Cervical cancer screening and clinical guidelines across Canada

Currently, all provinces and territories have clinical guidelines in place for their cervical cancer screening programs. All the provinces except Quebec have mass cervical screening programs in place, with the most recent being established in New Brunswick in 2014. In the territories, Nunavut is in the process of revising its guidelines, but does not yet have an organized screening program available and the North West Territories and the Yukon currently do not have programs available [18][19].

[20] Cervical Cancer Screening Programs: Provincial and Territorial Guidelines

To find out more about provincial and territorial screening programs, please visit the Canadian Partnership Against Cancer

[21] Cervical Cancer Screening Programs: Provincial and Territorial Guidelines, cont’d;

HPV screening in Canada

HPV DNA screening is not available as routine primary screening in any of the Canadian provinces or territories in 2015. Pilot trials and research into using HPV screening as primary screening are being conducted in British Columbia [22]. Primary screening is described as 'the first test used to screen for a particular condition.' 

HPV screening in Ontario

Cancer Care Ontario’s screening guidelines recommend that Ontario should transition to primary HPV screening. At the moment, HPV testing is not funded and is currently considered necessary as a triage following a ASCUS (atypical cells of undetermined significance) pap smear result for women who are age 30 years and older [23]. Dr. Joan Murphy, the clinical lead at the Ontario Cervical Screening Programs, says that women who are missed by the Pap test and may have pre-cancerous changes or are at-risk for cervical cancer will have a much less likely chance of being missed [24]. Murphy goes on to say, ‘The whole objective of cervical cancer screening is to reduce the frequency and the number of deaths due to cervical cancer. And we have very good evidence that using the HPV test, incorporating it with the Pap, is going to improve the performance of these programs - i.e. reduce the frequency of cervical cancer [25].’ 

While Cancer Care Ontario has stated that they are actively working with the Ministry of Health and Long-Term Care to ensure the HPV test a fully-funded part of the Ontario Cervical Screening Program [26], it is important to note that Cancer Care Ontario changed Ontario’s cervical cancer guidelines in 2012 to recommend HPV screening as the primary test, but over three years later, Ontario has not changed its program. It still funds the Pap test as a primary screening test, but not the HPV test. CCO’s Ontario Cancer Plan 2015-2019 commits to moving forward with primary HPV screening but the timeframe remains unclear [27].

References 

[18] "Provincial/Territorial Screening and Vaccine Programs." Cancerview.ca. Canadian Partnership Against Cancer, 11 Dec. 2015. Web. 15 Dec. 2015.
[19] Pehora, Brian. "Nunavut to Develop Colorectal Cancer Screening Program."Nunavut to Develop Colorectal Cancer Screening Program. Nunatsiaq Online, 9 Dec. 2015. Web. 15 Dec. 2015.
[20] Cervical Cancer Screening Programs: Provincial and Territorial Guidelines. Digital image. Cervical Cancer Screening Guidelines Across Canada: Environmental Scan. Canadian Partnership Against Cancer, Feb. 2015. Web. 21 Aug. 2015.
[21] Cervical Cancer Screening Programs: Provincial and Territorial Guidelines, Cont’d. Digital image. Cervical Cancer Screening Guidelines Across Canada Environmental Scan. Canadian Partnership Against Cancer, Mar. 2015. Web. 21 Aug. 2015..
[22] ibid.
[23] "Ontario Cervical Screening Program." Ontario Cervical Screening Program. Mississauga Halton/Central West Regional Cancer Program, 2015. Web. 21 Aug. 2015.
[24] CTVNews.ca Staff. "HPV Test Could Soon Be Used alongside Pap Test to Spot Cervical Cancer." CTV News. CTV News, 10 May 2014. Web. 21 Aug. 2015.
[25] ibid.
[26] "Human Papillomavirus (HPV)." Human Papillomavirus (HPV). Cancer Care Ontario, 15 June 2015. Web. 21 Aug. 2015.

[27] Tota, Joseph E. and Franco, Eduardo L et al. Introduction of molecular HPV testing as the primary technology in cervical cancer screening: Acting on evidence to change the current paradigm, December 2015