opinion: it's time to scrap the traditional pap test

hpv primary screening looks for the presence of  high-risk hpv  types in cervical cells. the pap test, on the other hand, screens for cervical changes that may result from hpv infection – but it doesn’t screen specifically for hpv. this matters because hpv causes almost all cases of cervical cancer and can be detected even before the cellular changes that can be picked up on the pap test.

the world health organization has set a goal to eliminate cervical cancer worldwide this century, and the canadian government has committed to achieving this by 2040. it will take a combination of immunization and screening, as well as timely and appropriate follow-up, to reach that goal. the  action plan for the elimination of cervical cancer in canada, 2020-2030 ,  outlines the priorities, targets, actions and key implementation partners needed to get us there. it was developed by the canadian partnership against cancer with a broad group of partners, experts and stakeholders, including the public health agency of canada as well as first nations, inuit and métis organizations and patients.

right now, the status quo for cervical cancer screening is a pap test every two to three years. replacing this with oncogenic hpv primary screening will  modernize cervical cancer screening to the benefit of individuals and the cancer-care system . it must be done only once every five years, it’s more cost-effective, and it prevents more cancers than the pap test.

we need to make this shift soon. moving to oncogenic hpv testing will have the greatest impact on achieving canada’s targets for the elimination of cervical cancer. by 2030, we need to ensure that  at least 90 per cent of eligible individuals  have been screened with an hpv test. if we can achieve that, an estimated 6,800 cancer cases can be avoided, and 1,750 lives saved through early detection of hpv and early-stage cervical cancer. the fact is, the longer we put off switching, the longer we put off the benefits – needlessly putting people at risk.

globally, a number of  other countries , including australia and the united kingdom, have already moved to hpv screening. australia began in 2017. it has also been using the self-sampling hpv test at medical centres. overall, australia expects that the hpv test will protect up to  one-third more women  than the pap test did. the u.k. switched in  2019 , and during the pandemic it also rolled out a pilot test of  home-based hpv  screening for people in certain regions who were at least 15 months overdue for a check.

in canada, a number of provinces are beginning to make the move.  ontario , for instance, has taken steps to adopt hpv screening and will be one of the first to do so along with british columbia . the canadian partnership against cancer is providing $1.4 million to support implementation of hpv primary screening – including self-sampling in some cases – in six other provinces: saskatchewan, manitoba, new brunswick, nova scotia, prince edward island and newfoundland and labrador. and quebec is planning for the transition to hpv screening.

what we need now is full commitment from all jurisdictions to make the switch and to do it as quickly as possible so we can reach our elimination target on time. preventing cancer, including cervical cancer, and identifying it early and accurately are essential to saving lives and are key priorities of the  canadian strategy for cancer control 2019-2029 .