January is Cervical Cancer Awareness Month! Dr. Amanda Selk, Obstetrician Gynecologist, Women’s College Hospital provides digestible information on the link between HPV and cervical cancer.
Q&A with Dr. Amanda Selk, Obstetrician Gynecologist, Women’s College Hospital
1. What is the human papillomavirus virus (HPV) and how is it connected to cervical cancer?
HPV is the most common sexually transmitted infection (STI) in Canada and worldwide. It is estimated that between 70 and 80 per cent of sexually active people will have at least one HPV infection in their lifetime. Like a cold virus, most people with healthy immune systems will clear the virus from their bodies. Sometimes, the body does not clear the virus. When the virus persists for many years, it can lead to cell changes that, if untreated, may get worse over time and become precancerous and then cancerous. This is more common for those who are immunocompromised and/or are cigarette smokers.
This is where cervical screening comes in which can help prevent cervical cancer or find it early. What are the options for cervical screening?
There are three main ways to screen for cervical cancer:
- The Pap test, also called a Pap smear or cervical cytology, collects cervical cells so they can be checked for changes caused by HPV that may, if left untreated, turn into cervical cancer. It can find precancerous cells and cervical cancer cells.
- The human papillomavirus (HPV) test checks cells for infection with high-risk HPV types that can cause cervical cancer.
- The HPV/Pap test uses an HPV test and Pap test together to check for both high-risk HPV and cervical cell changes.
HPV testing is more accurate than Pap tests at helping to find those at risk of cervical cancer.
2. What are the current recommendations for HPV testing in Ontario?
Starting March 3, 2025, the Ontario Cervical Screening Program will be implementing HPV testing as the first screening test for cervical cancer! For now, the provider will collect a Pap smear test and an HPV test at the same time. The test is one sample from the cervix and will feel the same as current Pap smears. The HPV test will be reviewed first and if the results are positive, the Pap will be processed to determine next steps.
This screening will be available starting the age of 25 years old. If the HPV test is negative, screening will occur every 5 years for most people with a cervix. If the HPV test is positive, you may be referred to a colposcopy, a procedure where the cervix is looked at with a microscope, while some people may need a repeat HPV test in 2 years. This depends on the HPV strain and the Pap test result. For those who are immunocompromised, screening will occur every 3 years.
More information is available on the Cancer Care Ontario website.
3. Is HPV self-testing (self-sampling kits) an option in Ontario?
Currently, there is no self-screening available in the Ontario program. We hope that it will be offered in the future!
4. What about the HPV Vaccine? What role does it play in preventing cervical cancer and what are the current recommendations for the vaccine in Ontario?
The HPV vaccine protects against most cases of cervical cancer. It also protects against cancer of the head and neck, the vagina, vulva, penis or anus caused by high-risk HPV, and genital warts caused by low-risk HPV strains. The vaccine we provide in Ontario is 90 per cent effective at preventing infections that may lead to these conditions.
All children in grade 7 receive the HPV vaccine free of charge. It’s approved for those over the age of 9 in Ontario. Nationally, it’s recommended for those aged 9-26 and for those at risk of new HPV infections over age 27 with risks for acquiring new HPV strains after shared decision making with their healthcare provider. The vaccine is not publicly funded after high school.