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Yahoo
27-02-2025
- Health
- Yahoo
Is an HPV test better than a Pap smear for cervical cancer screening? What to know as Ontario shifts guidelines
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. Ontario is the latest province to change how it screens for cervical cancer. Starting March 3, healthcare providers will be replacing Pap smears with 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. Previously, B.C. and P.E.I. announced plans to adopt HPV testing as the primary method of cervical cancer screening. 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. In B.C., eligible patients can request an at-home screening kit that includes a vaginal swap which can be sent by mail to be processed. Ontarians will still need to visit a healthcare provider to receive an HPV test, since at-home tests are not part of the current roll out. Cervical cancer is a sexually transmitted Kim Alexander 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." 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. 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. 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. Unlike the Pap test, which requires a cytopathologist to detect precancerous cervical cells, testing of a cervical sample for HPV subtypes uses polymerase chain reaction (PCR), the Canadian Medical Association Journal explained. "One of the bonuses of implementing [HPV testing] now is that the machines we're using are the same machines that they used for COVID," Alexander explained. "That's actually going to help speed up implementation." 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. For most people the virus is going to be a minor blip in their Kim Alexander 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." 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. Midlife vaccination is something to Kim Alexander "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.
CBC
25-02-2025
- Health
- CBC
Ontario shifts to HPV test for cervical cancer screening, but no at-home kits yet
Social Sharing Ontario will replace its main method of cervical cancer screening next week to a more accurate and less frequent test, but the dreaded speculum exam is not in the rear-view just yet. Human papillomavirus (HPV) tests in the province will replace Pap tests, also known as Pap smears or cervical cytology, on March 3, following similar moves in British Columbia and Prince Edward Island. Both tests aim to detect cervical cancer and involve collecting a cell sample from the cervix. Ontario Health says the HPV test is more accurate at catching cervical cancer than the previous method, which will mean most patients can get tested less often and start their routine monitoring later. But self-screening kits that have been adopted in British Columbia won't be a part of the upcoming rollout in Ontario, which means patients still need to visit the doctor to get tested. Dr. Amanda Selk, an obstetrician gynecologist in Toronto, explains what you need to know ahead of the change. What's different? Ontario doctors will pivot to testing for HPV first when screening for cervical cancer, rather than conducting a cytology test. The test will feel the same for the patient. It will still involve a doctor, nurse or midwife inserting a speculum into the patient's vagina to swab their cervix for a sample that will be sent to a lab. But starting next week, the lab will test for HPV, the primary cause of cervical cancer. "Previously they would look at the cells taken — it's called cytology — and look for pre-cancer cells, and sometimes they would have slightly abnormal changes that weren't pre-cancer and you would end up with more testing and actually nothing was wrong," Selk said. The new method tests for the virus that causes pre-cancer and cancer, catching it earlier, reducing false positives and identifying populations more at risk, Selk said. How often do I need to get tested? Ontario Health guidelines sent to physicians over the last several weeks in preparation for the rollout say cervical cancer screening will be for people aged 25 to 69. That's several years later than the previous guideline of starting at age 21 for individuals who are or have been sexually active. For those who test negative for HPV, the interval between tests will be extended to five years, from three. For positive specimens, the sample taken for HPV testing will undergo a Pap test at the lab to identify if the infection caused cell changes in the cervix, and determine if it's high-risk and likely to cause cancer. A provincial flow chart sent to doctors shows patients who test positive will be asked to screen again in two years. After those two years, if the patient's HPV test comes back negative, they can return to the five-year screening protocol, the document says. Cancer Care Ontario says 80 per cent of HPV infections clear within three years. Immunocompromised patients will be screened every three years. Why is this happening? Ontario Health's screening guide says HPV tests are increasingly being considered the standard of care for cervical screening programs internationally and in many other jurisdictions. Quebec began a gradual transition to HPV tests in 2023 and Nova Scotia health officials have said they plan to switch in the coming years. P.E.I. moved to this testing method in 2023 with plans to introduce a cervical cancer self-screening kit that allows patients to collect their own vaginal samples in March 2025. B.C. began its transition to HPV testing in January 2024 and no longer requires health providers to collect the samples. Patients can self-screen at home by swabbing their own vagina, placing the specimen in a tube and mailing it to a lab for testing. According to B.C.'s transition document on cervix screening, a patient-collected sample is just as accurate as one collected by a health provider, and reduces barriers to screening for vulnerable populations like transgender patients and those living in more rural and remote communities. Australia, the Netherlands and the United Kingdom have also adopted the HPV testing model for cervical screening. Why isn't Ontario rolling out self-screening? Self-screening isn't part of the rollout plan next week in Ontario. The Cancer Care Ontario website says self-collected HPV testing is available in the province, but it's not covered by Ontario Health Insurance Program (OHIP) or recommended by the Ontario Cervical Screening Program. A spokesperson for Ontario Health said they recognize the potential value of self-collected HPV testing to increase participation in screening. They said a phased approach will allow the province to determine how best to integrate the process. Why get screened? The incidence of cervical cancer in the country increased by an average of 3.7 per cent per year from 2015 to 2019, and is the fastest-increasing cancer among females, according to the Canadian Cancer Society. "We're suddenly losing some ground. I think this test will help improve that, but only if patients get screened," Selk said. She said the fact that many Canadians don't have family doctors could be part of the problem, and acknowledges that the speculum exam is not a favourite among patients.
CBC
21-02-2025
- Health
- CBC
He was critically hurt in a 2009 car crash. He's still in hospital, 16 years later
Ken Rekowski has had to make a home of his room at the Renfrew Victoria Hospital for most of the last 16 years. The 53-year-old was first admitted in 2009 after a car crash left him with a serious brain injury. Since then, he's been waiting for suitable permanent care in the community. "As far as I know … I'm cooped up in here for the rest of my life," Ken said. When CBC visited in early February, Ken's room still had a small Christmas tree to one side, dog-themed decorations and a photo of Ken with his motorcycle and dog Harley. His twin sister Kareen says he spends most days entirely in his bed, even though he can get around using a wheel chair. "I feel like criminals have more freedom than I do," Ken said. Ken still dreams of outings in the community with family and friends and wants to start a business involving dogs. "I want to get back out into ... the free world where I can actually do something productive," he said. Kareen says Ken is occupying a hospital bed because they haven't been able get the necessary supportive care for him to live in his hometown. "When it comes to acquired brain injury and especially in a small community like ours, there really is no choice. We need to create choices," she said. Kareen said throughout Ken's long hospital stay, she's worried about him getting appropriate care in his community. After a brief placement in a community home, Ken is again facing a challenge faced by people with acquired brain injury in the province: a long uncertain wait to be discharged from hospital. First stay lasted 13 years Ken was first hospitalized in January 2009. On the night of the car crash, he was on his way to his job as a security guard just outside Renfrew, Ont. Road conditions were poor and he lost control of his car. Initially, doctors thought Ken's injuries were so severe that he wouldn't survive. Kareen says the family was told to plan a funeral. Ken survived, but the crash left him with severe cognitive and physical impairments. He has problems forming new memories, gets confused about what year it is and suffers from a "right-side deficit" that leaves him with limited mobility in his right leg and virtually none in his right arm. He also requires a wheelchair. In 2016, a team of specialists in Hamilton, Ont., assessed him over three months and concluded he shouldn't be taking up a hospital bed. Back in 2019, Ken and Kareen were told it could be a "lifetime wait." Kareen said the COVID-19 pandemic worsened the situation. Infection control protocols reduced his access to the supports Kareen had arranged to maintain his cognitive and physical health. In 2022, Ken felt renewed hope when he was offered a spot funded by Ontario Health at the Pathways to Independence residence in Renfrew. "They were supposed to be an ABI [acquired brain injury] service provider, which meant we figured the support staff would understand acquired brain injury. We anticipated a plan in place for Ken to meet his needs," Kareen said. 'Locked up inside' Hope faded with time, however, as Kareen described an uphill battle to arrange visits and outings with Ken. Kareen became worried bed transfers weren't being done properly. Overall, Kareen felt the care didn't reflect Ken's personal needs and — just like at the hospital — he was being left in a chair for long periods of time. At one point, she discovered he'd been left in a recliner wearing pants soaked with urine. "Rather than getting back out into the community again, I was locked up inside in a wheelchair all the time," Ken said. CBC reached out to Pathways to Independence for an interview. Acting CEO Christie Swann provided a written statement and declined to share details on a "former resident," citing confidentiality. Swann said the non-profit provides residents with access to a variety of services and trains staff in progressive brain injury education. She said each team member in Renfrew receives one-on-one training on bed transfers and equipment. Kareen said she complained often and was in constant contact with management. She involved a health system navigator and even appealed to Ontario Health to help improve Ken's situation. Swann said the organization has "a thorough policy" for addressing client and family member complaints. The Ministry of Health said it couldn't comment on Ken's case, but if a client is unhappy with how a provider handles a complaint, the issue can be taken up with the Health Services Appeal and Review Board as well as the Patient Ombudsman. Back in hospital Kareen said Ken's knee was injured during a bed transfer on the morning of May 23, 2024, and he was taken back to the Renfrew Victoria Hospital. "It's devastating," Kareen said. "Ken doesn't want to be there. I don't want to be going in and out. Kenny's friends don't want to visit him there." Kareen said it has been difficult to re-establish the supports Ken had in hospital before he was sent to Pathways. She has arranged a support worker to visit him Monday to Friday. "I'm coming in in the evenings and I'm bringing him dinner," Kareen said. "Ken needs to get out of the hospital. He's right now pretty much spending ... 24/7 in a bed and that … that's inappropriate." After his hospital re-admission, Kareen tried going to Ontario's Patient Ombudsman to have the funding for Ken's bed transferred to a different care provider. She said they didn't want to go back to Pathways. "You have more freedom in hell than you did with Pathways," Ken said. In a letter from the ombudsman Kareen provided CBC, the office said funding issues are outside their jurisdiction and she needed to work with the hospital on a discharge plan. The Renfrew Victoria Hospital declined to comment on Ken's case. Ken's case not isolated The Ontario Brain Injury Association said others are facing similarly lengthy and uncertain wait times to be discharged from hospital. The province has 33 community living homes for people with acquired brain injury. The system hasn't improved since CBC reported on the Rekowskis six years ago. "Not a whole lot has changed. The government has invested in a few extra beds in some places," association president Ruth Wilcock said. "There's a huge gap still. It's something we do need to advocate for." She said the association also tries to help clients and caregivers advocate if they are having issues with a home. "It's not like, well, I stayed in this hotel, I don't really like it, I'm going down the street to another hotel. That option isn't there," she said. "I think the facilities try to do the best they can, but we also know that they're short funding on their end." 'I've been on my own' As for the Rekowskis, Kareen is reflective and resolute about their 16-year journey. Their mother, now 83, requires more care, and Kareen wants to see improvement from a system that has let her down repeatedly. "What we need is person-centred care. Our health system is really in a lot of turmoil and we need to change that," she said. "Ultimately, I've been on my own and our family's been on our own." Kareen is reaching out directly to service providers and trying to arrange housing so Ken can have both 24-hour support and the autonomy he needs. Ken is grateful that his sister hasn't given up.
