Fewer Canadian women are getting Pap smears — but do they really need one? What to know about HPV testing, and why it's becoming a routine test for women

Yahoo

6 days ago

A new StatCan report found that less women in 2024 received Pap smears than they did in 2017. Here's what an expert wants you to know about the future cervical cancer screening.
Less women are having Pap smears, according to new data from Statistics Canada (StatCan). In a new report released on Wednesday, the federal agency found that in 2024, 69 per cent of women aged 25 to 69 received a Pap smear test within the past three years. The number was lower than data from 2017, which found that 74 per cent of women in the same age bracket had received a Pap smear within a three year date range.
The report went on to note significant differences in Pap smear tests by age group. Less women aged 50 to 69 reported having a Pap smear test (64 per cent) compared to women aged 25 to 34 (70 per cent) and 35 to 49 (75 per cent).
Test rates also varied by race. Pap smear tests among Arab, South Asian and Chinese women were less than women who didn't present as a visible minority (non-racialized).
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.
Although Pap smear were once considered the most effective way to detect cervical cancer, many provinces, like Ontario British Columbia and Prince Edward Island, have been opting in favour of human paoillomavirus (HPV) testing. According to Ontario Health, HPV testing is a more accurate method for detecting cervical cancer, which means people could be tested less frequently.
Quebec began a gradual transition to HPV tests in 2023 with the goal of replacing Pap smears in 2025. In July 2024, Nova Scotia announced it's intention to switch to HPV testing, but it would take approximately two years before Pap smears would be replaced.
Why is an HPV test more effective than a Pap smear?
In a previous interview with Yahoo Canada, Ontario-based gynecologist Dr. Kim Alexander said that roughly 95 per cent of cervical cancers are caused by HPV: "Cervical cancer is a sexually transmitted disease … so if we know your HPV status, we actually know your level of risk."
With HPV testing, she added "we can actually know whether you have the virus that causes cancer. That's super powerful." Moreover, HPV testing is essentially more accurate than Pap smears, and they can now be done faster than before.
The Canadian Medical Association Journal stated: "Pap testing has a high specificity of 96.8 per cent but a low sensitivity (55.4 per cent), which means that screening misses almost half of existing abnormalities."
Pap test vs. HPV tests: What's the difference?
A Papanicolaou test, also known as a Pap smear or Pap test, checks for abnormal cervical cells which could lead to cancer if left untreated, but they don't test for HPV itself. An HPV test, however, screens for high-risk types of HPV that could cause pre-cancers of the cervix. Neither test actually detects cancer — only abnormalities or high-risk strains of HPV.
Alexander said HPV testing comes positive on average 15 years before a cancer develops. A Pap test may never become positive — even if a person has the virus.
"The false rate of Pap test is in the range of 10 to 20 per cent, so we can miss things on the Pap test. ... HPV testing missing rate is close to zero. … It's very effective in determining your risk," Alexander noted.
Both tests are performed by taking a swab of the cervix to obtain a sample of cervical cells which are then sent for testing. Usually, these tests are tests are performed by a doctor or nurse who may insert a speculum to open the vagina to access the cervix. Some people may feel discomfort or a slight cramp during the process and may experience light bleeding afterwards, but the swab can be obtained very quickly.
What is HPV?
Health Canada outlined HPV is one of the most common sexually transmitted infections (STIs) in the country — and worldwide. There are more than 100 types of HPV, most of which cause no symptoms and go away on their own. Some types, however, can infect areas such as the hands and feet, according to the federal agency.
"Other types target the anogenital area and are transmitted during vaginal, or oral sex or during intimate skin-to-skin contact with someone who is infected," Health Canada noted.
HPV causes almost all cervical cancers but is also linked to cancer of the throat, oral cavity, penis, anus, vagina or vulva. Moreover, it's possible to be infected by more than one type of HPV at a time, according to Health Canada. It estimated as many as 75 per cent of sexually active men and women will have at least one type of HPV infection in their lifetime.
How to test for HPV
According to Alexander, HPV testing is done in a similar way to a Pap smear, where a swab gets used to collect a small sample of cells from a cervix or vagina that may have the cancer-causing virus.
In Canada, HPV testing may not be covered by a provincial or territorial health program, and people may have to pay for it out-of-pocket.
Alexander described Ontario's current process: "If my patient gets a funny Pap test, I can actually call into the lab and ask them to run an HPV [test] on it.
"Or, I can check a box when I submit that Pap specimen that says please run HPV at this time. ... And because we really want to get a good idea about their ongoing risk, most of my patients do agree to pay the $100 that it cost to process their HPV test," she added.
How often should you get an HPV test?
Because HPV testing is able to catch problems so early, Alexander said it only needs to be done every five years, in comparison with the three years recommendation of Pap smears.
"The awesome thing about HPV testing is that it gives you a risk before you might even be developing a problem. ... Ideally, we're going to see that HPV test changed to negative for most people who get the virus," she explained.
Alexander added 80 per cent of people will clear the virus from their body within two years, especially patients in their 20s: "Most people are not going to get cancer. For most people, the virus is going to be a minor blip in their life … but at some point as we get older, that gets more challenging."
Is it too late for an HPV vaccine?
Alexander said cervical cancer "is a vaccine preventable disease." The vaccine is generally available for kids in school and for people up to the age of 26, but people who are older can get it too.
The HPV vaccine commonly used is the HPV9 vaccine, also known as Gardasil 9. This vaccine protects against nine different types of HPV and protects against seven types that can cause cancers of the cervix, anus, mouth and throat, penis, vagina and vulva, and two types that can cause genital warts.
At-risk people include those who:
Have had genital warts
Have had abnormal Pap tests
Have frequent new sexual partners
The vaccine is also recommended for people who are in midlife too, aged 40 and up.
"Doctors and non-doctors have stereotypes about who's at risk, and that married people are not at risk for acquiring the HPV virus," Alexander shared.
"But midlife relationship instability is so common, like divorce, affairs and those who decide to have non-monogamous relationships, which can put people in midlife at risk."
Unlike younger people who have a higher chance of clearing the virus, only 60 per cent of people in their 40s clear it within two years.
"This is why midlife vaccination is something to consider ... because the virus is just there for longer, with more ability to cause problems for people," Alexander added.