Ontario Health has announced changes to the way patients in this province will be screened for cervical cancer. Dr. Lisa Del Giudice is a family physician in Sunnybrook’s Department of Family & Community Medicine, and the regional primary care lead, Toronto Central, Ontario Health – Cancer Care Ontario. She breaks down the important points patients need to know.
What is cervical cancer?
The cervix connects the uterus (womb) to the vagina. Cervical cancer is almost always caused by human papillomavirus (HPV), which is passed from one person to another through sexual contact. There are over 100 strains of HPV, but only some can cause damage to the cervix that may lead to cancer.
Getting an HPV infection is very common. For most people, it will go away on its own without causing any harm. In some cases, however, a cancer-causing HPV virus can stay around for several years and cause more serious damage. This is why cervical cancer is very rare under the age of 25.
HPV vaccination is important because it can prevent many cases of cancer-causing HPV infections from developing. HPV vaccination does not prevent all cases, which is why screening is still important.
What will be changing around cervical cancer screening?
Ontario recently moved away from Pap tests as the first line of cervical cancer screening, to instead testing for the most common types of HPV viruses that can cause cervical cancer. HPV testing is better because it can identify those people who have a higher chance of already having or developing a cervical pre-cancer or cancer.
How is HPV testing done?
At this time, the most accurate way to detect an HPV infection with abnormal cervical cell changes is to take a sample directly from the cervix. Patients will still need to have a speculum exam at their doctor’s office, so the physical experience will feel the same as having a Pap. Patients will receive a copy of their results by mail. If positive for HPV, they will be advised of the necessary next steps. If negative, they will be told when they are next due for cervical screening.
A negative HPV test has been shown to be very good at correctly identifying people who do not have a cervical pre-cancer or cancer, and who will not develop a cervical cancer in the next five years.
If the presence of HPV is found, it doesn’t necessarily mean the patient will develop cervical cancer. Further tests will be done on positive HPV samples to look for pre-cancerous cells. Based on the HPV result and presence or type of pre-cancerous cells found, additional procedures such as colposcopy may be needed to look at the cervix more closely. For others, more frequent testing to make sure the HPV clears, or no new pre-cancer cells develop, may be all that is needed.
What is colposcopy?
Colposcopy is a procedure that closely examines the vagina, vulva and cervix using a special microscope. Sunnybrook is home to the largest colposcopy clinic in Ontario based on the number of patients seen. The multi-disciplinary team has specific training in detecting and managing genital cancers and pre-cancers.
At what age and how often should screening be done?
The other big change is around timing: screening will start at age 25. It’s recommended screening be done every five years because HPV infections need to be present for a long time before possibly developing into cancer. This change is based on science and people should feel safe. People who have a hard time fighting viruses due to a weakened immune system should be screened every three years.
Most people can stop screening between ages 65 to 69 if they have undergone regular cervical cancer screening during their lifetime. Your health-care provider can let you know what’s best for you.
Does it matter if I’ve ever been sexually active?
The HPV virus is spread through sexual contact with the genitals, which can include contact with the hands, mouth or genitals. This is why screening for HPV isn’t necessary unless a person has ever been sexually active.
Who specifically should be screened?
According to Ontario Health, get screened if you:
- are at least 25 years old
- are a woman, Two-Spirit person, transmasculine person or nonbinary person with a cervix
- have ever had sexual contact with another person
- do not have symptoms, like different bleeding or discharge (clear or yellow fluid) from the vagina
Ontario Health adds that you should still get screened if you:
- have had the HPV vaccine
- feel healthy
- have been through menopause
- have not had any family members with cervical cancer
- have had sexual contact with only one person
- have had the same sexual partner for a long time
- have not had sexual contact in a long time
- are in a same-sex relationship
How can I book screening?
There are a few ways. You can call your family doctor, nurse practitioner or midwife to book screening, or call Health811 to find a nearby screening clinic. Ontario Health also has a live chat option.
Where can I get more information?
To learn more about lowering your risk of cervical cancer, visit www.mycanceriq.ca.
Click here to read more about these new screening guidelines.
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