Le Sommeil / The Sleepers (1866). Artist: Gustave Courbet

KEY POINTS

  • Testing for high-risk human papillomavirus (HPV) will soon replace the Pap test for primary cervical cancer screening in Canada, as it is a more sensitive test that has been shown to be cost-effective and safe.
  • Given the success of school-based HPV vaccination programs, the prevalence of cervical cancer and its precursors is expected to decline, which is why a highly sensitive test is preferrable to strengthen detection rates while minimizing false positives.
  • Widespread public education is needed to overcome natural resistance to change and prevent misinterpretation of new recommendations as a merely cost-saving measure.

“Infection with high-risk strains of the human papillomavirus (HPV) is a known prerequisite for developing cervical cancer. Soon, a test for high-risk strains of HPV will replace the Papanicolaou (Pap) test for routine cervical cancer screening in Canada. Unlike the Pap test, which requires a cytopathologist to detect precancerous cervical cells, testing of a cervical sample for HPV subtypes uses polymerase chain reaction (PCR). Australia, the Netherlands and the United Kingdom have adopted the HPV testing model for cervical screening, and it is also endorsed by the American Cancer Society. A recent review by the Canadian Agency for Drugs and Technologies in Health considered available evidence; its report concluded that HPV PCR testing of cervical samples is better at detecting precancer or cancer than Pap testing and would decrease the overall cost of screening. However, shifting to this new screening modality will mean overhauling existing algorithms for age and screening intervals, changing resource allocation and educating physicians and patients. We discuss why and how cervical screening will need to change in Canada with the adoption of the new test.”

Shifting from cytology to HPV testing for cervical cancer screening in Canada via CMAJ.

More on the Human Papillomavirus vaccine via ImmunizeBC.

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