Cervical screening in Canada, 2023-24

HPV testing

On this page:

• Status of HPV primary screening implementation
• Activities to support the transition to HPV primary screening
• Current capacity in which HPV testing is being used
• Use of HPV testing after an abnormal cervical screening test result

Human Papillomavirus (HPV) testing is increasingly being recognized as the leading approach in cervical screening. The link between the persistent presence of HPV and the risk of developing cervical cancer has been established, making HPV primary screening advantageous as it identifies cervical pre-cancer earlier, resulting in a significantly lower likelihood of cervical cancer compared with Pap test screening. Learn more about HPV testing in Canada and the current state of the Elimination of Cervical Cancer.

One jurisdiction is currently using HPV testing as the primary screening method for cervical cancer. Eight provinces and two territories have plans to implement HPV testing for primary screening. Jurisdictions are currently undergoing activities to support the implementation of HPV primary screening, including developing guidelines and business and operation plans.

Status of HPV primary screening implementation

_{*BC: Self-screening is available province wide for eligible people. During BC’s 3-year transition, LBC samples will be triaged to either primary cytology or HPV, depending on the patient’s age. Not all samples will have HPV testing, but HPV testing is available through self-screening for those who choose that collection method.
^ON: Ontario plans to implement self-sampling for HPV testing in a phased approach which will enable the program to determine how best to implement self-sampling in the Ontario context (e.g., designing the best clinical pathways to ensure follow-up of positive test results and optimizing kit distribution and return processes).
~NB: As of March 2023, approval to proceed with the implementation of the phased-in transition from cytology based testing (Pap) to HPV primary screening, with an option for self-sampling.}

Definitions

Levels of implementation status (to show incremental implementation progress by jurisdiction):

1. No current HPV primary screening activities: “Status Quo” cervical screening activities.
2. Planning for implementation: Conducting environmental scanning, gathering requirements to determine approach for implementation (i.e., preparing/submitting business cases, forming advisory committees) and/or planning for pilots/programs for HPV primary screening and/or self-sampling.
3. Piloting: Pilot has been implemented to offer HPV primary screening. Pilots include time-bound screening activities that do not have confirmed sustainable funding.
4. Partially implemented: Organized HPV primary screening has rolled out in certain sites or for certain populations across the jurisdiction. Partial implementation includes organized screening being phased-in over a time by gradually increasing capacity of screening sites or if plans are in place to implement organized screening at additional site locations. Partial implementation has secured sustained funding to offer long-term organized screening.
5. Jurisdiction-wide implemented: A fully implemented organized HPV primary screening program, which is available jurisdiction-wide, with or without options for self-sampling and embeds a culturally safe approach to care. Note: An organized program would include elements such as eligibility criteria, quality assurance mechanisms, participant recall, abnormal follow-up, etc.

Activities to support the transition to HPV primary screening

Ten jurisdictions are working towards the transition to HPV primary screening. Activities to support the transition include developing business cases, updating existing infrastructure, developing recommendations and pathways, and implementing pilot programs.

_{*BC: BC is considering the following self-sampling and lab assays: Copan FLOQSwabs®, eluded into PreservCyt, COBAS instrument.
^PE: PE is considering the following self-sampling and lab assays: Self-vaginal FLOQSwabs® with breakpoint (COPAN HPC146R03 Date 2021.01 — product description), and BD Onclarity™ HPV Assay.
-NU, MB: No information was provided at the time data were collected.}

Current uses of HPV testing
Six provinces and two territories are using HPV testing in triage, with most specifying it is used in participants ≥30 years old with ASC-US. Some jurisdictions use HPV testing in post treatment, while others are researching its use for triage within their jurisdiction.

Current capacity in which HPV testing is being used

Use of HPV testing after an abnormal cervical screening test result

_{ON: * While in use in some cases, cytology screening alone is the current screening test recommended by the program. HPV testing with cytology triage is currently under development as part of planning for the implementation of HPV testing in Ontario.}

Abbreviations:

• ASC-US: atypical squamous cells of undetermined significance
• LSIL: low-grade squamous intraepithelial lesion
• HSIL: high-grade squamous intraepithelial lesion