Cervical Cancer Screening | Replacement of the Pap test is long overdue, after a premature announcement

Australia aims to eradicate cervical cancer by 2035, England by 2040. In Canada, it is the cancer whose incidence increases the most annually among women. And Quebecers are still waiting for the screening test which we have known since 2017 is more effective than the Pap test and which was officially announced in May 2022.

In interview with The Press in March 2022, Lionel Carmant, Minister for Health and Social Services, declared: “The Pap test is outdated. »

In May 2022, the Minister of Health and Social Services, Christian Dubé, officially announced its replacement by the HPV test – considered more sensitive – as the primary screening test for cervical cancer.

In 2023, in Quebec, it is still only offered in private clinics.

So simple that the sample can be done at home, this test uses molecular technology to detect human papillomavirus (HPV) DNA and thus screen for the genotypes most likely to cause cervical cancer.

Australia (since 2017), the United Kingdom, the Netherlands, Italy and Finland have already adopted the HPV test as a first-line screening test. It is also used in British Columbia and Prince Edward Island.

As early as 2017 in Quebec, the National Institute of Excellence in Health and Social Services (INESSS) wrote that “the HPV test compares favorably to cytology [le test Pap] “.

Rush to pilot HPV testing

In the public system, 400 women from Estrie had free access as part of a research project on self-screening to be done at home. “An advertising campaign was planned, it was canceled: the 400 kits were sold out in four hours,” explains the instigator of the project, the D^D Jessica Ruel-Laliberté, that The Press questioned.

Of the 400 women, 11% had an HPV test indicating they had precancerous cells. They were referred for follow-up which may have saved their lives.

But above all, continues the D^D Ruel-Laliberté, “we have had a lot of positive comments from women, particularly those who have suffered sexual assault and who told us that they were not at all comfortable having a gynecological examination [et un test Pap] “.

The D^D Ruel-Laliberté insists: the HPV test will not replace the gynecological examination. However, everything indicates that with a test that is much less invasive than the Pap test (rather painful, moreover), we succeed in reaching women who would not otherwise be tested.

Incidentally, the D^D Ruel-Laliberté points out that Health Canada has just approved a test called Switch Health, sold for $99, that women can bring to their home. “This is clearly not the solution,” says the D^D Ruel-Laliberté. We don’t want two-tier medicine where people are tested at home with a private company. »

The causes of the delay

But why is this HPV test, offered in other countries for several years, still not available?

Marie-Claude Lacasse, from the communications department at the Ministry of Health and Social Services, says that in fact, the Ministry announced in 2022 “that it was moving forward with the recommendations of INESSS to implement the HPV test as a primary cervical screening test […] since it is more sensitive than the Pap test.

However, she adds, “the deployment of the new test also requires the acquisition of specific equipment. Work under the tender process began in autumn 2023.”

The government now indicates on the website on this subject that “the replacement will take place gradually between 2023 and 2025. The test [Pap] could continue to be used as a complementary examination in certain situations,” we can read.

Returning from last week’s meeting in Halifax of the Canadian Cervical Cancer Elimination Task Force, Dr.^D Diane Francoeur, obstetrician-gynecologist, explains that when it comes to the self-test to be done at home, “the problem comes from an approval problem. Health Canada has only authorized the test for use by professionals.”

But then, why don’t doctors themselves suggest it? The D^D Francoeur explains that much clearly remains to be done, that the test supposes, for example, the establishment of a database, a reminder system, a bit like for mammography.

Also, underlines the D^D Ruel-Laliberté, “the laboratories must be ready”, which is not the case everywhere, now, across the province.

In the meantime, the numbers are bad

In any case, the numbers are bad. While lung cancer and colorectal cancer continue to decline in both sexes, among women, cervical cancer is now the one whose incidence is rising the fastest, up 3.7% per year. year since 2015, the largest increase in this cancer since 1984. In 2023, says the Canadian Cancer Society, it is expected that 1,550 women in Canada will be diagnosed with cervical cancer.

And the still unavailable HPV tests are not the only ones to blame. Because even if they were already deployed on a large scale, other problems remain. First, she notes, “there is still a certain reluctance among parents to vaccinate their child against cervical cancer,” even though it is preferable to do so before the first sexual relations. .

In addition, “smoking is a major risk factor for cervical cancer.” Difficult access to family doctors also complicates things.

Added to this is the pandemic, finally notes the D^D Céline Bouchard, gynecologist. For a long time, doctors’ offices were closed, with the result that the number of Pap tests performed dropped and screening was thus undermined.

Regardless, HPV testing is still awaited and the D^D Diane Francoeur hopes that Quebec, which she believes is in good faith in this matter, will soon be able to offer them. “Women’s health must become a major issue,” and this one in particular, since a large number of women are at risk.

Which ones? We are exposed to cervical cancer “as soon as we have a cervix and we have sexual relations”.