HPV primary screening and abnormal screen follow-up

Key recommendations for implementing HPV primary screening in Canada

There is much to learn from how other countries successfully implemented HPV primary screening.

1. Tailor programs to communities experiencing inequity in screening to increase participation. Some communities face inequity, which leads to decreased participation in cervical screening programs and poorer outcomes. Strategies used to increase equity include community engagement and co-design, research, ongoing relationships, tailored communication, and self-sampling.

2. Develop a care pathway early. A foundational element is forging agreement on the structure of the care pathway. Since development involves numerous stakeholders and advisors, it should be started early in the process.

3. Balance risk with resources. Pathway design has impacts on health system resource use, clinician practice, and patient experience. While the development of pathways must be firmly rooted in the evidence, system leaders and the people designing the pathway also need to make value and risk judgements while closely monitoring the impact of these decisions on patient outcomes.

4. Increase screening participation rates by using self-sampling, especially for populations with barriers to screening; by having good clinician-patient relationships and primary care providers who are supportive of HPV primary screening; and by developing  communication materials that are tailored to different audiences.

5. Consider how self-sampling can be used to increase participation in cervical screening programs. Self-sampling is a promising method to enable participation in screening programs, especially for under- or never-screened populations.

6. Consider the extent to which the screening program is involved in follow-up of abnormal results. The transition between an abnormal result and follow-up care can be a step where people get “lost” in the care pathway. The organized screening program can create mechanisms to maximize the likelihood that patients participate in follow-up activities, like colposcopy.

7. Create a plan to limit and manage the temporary increase in demand for colposcopy. Colposcopy is the main diagnostic procedure for cervical cancer and cancer precursors. There is often a 2-3 times increase in referral to colposcopy when HPV primary screening is introduced in an organized cervical screening program. Ways to limit and manage demand include pathway design, screening age and interval, and test types used. It is important to note that the increase is temporary.

8. Engage with clinicians and the public to communicate the superiority of HPV primary screening. There is a need to educate clinicians and the public about the superiority of HPV primary screening and reinforce that this is the preferred approach to cervical screening.

9. Monitor advancements in cervical screening technologies and approaches. HPV primary screening science and technology continues to advance and new studies and technology should be monitored to ensure cervical screening practices are using the best and most current evidence.