CERVICAL CANCER  
SCREENING: HPV TEST

• HPV testing does a better job of detecting cervical pre-cancer or cancer than a Pap test alone.  

• HPV testing is objective, which means that results are highly consistent and reproducible, whereas Pap tests involve a subjective assessment of the cells collected. 

• HPV testing has a high negative predictive value, which means that it is more likely that negative results will correctly identify people who do not have a cervical pre-cancer or cancer, and who will not develop a cervical cancer within the next 5 years.

 
WHO IS ELIGIBLE FOR HPV TESTING?

 
Eligible population include people who have a cervix (1), are age ≥ 25, have ever been sexually active (2) and are asymptomatic, who have Ontario Health Insurance Plan (OHIP) coverage.
 
Cervical screening is not recommended for people under age 25, even if sexually activity occurred, and is not recommended for people aged 25 and older who have never been sexually active. People who have never been sexually active do not need cervical screening because they have not been exposed to human papillomavirus (HPV).
 
1.     Including women, Two-Spirit people, transmasculine people, nonbinary people, pregnant people, postmenopausal people, people who have undergone a subtotal hysterectomy and retained their cervix and people who have had the HPV vaccine. Routine screening is not recommended for people who have had their cervix removed as a result of a hysterectomy.  
2.     Sexual activity is defined as any sexual contact with another person’s genitals (private parts). This contact can be with the hands, mouth or genitals, and includes the sharing of sex toys. This includes people who have had sexual contact with only one person, have had the same sexual partner for a long time, have not had sexual contact in a long time or have had sexual contact with someone of the same sex.
 

If you meet the above criteria you should have regular screening for cervical cancer with a pap test even if you:

• feel healthy and have no symptoms

• are no longer sexually active

• have only had 1 sexual partner

• are in a same-sex relationship

• have been through menopause

• have no family history of cervical cancer

• have received the HPV vaccine

WHEN SHOULD YOU HAVE YOUR HPV TEST?
 
People should have an HPV test when they are next due for screening. Someone’s screening interval is determined based on their last screening test. Screening earlier than the recommended intervals is not necessary.
 
HOW OFTEN IS HPV TESTING DONE?
 

• Average risk screening is done every 5 years

• Immunocompromised* screening is done every 3 years

 
* The following immunocompromised populations may be at a higher risk of cervical pre-cancer and cancer, and should screen every three years if their last HPV test was negative: people living with HIV/AIDS, regardless of CD4 cell count; people with congenital (primary) immunodeficiency; transplant recipients (solid organ or allogeneic stem cell transplants); people requiring treatment (either continuously or at frequent intervals) with medications that cause immune system suppression for three years or more; people who are living with systemic lupus erythematosus (SLE), regardless of whether they are receiving immunosuppressant treatment; and people who are living with renal failure and require dialysis.
 
A family history of cervical or other forms of cancer does not impact the onset or frequency of screening.
 
HOW OFTEN IS HPV TESTING DONE?
 
Cervical cancer is caused by persistent HPV infections, and it takes many years for cervical cancer to develop, therefore someone has a very low risk of developing pre-cancer and cervical cancer if they get an oncogenic HPV infection in the five years after a negative HPV test result.
 
Published evidence shows that the risk of high-grade abnormal cervical cell changes five years after a negative HPV test result is lower than the risk three years after a normal Pap test result, which provides reassurance that the five-year cervical screening interval will not result in additional cancers.
 
Screening more frequently does not provide extra protection and can cause harm. Most oncogenic HPV infections clear on their own, but it can take several years. Almost 80 per cent of infections clear within three years. 
 
Only persistent oncogenic HPV infections cause cervical cancer, which takes many years to develop (15 to 20 years in people who are have a normal immune system). There is no treatment for oncogenic HPV. Only the pre-cancer and cancer that can develop as a result of a persistent oncogenic HPV infection can be treated. 

Screening more frequently is not beneficial and increases the risk of harm by detecting transient HPV infections. 
 
Detecting a transient infection (one that is likely to resolve spontaneously) leads to unnecessary referral, colposcopy, biopsies and possibly treatment. For some people, colposcopy is associated with anxiety, discomfort and pain, and it should only be performed when the benefit of cancer prevention outweighs the risk of harm. Also, some treatments used in colposcopy, particularly when they are repeated, have been associated with pregnancy complications, such as preterm labour and cervical stenosis.
 
WHEN DO YOU STOP CERVICAL CANCER SCREENING?
 
People can stop cervical screening if they have had one negative HPV test result from age 65 to 69, with the following exceptions: 
If they are immunocompromised, they should be screened until age 74 
If they are age 65 to 69, have been discharged from colposcopy and have been advised to screen every 2 years because they have not yet met the criteria to return to routine cervical screening, they should continue to screen until age 74
 
WHAT IF YOU RECEIVED HPV IMMUNIZATION?
 
The cervical screening recommendations are not different for people who have had HPV immunization. HPV vaccination does not protect against HPV infections that were acquired before the vaccine was administered and does not protect against all oncogenic HPV types (1, 2).
 
IS THE HPV TEST PART OF SEXUALLY TRANSMITTED INFECTION TESTING?
 
No. HPV testing should only be used for cervical screening and should not be used as a sexually transmitted infection test.
 
HPV tests only detect certain types of HPV. Of the over 100 types of HPV, the HPV test only checks for 13 types of HPV that are considered oncogenic (i.e., types that cause cervical cancer). 

The HPV test does not check for non-cancer-causing types of HPV, such as those that cause genital warts. The types of HPV that cause genital warts (e.g., types 6 and 11) are non-oncogenic and are not known to cause cervical cancer.
A negative HPV test does not necessarily mean that someone does not have an HPV infection. It only means that an oncogenic HPV infection was not detected.
 
Resource: Ontario Health Human Papilloma Virus (HPV) Testing Frequently Asked Questions (FAQs) - https://www.cancercareontario.ca/sites/ccocancercare/files/assets/HPV-Testing-FAQs.pdf

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Human papillomaviruses (HPV) are viruses that can infect many parts of the body. HPV is a family of viruses commonly found in both men and women. There are more than 100 strains of HPV, and each one is named with a number.

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Some types of HPV are sexually transmitted and can cause warts or other consequences such as cancer (e.g., cervical, throat, and anal). The types of HPV that infect the anal and genital (anogenital) areas are not the same as the ones that infect other areas of the body such as the fingers, hands and face.

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Certain types of HPV cause cervical cancer (and mouth/throat cancer) and are passed from one person to another through intimate sexual contact. Most sexually active people (80%) come into contact with HPV at some point in their lifetime. People at high risk of HPV infection include those who are dating; people who have had an abnormal pap test; and those who are immune suppressed. Even people in monogamous relationships are at risk: 40% of marriages end, and the percentage of relationships with infidelity is significant. Therefore, HPV infection occurs throughout the lifetime and the risk for disease is life-long.

 

Usually there are no symptoms and often people do not know that they have an HPV infection. The infection usually goes away naturally within two years for most people, but for 1 in 10 people it does not, and it can cause disease; the time from infection to invasive cancer is between 9 and 15 years. 

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HPV VACCINE: GARDASIL® 9

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HPV vaccine (Gardasil® 9) provides protection against 9 types of HPV that cause cervical, vaginal, and vulvar cancers in females, anal cancer, certain head and neck cancers, such as throat and back of mouth cancers and genital warts in both males and females. There is no upper age limit for the use of the HPV vaccine. In 2018, the Society of Gynecologic Oncology of Canada recommended universal HPV vaccination.

 

Book an appointment with Dr. Manning to discuss vaccine benefits, schedule, costs and risks, and she can prescribe the vaccine, for administration in the clinic, or at your pharmacy. The vaccine is covered by most drug insurance plans, and costs about $170 - 195 per dose (individuals receiving their first dose after age 15 years require a three-dose series).

 

The vaccine is fully covered for girls and boys in Grade 7 across Ontario. Girls or boys who are unable to begin or complete the HPV vaccine series in Grade 7 are eligible to catch-up missed doses through their local public health unit, free of charge, until the end of Grade 12​

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