Eliminating cervical cancer in Canada
Cervical screening in Canada
Key takeaways
- In 2017, cervical screening participation for women 21 to 69 years of age, corrected for a previous hysterectomy, in Canada was 76.6%.
- In the same year, cervical screening participation was 62.2% for people in the lowest income quintile, 63.5% among newcomers and 72.5% for those living in rural or remote locations, demonstrating more work is needed to improve access for people who face barriers to screening and care.
Cervical screening is available across all provinces and territories in Canada. Since it was first introduced, significantly fewer people have been diagnosed with or have died from cervical cancer.1 Organized cervical screening programs coordinate the delivery of services, which can increase participation, support timely follow-up and retention, and limit the harms of screening. As of January 2024, organized cervical screening programs exist in nine provinces, with additional provinces and territories actively working to implement their own programs.
Updates to cervical screening guidelines and processes are underway across Canada. Provincial and territorial guidelines for cervical screening, including start/stop ages and frequency, are outlined in the Cervical cancer screening in Canada: 2021/2022 report. Where organized screening programs are not available, individuals may request screening directly from a primary care provider as part of their regular care.
Provinces and territories are in various stages of planning for the transition to HPV primary screening, which is superior to Pap tests and offers the opportunity for self-screening, where people can collect a screening sample themselves. A few provinces have already made the switch and recommend HPV primary screening for eligible people aged 25 to 69, once every five years.2,3
Story of progress
Introducing organized cervical screening in the territories
Northwest Territories will be piloting an organized cervical screening program using HPV self-screening as the primary test. This will be the first organized cervical screening program to roll out in the territories. About half of the population of Northwest Territories is First Nations, Inuit or Métis, and the majority (86%) live in smaller communities with multiple barriers to accessing screening. Currently, the onus is on individuals to request cervical screening from a primary care provider, which can lead to some people being missed. The creation of a culturally safe, organized cervical screening program will support territorial access to screening, build relationships and improve health outcomes across Northwest Territories, with HPV primary screening at the forefront.
Cervical screening coverage and program status
Hover over each province and territory for cervical cancer screening coverage and program status.
Legend
● Opportunistic screening
● Program announced or planned
● Organized population based screening
Data table and footnotes
Percentages of women (aged 21-69) reporting at least one Pap test in the past three years, 2017
Canada has a target that no less then 80% of eligible individuals in any identifiable group are up to date with cervical screening.
Legend
● Coverage target
Data table and footnotes
Screening uptake is critical to the elimination of cervical cancer
Recent trends indicate that cervical cancer incidence in Canada is on the rise and has been increasing by 3.7% per year since 2015.4 Optimizing screening uptake will be essential to reverse the trend and achieve elimination. Canada has set a target of 90% of eligible individuals being up to date with cervical screening by 2030. In 2017, cervical screening participation for women 21 to 69 years of age, corrected for a previous hysterectomy, ranged from 70.1% in Quebec to 83.5% in Newfoundland and Labrador.
In addition to the overall target of 90%, Canada has a target of at least 80% of eligible individuals in every identifiable group being up to date with cervical screening. Several strategies are being used to increase and improve screening participation among identifiable groups. For example, after an Afrocentric screening program was implemented for newcomers to Ontario, cervical screening rates among those eligible increased from 59% to 70% between 2011 and 2018.5
First Nations-, Inuit- and Métis-governed research and data systems
To further support closing gaps in care, health system partners are prioritizing First Nations-, Inuit- and Métis-governed research and data systems and collaborating with First Nations, Inuit and Métis communities to co-design tailored solutions.
Efforts are also needed to enhance linkages across cancer data and fill data gaps, including collecting data on equity identifiers, to better understand who experiences disparities and report on screening participation data among those who experience barriers to screening, including members of racialized communities and 2SLGBTQIA+ individuals. This reporting will provide actionable insights to support program improvement and further understanding of screening uptake and inform strategies to enable reach.
Story of progress
Equity in cervical screening participation in Manitoba
Bringing care closer to home, introducing easy-to-use tools and resources, and embedding culturally safe approaches to care makes it easier for people to access screening. In Manitoba, HPV self-screening is being offered as a key strategy to support screening participation in general, but especially among equity-denied groups.
CancerCare Manitoba conducted a pilot from April 2021 to March 2023 to provide at-home HPV test kits to people who had never participated in cervical screening, were overdue for screening and/or faced specific barriers to screening. Early results show that at least 90% of participants found the kits easy to use, would choose the HPV at-home kits for future testing and would recommend a kit to their friends.6
- Caird H, Simkin J, Smith L, Van Niekerk D, Ogilvie G. The path to eliminating cervical cancer in Canada: past, present and future directions. Curr Oncol. 2022 Feb 14;29(2):1117-1122. doi: 10.3390/curroncol29020095. PMID: 35200594; PMCID: PMC8870792.
- Government of Prince Edward Island. HPS screening and cervical cancer prevention [Internet]. Prince Edward Island; 2023 [cited 2024 Feb 8]. Available from: https://www.princeedwardisland.ca/en/information/health-pei/hpv-screening-and-cervical-cancer-prevention.
- BC Cancer. Cervix self-screening pilot project: frequently asked questions [Internet]. BC Cancer; 2023 [cited 2024 Feb 8]. Available from: http://www.bccancer.bc.ca/screening/Documents/cervix-self-screening-provider-guide.pdf.
- Canadian Cancer Statistics Advisory Committee, Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada. Canadian cancer statistics 2023 [Internet]. Canadian Cancer Society: 2023 [cited 2024 Feb 6]. Available from: https://cancer.ca/Canadian-Cancer-Statistics-2023-EN.
- Nnorom O, Sappong-Kumankumah A, Olaiya OR, Burnett M, Akor N, Shi N, et al. Afrocentric screening program for breast, colorectal, and cervical cancer among immigrant patients in Ontario. Can Fam Physician. 2021 Nov;67(11):843-849. Doi: 10.46747/cfp.6711843.
- Fernandes B, Dworkin S, Bunzeluk K, Turner D, Baldry L, Coulter L, et al. Elimination of cervical cancer in Canada: exploring invitation strategies for HPV self-sampling among under screened women [Poster Presentation]. ICSN 2023, Turin, Italy. 2023