Eliminating cervical cancer in Canada

Follow-up for positive HPV tests

A critical step to eliminating cervical cancer is ensuring people who test positive for HPV have timely access to culturally safe and appropriate follow-up services, which may include a colposcopy. Colposcopy is the primary follow-up diagnostic test to confirm the presence of pre-cancer and cancer and to determine appropriate management.

The Partnership is supporting and encouraging provinces and territories to include follow-up pathways as an essential part of their transition to HPV primary screening. Additionally, provinces and territories should collect data on follow-up indicators so they can better understand the impact this has on patient care and outcomes.

Follow-up data improves patient care

Collecting data is critical to measuring the effectiveness of follow-up care pathways for people who test positive for HPV. Cancer agencies and programs are currently exploring opportunities to expand data sources to ensure no one gets left behind.

Provinces and territories are also using modelling projections to plan for the necessary resources to support follow-up care. For example, the projections below demonstrate how switching to HPV primary screening is predicted to decrease colposcopy demand over time, despite an initial increase. Building on these results, provinces and territories continue to explore strategies to manage demand for colposcopy services, which include a gradual switch to HPV primary screening based on age, cytology triage to support referral to colposcopy and further investigation of HPV sub-types to inform follow-up pathways.

Projected colposcopy demand, 2023 to 2053

Colposcopy demand modelling projections using the OncoSim-Cervix tool. Implementation follows an age-based approach (aged >50 first, followed by aged >40, and lastly aged >= 25).

Age-based transitioned over 7yr to HPV testing every 5yr
Age-based transitioned over 3yr to HPV testing every 5yr
 Immediate transition to HPV testing every 5yr
PAP testing every 3yr
Data table and footnotes

Clinical guidelines to support pathways of care

In 2023, two guidelines were released to help cancer agencies and programs transition to HPV primary screening and provide evidence-informed guidance on how to support patients who test positive for HPV.

The guidelines focus on the management of a positive HPV test and risk-based colposcopy and surveillance and are meant to complement approaches already in use by cancer agencies and programs. The guidelines can also serve as a roadmap for those still developing clinical resources.

The guidelines were developed by the Society of Gynecologic Oncologists of Canada and the Society of Canadian Colposcopists, with support from the Partnership. They include recommendations on how to ensure high-quality, culturally safe and appropriate follow-up care is provided after a positive test result for people who face barriers, such as 2SLGBTQIA+ individuals; First Nations, Inuit and Métis; and newcomers to Canada. Increased awareness led by the Partnership is prompting cancer agencies and programs to actively consider how to leverage the guidelines within their screening programs, and clinicians are incorporating them into their practice.

First Nations, Inuit and Métis have identified Peoples-specific and collective priorities and actions to eliminate cervical cancer. The guidelines are one example of the collective call to action to establish national guidelines to promote consistent cervical cancer care.

HPV primary screening and follow-up pathway

In addition to the clinical guidelines, the Partnership developed the HPV primary screening and follow-up pathway in collaboration with the provinces and territories. This pathway contains evidence and real-world considerations that support cancer agencies and programs that are working toward implementing HPV primary screening and follow-up.

Story of progress

Updating pathways for HPV primary screening and follow-up in Newfoundland and Labrador

In 2022, Newfoundland and Labrador brought together a working group to review the clinical evidence related to the province’s HPV primary screening and follow-up clinical pathways. These efforts resulted in updates to the pathways and algorithms for HPV primary screening and follow-up guidance for HPV positive test results. The updates were informed by the clinical guidelines on management of a positive HPV test and risk-based colposcopy and surveillance.

Newfoundland and Labrador’s revised pathways and follow-up algorithms for HPV primary screening will provide guidance on who is most at risk for developing cervical cancer and who is eligible to be transitioned back to primary care. The pathways will also provide guidance to primary care providers on follow-up for people with normal and positive HPV test results. A process will be established to manage people without a primary care provider to ensure appropriate follow-up care is in place.