Is a HPV test better than a Pap smear? What to know as Ontario set to update cervical screening

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Ontario’s Ministry of Health is making changes to its cervical screening program. Minister of Health Sylvia Jones confirmed to CityNews on Thursday that the ministry and Cancer Care Ontario are working together to include human paoillomavirus (HPV) testing in the Ontario Cervical Screening Program (OCSP) instead of the current Pap smear test.

“This is a multi-year transition that will ensure that Ontarians have access to the most effective cervical screening test based on the best scientific evidence,” Jones said in a statement to CityNews.

An internal memo to Ontario labs and hospitals obtained by CityNews said HPV testing will launch in the spring of 2025 and can be performed by laboratory service providers like LifeLabs and Dynacare.

In 2023, Prince Edward Island replaced Pap tests with HPV testing with Québec following suit earlier this year. In January, British Columbia announced it would be moving to at-home HPV tests, where people can self-swab and return via mail.

In a previous interview with Yahoo Canada, Dr. Kim Alexander, an Ontario-based gynecologist said approximately 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," said Alexander.

With HPV testing, she added, "we can actually know whether you have the virus that causes cancer. That's super powerful," she added.

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."

Essentially, HPV testing is more accurate than a Pap test, and can now be done faster than before.

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," she claimed.

"HPV testing missing rate is close to zero… it’s very effective in determining your risk," said Alexander

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 outlines 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."

HPV causes almost all cervical cancers but is also linked to cancer of the throat, oral cavity, penis, anus, vagina or vulva.

"It is possible to be infected by more than one type of HPV at a time," Health Canada stated.

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 Dr. Alexander, HPV testing is done in a similar way to a Pap test, where a swab gets used to collect a small sample of cells from a cervix or vagina that may have the cancer-causing virus present.

In Canada, HPV testing may not be covered by a provincial and territorial health program and people may have to pay for it out-of-pocket.

Alexander's interview in 2023 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," said Alexander.

"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."

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 tests.

"The awesome thing about HPV testing is that it gives you a risk before you might even be developing a problem… And ideally, we're gonna 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," Alexander said.

Why is HPV vaccination important?

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.

"You also provide vaccines to at-risk populations," said Alexander.

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 claimed.

"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," said Alexander.

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