Cervical Cancer Screening

Cervical Cancer Screening Service 

Lab Message 2025-01:  The lab informs about vaginal vault testing.  The lab cannot test for HPV from a broom/brush in LBC taken from the vagina! Patients can be tested for HPV from the vaginal vault by using the dry swab ONLY.  This sample can be taken by the clinician or the patient.  If the clinician also wants the lab to look at the cells, a brush/broom sample in LBC has to be collected. The Cytology Requisition will be updated.  There is no place to check off dry swab for HPV at this time, add your order to the form by making a note. The lab is aware of this.

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 cervical cancer self-screening kit in March 2025.  The vaginal self-screening swabs for HPV-based Cervical Cancer Screening provided to health care offices will allow patients to collect their own samples. The self-screening swab is intended for vaginal use only.

March 2025 - Clinic Resources:

Pilot HPV June 10, 2024 to September 9, 2024: Primary Care: HPV screening Pilot [PDF]  with extended use in participating clinics and doctor offices since the end of the pilot. 

Lab Memo [PDF] If you were 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)

LAB RESOURCES: 

Lab is changing to Liquid-based Cytology (LBC) and will no longer be accepting conventional Pap smears: 

Presentation: Primary HPV Screening for Cervical Cancer in PEI, Q&A Clinicians Live session recording 2023-06 

HPV Information:

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

 

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