Manitoba

CancerCare Manitoba’s CervixCheck was provided funding from CPAC to help make cervical cancer screening more accessible during the COVID-19 pandemic, and to support recovery. The purpose of the project was to increase participation in cervical cancer screening by inviting under-screened/unscreened participants to complete a cervical cancer screening kit (HPV self-sample). Inclusion criteria included participants 30 years of age and older who had not completed a Pap in at least five years, or had never participated in Pap testing. Three streams were evaluated: opt-in, opt-out, and control groups. Project results were better than expected, with 14% participation in the opt-out group, and 50% participation of those who requested a kit within the opt-in group (completed the kit within the study timeframe). Close to 750 of participants completed a satisfaction survey, with 80% of respondents indicating that they would prefer to complete a self-sample kit in the future, and an overall rate of 90% for either self-sample or Pap.

New Brunswick

Elimination of cervical cancer in New Brunswick: HPV self-sampling initiative’s primary objective was to assess feasibility and complete necessary steps to provide key recommendations for introduction of HPV self-sampling for the NB Cervical Cancer Screening Program. New Brunswick Cancer Network’s (NBCN) goal is to integrate and promote at-home access to cervical cancer screening to advance adoption of initiatives, which can support functioning of screening programs during possible successive waves of COVID-19 and increase participation rates, specifically among underserved populations. A formal business case to transition from Pap testing to primary HPV cervical cancer screening was submitted and approved as of April 2023. Implementation planning is underway.

Nova Scotia

Nova Scotia’s project is part of a phased approach for transitioning to primary HPV screening in Nova Scotia. The first phase focused on building the necessary data infrastructure for navigating patients through a more complicated pathway. This included updating the program’s privacy impact assessment, establishing mechanisms for direct mail and email to screening participants, and education for PCPs about upcoming changes.

Prince Edward Island

Goal:

  • Implementation of HPV testing, particularly self-sampling, to increase access to high-quality cancer detection, strengthen existing services, and strive to reduce barriers to screening, particularly during the pandemic

Key activities:

  • Sourcing equipment and instruments
  • Evaluating self-sampling collection devices
  • Modifying the primary database
  • Developing communication tools for education and training of providers and staff
  • Developing approved HPV screening guidelines and algorithms

Prince Edward Island also conducted pilot phases for validation and implementation, and provided education and training for providers and staff.

Result/outcome:

  • Roll-out of HPV testing as the primary screening tool as of end of May 2023.

Newfoundland and Labrador

Within Canada, Newfoundland and Labrador leads the country in HPV vaccination rates (92%), thus the province is in an excellent position to lead the country in elimination of cervical cancer. The CPAC-funded project will result in the development of a business and operational plan to support the transition from LBC to HPV primary screening for cervical cancer.

The COVID-19 pandemic had a profound impact on health services across the country, including reducing or pausing cancer screening. Throughout the COVID-19 pandemic, and as screening programs resumed, many jurisdictions developed innovative tools and updated their processes to better serve the community.

Innovations in cervical screening programs

British Columbia

British Columbia is running a pilot for HPV screening with self-collection.

Saskatchewan

The SPCC has been able to track overall changes in screening volumes for the program during COVID-19. However, this data has not yet been analyzed to determine or propose any actionable changes.

Nova Scotia

To help assist with capacity and wait times in colposcopy clinics around the province, the Cervical Cancer Prevention Program offered to support early discharge of patients with ASCUS/LSIL referral Pap and CIN 1 on biopsy. Reminder letters were mailed to physicians or healthcare providers for patients without a follow-up Pap recorded in the registry. Patients with a normal repeat Pap could return to normal screening intervals.

The Cervical Cancer Prevention Program noticed a 35–40% deficit of Pap smears during the COVID-19 pandemic. In response, letters were mailed to PCPs with the offer to help prioritize patients. Using the last Pap performed as a proxy, Nova Scotia generated a list of patients between 3.5 and 5 years overdue for any provider requesting one. Just over 800 letters were mailed to healthcare providers and Nova Scotia received 445 requests for the customized list, representing approximately 15,000 patients.

Prince Edward Island

As of May 23, 2023, Prince Edward Island transitioned to HPV primary screening, and transitioned to LBC equipment to perform reflex cytology of HPV samples.

Jurisdictions are committed to continuous improvement of cervical screening programs. The priority work in each jurisdiction is presented below.

Priority work in cervical screening

P/T Priority work in cervical screening
YT –
NT Laboratory services centralizing gynecological cytology and HPV testing. Active planning for transitioning to primary HPV testing.
NU –
BC Planning and preparation for implementing HPV screening provincially, using both provider-collected and self-collected specimens.
AB HPV Test of Cure was launched in September of 2022. HPV self-sampling pilot planning is underway, targeting Indigenous, newcomer, and rural and remote populations in Alberta.
SK Planning for a provincial move to HPV primary screening from 2023–2026, including governance framework development, implementation, and strategic and operational plan development.
MB CancerCare Manitoba’s CervixCheck is initiating a study to determine if invitation letters will increase HPV vaccine uptake among young adult participants, and to determine the sustainability and feasibility of absorbing this invitation practice within standard program operations. The project will target participants born in 1997 or later who have less than one dose of an approved HPV vaccine. Approximately 15,000 females will be enrolled in the study.

Those enrolled will be broken into three study streams:

  • Invitation only
  • Invitation and reminder sent 28 days later
  • Control group (no invitation sent)

Evaluation will take place at the end of the study period to determine if invitation letters increase HPV vaccine update among eligible young participants.

The CervixCheck’s database registry has expanded to include management for those of M, F, or X genders who require cervical cancer screening. These changes allow the program to accept and register all cervical cancer screening reports, send appropriate recalls when the person is due to return, manage abnormal follow up, and communicate in a respectful, equitable, and inclusive manner.
 
ON –
QC A purchasing process is underway for liquid-based cytology equipment for laboratory clusters. There will be a call for tenders in the near future to acquire liquid-based cytology equipment in order to begin rolling out HPV as a primary test in Quebec.
NB Revision to NB Cervical Cancer Prevention and Screening Program’s clinical practice guidelines: specific to increase in initiation age to 25, incorporating risk-based approach, statement regarding eventual transition to HPV primary screening, and gender-inclusive terminology.

Work towards the implementation of LBC province-wide is in alignment with the Department of Health’s current Provincial Lab Reorganization project.

Collaborations with regional health authorities (RHA) and provincial initiatives (e.g., NB HealthLink, eVisitNB) to improve access to Pap testing services for those without PCPs
NS Laboratory services centralizing Pap and HPV testing. Active planning for transitioning to primary HPV testing.
PE Priority work in cervical cancer screening includes:

  • Implementing primary HPV screening with an emphasis on self-sampling
  • Quantifying resource requirements for ongoing delivery of the service
  • Ensuring appropriate evaluation processes are in place for ongoing monitoring and improvements
NL The cervical screening program is also working towards data integration of HPV vaccine status and reported testing outcomes to help build the operational plan and transition to HPV primary cervical cancer screening.

-YT, NU, ON: No information was provided at the time data were collected.

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