Since May 23, 2023, Provincial Laboratory Services has replaced the conventional Pap smear with primary HPV (human papillomavirus) testing using PCR. This test helps detect the presence of HPV, which is the leading cause of cervical cancer.
To increase participation in cervical cancer screening, HPEI is planning to introduce a self-test HPV kit. This kit will work similarly to the FIT test kit for colorectal cancer screening. The goal is to have the new HPV self-test kit widely available to primary care offices in the next months.
To test all processes and pathways, a mini-pilot will be conducted at the provincial cervical screening clinics, gender-affirming clinics, and three primary care providers, each from a different network; the start date will be June 10, 2024.
Pilot HPV: Self-screening kit for cervical cancer screening June 10, 2024.
Primary Care: HPV screening Pilot [PDF] new start date: June 10, 2024
HPV self-screening kit - Patient Fact Sheet Eng/Fre [PDF] Patient Rack Card Eng [PDF]
HPV self-screening kit - Patient Instruction [PDF]
HPV self-screening kit - Reception Tool for participating offices in the pilot [PDF]
Lab Memo [PDF] If you are an affiliated provider in CERNER, you will be copied on the results of the HPV self-screening tests. You can easily recognize these results by looking at the provider's name, which will be the Health PEI Cervical Cancer Screening Service, and the site field on the lab result, which will say "self-collection vaginal sample." However, it is important to note that these results are for your information only. No action is needed by you. PILOT PHASE: Each individual performing an HPV self-test will be linked to a pilot provider for result sharing and further follow-up if indicated.
Policy
Cervical Cancer Screening – Clinical Practice Guidelines 2023 (available on the PDMS website, log-in and search)
RESOURCES FAMILY PHYSICIAN OFFICES / NURSE PRACTITIONER OFFICES
Guideline Package Request [PDF]
CURRENT: Cervical Cancer Screening Clinical Reference Tool 2023 [PDF]
PREVIOUS: Cervical Cancer Screening Clinical Reference Tool 2019 [PDF] ended May 2023.
Patient: HPV Screening FAQ [PDF] , HPV Screening Brochure Eng[PDF] HPV Screening Poster Eng[PDF]
LAB RESOURCES:
Lab is changing to Liquid-based Cytology (LBC) and will no longer be accepting conventional Pap smears:
Lab Memo LBC, HPV [PDF]
Collection video: BD SurePath - LBC Collection Video
Spatula: Cooper’s spatula should be used to collect cells from the cervix of patients that are >10 weeks pregnant: Lab Memo Pregnant Women [PDF]
Presentation: Primary HPV Screening for Cervical Cancer in PEI, Q&A Clinicians Live session recording 2023-06
Fact Sheets and Brochures, Q&A Sheet 2023-06, Q&A 2023-12
Canadian Colposcopy Guideline 2023-06
Primary Care Providers
As a primary care provider, you are the first access point for offering cervical cancer screening. Primary care physicians, nurse practitioners, and nurses are key in offering cervical cancer screening.
Your role in Cervical Cancer Screening includes:
- Primary HPV testing: Taking an HPV test using liquid-based cytology allows reflex cytology to occur in the lab when required.
- Talk about it: Discuss cervical cancer screening with your patients who have a cervix at their next appointment.
- Follow up on abnormal/positive results.
PAP Screening Guidelines 2023
These guidelines are for screening asymptomatic individuals with a cervix.
- Screening initiation:
Primary HPV screening should be initiated at 25 years of age for individuals with a cervix who are or have ever been sexually active. Individuals who are not sexually active by age 25 should delay cervical cancer screening until they are sexually active.
- Screening intervals:
If HPV is negative, routine screening should be done every 5 years.
- Screening cessation:
Screening may be discontinued for individuals with a cervix aged 66 years or older if there is an adequate negative pap screening history in the previous 10 years. Adequate negative screening is defined as two consecutive negative primary HPV tests, three negative cytology tests or a combination of both (one HPV test and two cytology tests) within the past 10 years.
Note: If previous PAP cytology was normal for cervical cancer screening, routine screening with primary HPV testing can start in 3 years.
Note: If you follow up on patients with a previous recommendation to repeat a pap in 3, 6 or 12 months, complete a pap test only (no HPV test) using liquid-based cytology.
FAQs for Healthcare Providers
What do I tell my patients who want to be screened every 3 years or more often? HPV testing is more sensitive and effective at identifying individuals at greater risk of developing pre-cancerous cervical lesions than the Pap smear test.
Under what circumstances should I screen women more frequently? Certain individuals benefit from more frequent screening than the average risk population. HPV testing is advised every three years for:
• People living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
• People with congenital (primary) immunodeficiency
• Transplant recipients
• People requiring treatment with medications that cause immune suppression for three years or more
• People living with systematic lupus erythematosus (SLE)
• People living with renal failure and require dialysis
Follow up on positive HPV tests / abnormal Paps.
Please follow the HPV Testing Cervical Screening Pathway (Provided in the 2023 clinical practice guidelines) for recommendations on patient follow-up.
Laboratories send results of cervical cytology and reminders for overdue follow-ups to primary care providers.
Screening Women with Special Circumstances
- Women who have undergone subtotal hysterectomy and retained their cervix should continue screening according to the guidelines.
- Pregnant women should be screened according to the guidelines. Only conduct HPV tests during pre-and post-natal care if a woman is due for regular screening.
- Women who have sex with women should be screened according to the guidelines. Transgender Men, LGBTQ+, all individuals with a cervix, age 25 to 65, are eligible for regular cervical screening. Transgender men who have retained their cervix should be screened.
- Women who have received the HPV vaccine should be screened according to the guidelines.
Consider HPV Immunization for adults through Public Health Nursing PEI
Detailed information on adult immunization in PEI for use by Healthcare Providers:
https://www.princeedwardisland.ca/en/publication/adults-immunization-schedule-use-health-care-providers
https://www.princeedwardisland.ca/en/information/adult-immunizations
Contact Public Health Nursing:
https://www.princeedwardisland.ca/en/information/health-pei/public-health-nursing