N.B. to replace Pap tests with HPV tests to screen for cervical cancer

After decades of using the traditional Pap test to detect early signs of cervical cancer,New Brunswick plans to transition to using HPV testsinsteadand will eventually introduce self-sampling, the Department of Health has confirmed.

An advisory group isbeing established, and work on the transition is expected to begin this fall,said department spokesperson Sean Hatchard.

"This initiative aligns with the Canadian Partnership Against Cancer action plan to eliminate cervical cancer by 2040, and the World Health Organization's goal to eliminate cervical cancer world-wide," he said.

HPVtesting identifiescervical pre-cancer earlier, resulting in a "significantly lower likelihood of cervical cancer compared with Pap test screening," according to the partnership's website.

It should also mean more accurate results and less frequent testing, which could spare people unnecessary stress and savethe province money,said Dr. Jaime Reardon, a obstetrician-gynecologist in Saint John.

The phased-in implementation is expected to take up to six years, according to department officials.

Prince Edward Island made the switch in May, making it one of the first jurisdictions in Canada to do so.

Tests for virus vs. after-effects

While the samples are collected the same way, using a soft brush to collect cells from the cervix, HPV is "definitely a better test overall," said Reardon.

"When we are doing Pap smears, we're looking for the after-effects of [thehuman papillomavirus], when they've actually already caused changes to the cervix," she said.

The HPV test, on the other hand,detects the presence of the virus itself, whichcauses "99 per cent" of cervical cancers.

If someone has a negative HPV test, we knowfrom studies and they've done big, big, long-term studies that it's safe to wait five years before repeating that test again.- Jaime Reardon, obstetrician-gynecologist

It typically takes about 10 years from an HPV infection to a cancer developing, which is why Pap tests tend to be done every one to three years, said Reardon.

"If we do multiple Pap smears, we're likely to pick up these changes."

The HPV test, however, ismoreaccurate and predictive, according toReardon.

"If someone has a negative HPV test, we knowfrom studies and they've done big, big, long-term studies that it's safe to wait five years before repeating that test again."

This will also mean fewer false-positivesand follow-up testingthat comeswith that, she said.

Mixed reactions predicted

Reardon said the change is a big cultural shift, andpredictedpublic reactionwill be mixed.

Some peoplewill be relievedthey only need to get checked out every five years, she said. But others, who are used to getting a Pap every one to three years, won't feel safe,"even when the science is there."

"I think it'll be a little bit tricky for people to wrap their heads around."

Testingto start later in life, self-sampling coming

Asked who the target group for HPV testing will be, Hatchard said "all individuals between the ages of 25 and 69 with an intact cervix and who have ever been sexually active will be eligible."

The province will also introduce self-sampling "to encourage screening participation in under- and never-screened populations," he said.

This would likely involve a swab of the vagina at home, according to Reardon. She said it could be especially helpfulfor people who live in remote locations, or who have a history of trauma orpain with pelvic exams.

"We see people all the time who are anumber of years overdue because they've, you know, had a painful experience or they're nervous about it and it takes them a while to kind of work up the comfort to go and see somebody," she said.

Between Jan. 1, 2020 and June 30, 2023, just over half ofNew Brunswick women aged 21 to 69had had at least one Pap smear test, according to figures from the department.

P.E.I. started planning 4 years ago

On P.E.I., work is ongoing to implement HPV self-sampling,saidMarla Delaney, the provincial cancer co-ordinator.

But P.E.I.fully transitioned tousing HPV as the primary screening test for cervical canceras of May, she said. By July, more than 1,000 tests were completed.

P.E.I. began planning in 2019,she said, and the province received fundingfrom the Canadian Partnership Against Cancer in 2021.

CBC asked the Department of Health why the transition is expected to take so much longer in New Brunswick.

"We cannot speak to the PEI situation," spokesperson Clarissa Andersensaid in an email.

"But considerable work will be needed to ensure efficient and coordinated implementation of this change in practice, including laboratory testing processes, new information technology infrastructure, clinical practice guidelines, and communication and awareness tools for health-care providers and the public," she said.

HPVtesting is already being used in New Brunswick for certain abnormal Pap test cases,based on clinical practice guideline recommendations, Andersen said.