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 tests instead and will eventually introduce self-sampling, the Department of Health has confirmed.

An advisory group is being 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.

HPV testing identifies cervical 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 save the 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 [the human 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, which causes “99 per cent” of cervical cancers.

If someone has a negative HPV test, we know from 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, is more accurate and predictive, according to Reardon.

“If someone has a negative HPV test, we know from 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-positives and follow-up testing that comes with that, she said.

Mixed reactions predicted

Reardon said the change is a big cultural shift, and predicted public reaction will be mixed.

Some people will be relieved they 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.”

A woman wearing grey scrubs and glasses with her dark hair pulled back.
Dr. Jaime Reardon, an obstetrician-gynecologist in Saint John, said Pap tests are less reliable than HPV tests, so they need to be repeated more often. (Dr. Jaime Reardon)

“I think it’ll be a little bit tricky for people to wrap their heads around.”

Testing to 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 helpful for people who live in remote locations, or who have a history of trauma or pain with pelvic exams.

A Pap test that includes a spay bottle, two small wands and a blue container along with  an HPV test sit on the counte.
The HPV test looks for the virus before cell changes happen instead of testing for cell changes that have already occurred. (Sheehan Desjardins/CBC News)

“We see people all the time who are a number 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 of New Brunswick women aged 21 to 69 had 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, said Marla Delaney, the provincial cancer co-ordinator.

But P.E.I. fully transitioned to using HPV as the primary screening test for cervical cancer as 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 funding from 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 Andersen said 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.

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

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