Health systems in most states have switched or are considering switching to new tests that detect high-risk HPV strains and can be performed less frequently.
Canada has begun phasing out Pap tests, a decades-old women’s health care ritual that has dramatically reduced deaths from cervical cancer, to make way for less frequent and more accurate tests. There is.
Health systems in most states have switched or are considering switching to new tests that detect high-risk strains of human papillomavirus (HPV), the sexually transmitted pathogen that causes nearly all cervical cancers. .
“It’s better because it’s more accurate in detection,” said Gina Ogilvie, Canadian Tier 1 Research Chair in the Global Control and Prevention of HPV-Related Diseases and a professor at the University of British Columbia. “It allows for earlier detection of precancerous lesions and increases confidence in the results if the HPV test is negative.”
Because the new HPV test is more reliable than the old-fashioned Pap test, women’s health experts say it can be safely performed every five years instead of every three years. It can also be done at home by a woman administering the swab herself and having it mailed to her.
May, Prince Edward Island became It was the first state to publicly fund HPV testing as the primary screening method for cervical cancer, but it does not include self-swabbing at home as an option. quebec and New Brunswick have publicly announced plans to switch, but have not yet made the switch. Other states are also laying the groundwork for this change and implementing pilot projects. Among them is British Columbia, which hosted a landmark randomized clinical trial that showed HPV testing was superior to Pap testing.
Dr. Ogilvie HPV focusIn the study, more than 19,000 healthy British Columbian women were divided into two groups, one group was screened with an HPV test, and the other group was screened with a Pap test.
Named after Greek creator George Papanicolaou, the Pap test involves a doctor or nurse scraping cells from the cervical wall and sending them to a lab, where they look for abnormalities that may signal cancer. It will be examined under a microscope to see if it is present.
HPV testing begins in much the same way, with a cervical swab taken by a health care professional or someone in your household, but ends with a different type of testing equipment that searches for HPV DNA and determines the genotype. to determine the presence of HPV. It is one of the strains that are more likely to cause cancer.
The HPV FOCAL trial found that cervical precancers were detected earlier in women who underwent HPV testing and could be treated before invasive cervical cancer developed.
Those results are published In 2018, it reinforced earlier research and strengthened its case on behalf of Pap, but it did not prompt change overnight in Canada. In fact, some women’s health experts say the country’s fragmented health care system, in which each state and territory is moving at its own pace, is similar to what some peer countries, including Australia and the United Kingdom, have already put in place. They claim it takes too long to make the switch.
“This is a great project,” said Diane Francoeur, CEO of the Canadian College of Obstetricians and Gynecologists. “But for now, it’s slow, slow, slow. Too slow.”
Some say it is important that jurisdictions take the time to build the testing infrastructure and public education campaigns needed to successfully transition to HPV testing without causing a backlash in Australia. experienced In 2017, women were required to undergo an HPV test every five years instead of having a cervical cancer test every two years.
“It’s not as easy as it sounds to make the switch,” said Craig Earle, chief executive officer of the federally funded Canadian Cancer Control Partnership (CPAC). In addition to educating women and doctors about increasing the time between tests, health care leaders should track results and test results for patients who do not have a regular primary care physician, especially if at-home HPV testing is widely adopted. We need to find a way to follow up, he said. . Earl added.
Still, some concrete progress has been made. In June, CPAC (which is encouraging a switch to HPV testing as part of the national commitment to eliminate cervical cancer by 2040) and Canada’s two medical professional societies released their first report. . national guidelines About HPV testing for clinicians. That came weeks after PEI implemented a statewide program with her $621,000 grant from CPAC.
For now, P.E.I. only offers in-person HPV testing, so the experience for women is limited by the five-year interval between tests, said Krista Cassel, an obstetrician-gynecologist in Charlottetown. , it’s not that different from getting a traditional cervical cancer test.
PEI hopes to eventually offer self-sampling, but B.C.’s Dr. Ogilvie says this approach is already being tested in her province, which has given more than 10,000 women home test kits. The pilot program sent out has proven to be successful.
Self-sampling could increase cervical cancer screening rates among women who live in rural or remote areas, don’t have a doctor, or avoid having a Pap smear because of past trauma, says the Women’s Association of Gynecologists. said physician Amanda Selk. She is the president of the Canadian Association of Colposcopists, a university hospital in Toronto and one of the organizations supporting new guidelines for HPV testing.
Dr. Selk knows that some people may want to continue getting an in-person cervical cancer test, if only to talk with their doctor about their overall health.
She and others who support phasing out Pap tests argue that HPV testing should be available both in person and at home. “I think we’re doing Canadians a disservice by not allowing people a choice when we have the technology,” Dr. Selk said. “Not having the option of self-testing is a huge loss.”
Lucy Gilbert, head of gynecologic oncology at McGill University’s School of Health, says if home HPV screening reaches more women and enough young people receive the HPV vaccine, Canada will be able to achieve cervical cancer by 2040. It is hoped that the goal of eradicating cancer will be achieved. center. “Then my grandchildren’s generation won’t be talking about HPV screening.”
