HPV primary screening in Canada

HPV screening in other countries

Over the past ten years, substantial evidence has emerged from large randomized population studies across Europe and North America showing HPV screening to be more effective than Pap testing in detecting precancerous legions [27]. The executive summary from the 2012 Expert Panel on HPV Testing for Cervical Cancer Screening presented by the Canadian Partnership Against Cancer (CPAC) reports [28]:

While the design and protocols of these trials vary considerably, the overall findings do find that screening with the HPV test results in a higher detection rate for pre-cancerous lesions (CIN2 or CIN3) compared to Pap testing after one round of screening. Results from second rounds of screening show a decreased detection rate of these lesions compared to the Pap test arm, presumably because the increased sensitivity of the HPV test resulted in first round detection of some lesions that would have only been detected on subsequent rounds of Pap testing.

A data analysis of four major European trials in England, Italy, the Netherlands and Sweden which compared HPV-based screening and Pap smears, showed HPV screening every five years was most protective against cervical cancers, compared with pap smears being performed every three years [29]. In fact, countries around the world including the U.S., the Netherlands, Italy, Turkey, Mexico, and others are in various stages of adopting primary HPV screening and tens of millions of women have been screened [30]. 

HPV test screening in Canada 

In November 2014, at a Canadian Partnership Against Cancer (CPAC) Pan-Canadian Cervical Cancer Screening Network (PCCSN) meeting, experts from across Canada agreed that the provinces need to adopt the HPV test as the primary screening method.  In 2012, round one of the  HPV FOCAL Study—conducted to find out if the HPV test can enhance cervical cancer screening for women in BC—conducted by the Provincial Health Services Authority/BC Cancer Agency, showed that HPV primary screening detected more potentially cancerous  lesions than the Pap test as the primary screening method [31]. However, despite the movement in other countries and overwhelming support from experts, Canada has taken a relatively tentative and go-slow approach to implementation [32].

Challenges of HPV testing

While the evidence overwhelmingly supports a transition to HPV testing, as with any diagnostic test there are considerations that need to be accounted for: 


[27] Petry, K. Ulrich. "Human Papillomavirus Testing in Primary Screening for Cervical Cancer." Diagnosis for Early Detection 28 (2012): 120-26. Karger. Karger, 2012. Web. 24 Aug. 2015.
[28] Mayrand, Marie-Hélène, Verma Mai, François Coutlée, Yvonne Taylor, Patricia Ogilvie, Dirk Van Niekerk, and Patricia Goggin. HPV Testing for Cervical Cancer Screening: Expert Panel: Summary of Evidence. Rep. Canadian Partnership Against Cancer, 29 Mar. 2012. Web. 24 Aug. 2015.
[29] ibid 
[30] 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 
[31] ibid. 
[32] ibid. 
[33] Dudding, N. and Crossley, J. (2013), Sensitivity and specificity of HPV testing: what are the facts?. Cytopathology, 24: 283–288. doi: 10.1111/cyt.12104.Web. 24 Aug. 2015.
[34] ibid.
[35] Petry, K. Ulrich. "Human Papillomavirus Testing in Primary Screening for Cervical Cancer." Diagnosis for Early Detection 28 (2012): 120-26. Karger. Karger, 2012. Web. 24 Aug. 2015.