More than 70% of cervical cancers diagnosed in females aged 18–39 years were diagnosed at stage I (Canadian Cancer Statistics, 2018). The Canadian Cancer Society states that this is likely due to early detection through cervical cancer screening programs.
Human papilloma virus (HPV) is a common sexually transmitted infection (STI) that is known to cause cervical cancer. Most sexually active people will contract HPV in their lifetime without realizing it.
Health Canada has authorized two vaccines to prevent infections from the most common types of HPV: Gardasil™ (for females and males) and Cervarix™ (for females only). Both vaccinations protect women against the two HPV strands that are known to cause 70% of cervical cancers. For more information on the HPV virus and vaccine, visit http://healthycanadians.gc.ca/health-sante/sexual-sexuelle/hpv-vph-eng.php.
Cervical Cancer Control in Canada is an online resource that packs information about cervical cancer, HPV, screening across Canada, HPV vaccination programs and more into one easily accessible web page. The site was launched by the Canadian Partnership Against Cancer in order to share information and resources regarding the prevention, early detection and treatment of cervical cancer across Canada.
Cervical Cancer Control in Canada informs the public, and patients on:
- What cervical cancer and HPV are.
- What HPV vaccines are available.
- Tests for cervical cancer.
- Understanding abnormal test results.
- Living with a diagnosis.
- Provincial/Territorial Screening and Vaccine Programs.
- A detailed history of Pap testing in Canada.
Cervical cancer will affect 1,350 Canadian women in 2012. The cancer is preventable with the HPV vaccine and treatable if it is detected early through cervical screening. Health Canada recommends that women who are 18 years old, or have been sexually active begin making Pap tests part of their routine health examinations.
Please find the name of your province below to read about the cervical cancer screening guidelines specific to you.
Alberta
Pap tests in Alberta are performed by healthcare providers or through a women’s health clinic.
The Alberta Cervical Exam Screening Program (ACESP) is a province-wide initiative to increase the number of women between the ages of 21-69 who receive regular pap tests. The ACCSP’s correspondence component is operational in the Calgary and Lethbridge areas and will be rolled out to the rest of Alberta over the next few years. Once in place, ACESP will correspond directly with patients with results and reminders.
For more information on Cervical Screening in Alberta, visit Alberta Health Services.
Or visit: www.screeningforlife.ca
The Government of Alberta started an HPV immunization program in 2008. This school-based immunization program targets girls entering Grade 5, beginning in 2008. Any girls not eligible under this program can speak to their doctor or health care provider about purchasing the vaccine.
For more information about HPV and the Alberta immunization program, visit the Government of Alberta.
For service and various loacation:
Alberta-Wide Web / or Telephone Access
1-886- PAP EXAM (727-3926) (Toll Free)
British Columbia
The Cervical Cancer Screening Program (CCSP) provides regular screening for cervical cancer. Women should start getting pap tests at the age of 21, or three years after becoming sexually active, whichever comes later. The test is administered regular by family doctors or nurse practitioners.
For more information on the screening program, go to the BC Cancer Agency.
The HPV vaccine is available free of charge for girls in Grade 6 as well as Grade 9 during the school year. Girls born after 1994 who missed the immunization at school may contact their local health units to book appointments.
For more information about the British Columbia HPV immunization program, visit HealthLink BC.
For a limited time, women in the province who were born in 1991-1993 have the opportunity to be immunized free of charge. The vaccine is given in a series of three shots and may be obtained through doctors, pharmacists, youth and sexual health clinics, student health centres and public health units.
Women who want to receive the vaccine but do not fall into the eligible age range have the option of consulting with their physician or pharmacist about purchasing the vaccine.
For information about the program for young women, visit the BC Centre for Disease Control.
Health Link BC is as close as your phone or the web any time of the day or night, every day of the year. Call 8-1-1 toll free in B.C. or for the hearing impaired, call 7-1-1.
Manitoba
CervixCheck Manitoba offers women in the province education about the importance of cervical screening as well as easy access to pap tests. To receive a pap test patients in Manitoba, you can ask a doctor or nurse, or contact your local health centre.
To find out where to have a pap test in your community, call CervixCheck toll free at 1-866-616-8805. In Winnipeg, call 204-788-8626.
You can also go to CancerCare Manitoba for more information.
For more information on CervixCheck, please click here.
Manitoba Health has introduced a voluntary HPV immunization program. Girls in Grade 6 are eligible for the program with the consent of a parent guardian. Women and girls who do not qualify for the program and wish to be immunized must seek a prescription in order to purchase the vaccine.
For more information about the HPV immunization program, visit the Government of Manitoba website.
For general inquiries you can also call:
Communicable Disease Control
Public Health
Call:204-788-6737
Health Links- Info Sante’
204-788-8200 or 1-888-315-9257
New Brunswick
The cervical screening guidelines in New Brunswick are currently being developed. Until this program is in place appointments for pap tests can be made through your health care provider or a community clinic.
Girls in Grade 7 are eligible for the school-based HPV vaccination program in New Brunswick. The program aims to immunize girls before they become sexually active in order to effectively diminish cervical cancer rates in the province.
For General Information:
Call: (506) 457- 4800
Email: Health.Sante@gnb.ca
http://www.gnb.ca/0051/index-e.asp
Newfoundland and Labrador
Women are encouraged to start having pap tests from the age of 20. Tests can be arranged with family doctors, nurse practitioners or local clinics.
The Cervical Screening Initiatives (CSI) is a province wide program that helps women in Newfoundland and Labrador have access to pap tests.
For more information, go to Western Health.
Girls in Grade 6 are eligible for the school-based HPV vaccination program in Newfoundland and Labrador. The program aims to immunize girls before they become sexually active in order to effectively diminish cervical cancer rates in the province.
Northwest Territories
The cervical screening guidelines in the Northwest Territories are currently being developed. Until this program is in place appointments for pap tests can be made through your health care provider or a community clinic.
Girls in Grade 4 are eligible for HPV immunization free of charge throughout the territory. A catch-up program will also be offered over the next 5 years for girls in grades 9-12. The vaccine is given at school as a series of three doses over a six-month period.
For more information about the immunization program, visit the Northwest Territories Health and Social Services website.
Nova Scotia
Women are encouraged to start having pap tests from the age of 21, or three years after they first become sexually active. Tests are done by doctors or in clinics.
The Cervical Cancer Prevention Program (CCPP) was initiated by Cancer Care Nova Scotia, the Department of Health and Wellness, Doctors Nova Scotia, the Nova Scotia College of Medical Laboratory Technologists and the Canadian Cancer Society – Nova Scotia. This objective of this program is to educate women about the importance of cervical exams to develops and implement screening guidelines for Nova Scotia.
For more information, visit Cancer Care Nova Scotia.
Nova Scotia has a publicly funded HPV vaccination program in place. The program provides girls in Grade 7 three doses of the vaccine over six months free of charge. The vaccination is not mandatory and requires parental consent. For women who were born after October 1, 1993 and who were refused, or missed the vaccination the HPV vaccine will be provided to the family physician or Public Health Nurse upon request for completion of the immunization series.
The Cervical Cancer Prevention Program (CCPP):
Call: 1-888-480-8588 or ( 902) 473- 7438
Nunavut
The cervical screening guidelines in the Nunavut are currently being developed. Until this program is in place appointments for pap tests can be made through your health care provider.
The Government of Nunavut has an HPV vaccination program in place for Grade 6 girls. With parental consent, nine-year-old girls will be inoculated at school free of charge. Anyone who is not eligible for the program but still wishes to be immunized must pay for their own vaccinations.
For more information contact your Community Health Centre or Public Health.
Or visit:
http://www.hpvinfo.ca
Ontario
Appointments for pap tests can be made with healthcare providers. Some Public Health Units and Community Health Centres also provide tests.
Cancer Care Ontario runs the Cervical Cancer Screening Program for the province. Their goal is to effectively reduce cervical cancer incidence and mortality by encouraging pap tests in women over 21. The program sends eligible women letters reminding them to get screened, detailed information about the results of their screening as well as reminders to return for a future screening.
For more information, visit Cancer Care Ontario.
The HPV vaccine is available for Grade 8 girls. Public health units plan and organize school-based immunization clinics throughout the school year for eligible girls with parental consent. Girls who miss the program and still wish to be vaccinated must cover their own expenses.
For more information on the vaccination program and HPV, visit the Government of Ontario’s Ministry of Health and Long-Term Care.
For General Information:
Please call:
ServiceOntario, INFOline at 1-866-559-4598
TTY 800-387-5559
In Toronto, TTY 416-327-4282
Prince Edward Island
The current Pap screening guidelines recommend women should have a Pap test if they:
- are 21-65 years of age and have been sexually active (including intercourse, as well as oral or touch with a partner’s genital area, male or female);
- are over 65 years of age and have not had three negative tests in the last 10 years.
More evidence is now available demonstrating that abnormal cervical cells in young women are more often able to go away on their own without treatment or follow-up procedures, and that some procedures, when performed at a young age, could cause potential harm. If you are of higher risk or not sure if you should wait until age 21, consult with your health care provider.
To book an appointment at one of the cervical cancer screening clinics:
Telephone: (902) 368-5901
Toll-free: 1-888-561-2233
Fax: (902) 368-6936
Quebec
The cervical screening guidelines in Quebec are currently being developed. Until this program is in place appointments for pap tests can be made through your health care provider or a community clinic.
Girls in Grade 4 are eligible to free HPV vaccination as a part of the province-wide immunization program. Go to the Government of Quebec’s Santé et Services Sociaux (Health and Social Services) for additional information.
For General Information, You may contact:
418-644-4545 ( Quebec area)
514-644-4545 ( Montreal area)
1-877-644-4545 (toll free) ( Elsewhere in Quebec)
Saskatchewan
Women who are sexually active or over the age of 21 can contact their doctor or nurse for an appointment for a pap test. Arrangements can also be made through the PPCC by calling 1-800-667-0017 or send an email at info@health.gov.sk.ca
Saskatchewan women have access to the Prevention Program for Cervical Cancer (PPCC) screening program. The PPCC is run by The Saskatchewan Cancer agency. It helps educate women about cervical cancer as well as the benefit of having regular pap tests. Women will be sent reminders, results and information for follow up appointments.
For more information on the PPCC screening program, go to the Saskatchewan Cancer Agency.
A school-based immunization program is in place for girls who are in Grade 6. Girls born after 1996 who missed getting the vaccine when it was offered in Grade 6 may contact their local health unit to get vaccinated.
For more information about the program, visit the Government of Saskatchewan website.
Yukon
The cervical screening guidelines in the Yukon are currently being developed. Until this program is in place appointments for pap tests can be made through your health care provider or a community clinic.
The Yukon’s Territorial Advisory Committee on Immunization (TACI) supports the HPV vaccine. The vaccine is now available for girls in Grade 6. A catch-up program will also make the vaccine available to girls in grades seven and eight. The vaccine is voluntary and will require parental consent.
Girls who do not qualify for the program and still wish to be immunized must contact their local health centre to make arrangements.
For more information about the program, visit the Government of Yukon’s Department of Health and Social Services.
Screening programs:
- Screening tests for cervical cancer:
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- A Pap test, or Papanicolaou test, is a procedure that removes a small sample of cells from the surface of the cervix. An instrument called a speculum is inserted into the vagina so the cervix can be seen. Cells are taken from the cervix and are sent to a laboratory to be examined under a microscope [16]. By observing the cells, a Pap test finds abnormal changes in cells early before cervical cancer develops [17].
- A Pap test screens for cervical cancer but does not screen for other cancers in the reproductive organs, such as ovarian cancer, or for sexually transmitted infections (STIs) [18]. The Pap test is performed every one to three years, depending on the screening guidelines in your province or territory and your health history. According to the Ontario Cervical Screening Program guidelines [19], all women and people with cervixes who have ever had sexual skin-to-skin contact need to have to regular Pap tests starting at age 21.
- The Pap test is a screening test, not a diagnostic test. An abnormal Pap test result means more testing, as cell changes found in Pap tests are very rarely cancerous, but do require follow-up [20]. Follow-up diagnostic tests are used to determine if a cancer or a pre-cancerous lesion are present [21].
- Pap tests should be performed regularly performed on women, transgender men and other female-bodied non-gender conforming people who are over the age of 21 and have been sexually active. This includes women vaccinated with the HPV vaccine, women engaged in any sexual activity with genital-to-genital contact, women who have stopped having sex, women who have had a partial hysterectomy and still have a cervix and transgender men with a cervix that are sexually active.
- There are people who should first discuss with their doctors whether or not they need a Pap test performed regularly:
- If you have never been sexually active
- If you have had a total hysterectomy
- If you are older than 69
- If you are a transgender woman with a neo-vagina and/or neo-cervix and are sexually active
- If you are transgender man, based on your health and surgical history
- HPV primary screening and vaccinations
-
- The HPV DNA test checks for the presence of high-risk types of HPV in the same way as a Pap test is performed. HPV DNA tests help identify women or people with cervixes that currently have cervical lesions, or are more likely to have precancerous lesions and a higher risk of developing cervical cancer. Studies have shown the HPV test to be significantly more effective in detecting precancerous changes in the cervix than the Pap test. The Canadian Cervical Screening Trial (CCCaST) was the first North American randomized controlled trial of Pap vs HPV testing, which targeted women between the ages 30-69 years, that confirmed the increased sensitivity of HPV testing to detect high grade lesions [23].
- As a screening tool, HPV testing is more effective in screening people 30 and older. HPV testing is not an effective screening tool for those under 30, as HPV infections are more transient in this age demographic and usually go away on their own. There is a current gap in research as to what testing algorithm is most appropriate for this younger age group.
- The HPV test is available in Canada, but is not currently funded as part of regular cervical cancer screening in any of the provinces or territories. Where it is available, the HPV test is used only for women 30 years of age and older as a follow-up to abnormal Pap test results [24].