HPV screening and follow-up pathway

Communicating results

person reading HPV informationRecommendation: Ensure there are clear processes for reporting screening results to providers and screening participants. 

Key evidence and implementation considerations:

  • To ensure participants understand their screening results and next steps, there should be clear points of contacts for them to ask questions.
    • Primary care providers can play an important role in supporting participation in follow-up by triaging and providing referrals to other tests and specialists, as appropriate.1 Research from Australia found that having a trusting and empathetic relationship with primary care providers improved follow-up after self-sampling in under- or never-sampled populations.1
  • Screening test results can be communicated to primary care providers and participants using mailed letters, phone calls or electronic systems, such as a health information system.1 Results should be communicated in a timely manner, standards for communicating results should be put in place, and turnaround times for results should be monitored.
  • How results are reported to participants may differ depending on technical solutions available and different preferences across populations. Participants could be contacted if their test is positive or indeterminant (and therefore needs to be redone). Results could also be made available online. In the Netherlands, primary care providers call participants to share results if significant abnormalities are detected; otherwise, the results are mailed.2
  • Participants should be encouraged to seek out their screening results and be reminded that not receiving news about their results does not necessarily mean their results are normal.
  • Where possible, programs should use existing mechanisms for relaying results to providers.
  • Individuals who directly communicate positive HPV results to participants, including primary care providers and screening program staff, should be equipped with the information necessary to communicate positive HPV results appropriately to participants, answer their questions, and counsel those with concerns or anxieties around their results.
    • Prior to HPV primary screening, one’s HPV status was not connected with cervical screening. Explaining this change to participants and being prepared to answer any questions is important.
    • It is important to use plain language and avoid language that may promote stigma of a positive HPV diagnosis.

flow diagramRecommendation: Develop a clear follow-up pathway for screening participants to follow in cases where they have a positive HPV primary test result.

Key evidence and implementation considerations:

  • Pathways for further investigation of screening participants who have a positive HPV test result should be established and available prior to initiating screening. This is particularly important for self-sampling, as participants may not have had previous contact with primary care providers.
  • Ensuring processes are in place to ensure participants with positive results participate in follow-up is critical. This can include phone call, email, or text reminders, and including this information alongside the self-sampling kit.
  • Jurisdictions should evaluate and monitor follow-up rates to ensure appropriate and timely follow-up is taking place.

patient and doctorCommunicating results for unattached participants

There are many people who do not have access to regular primary care. Establishing mechanisms to allow these people to fully participate in screening, including ensuring results and next steps are communicated and actioned, reduces barriers to screening and improves outcomes.

  1. Canadian Partnership Against Cancer. HPV primary screening and abnormal screen follow-up for cervical cancer environmental scan. 2021. Accessed January 19, 2022. Available from: https://www.partnershipagainstcancer.ca/topics/hpv-primary-screening-environmental-scan/
  2. Polman N, Ebisch R, Heideman D, et al. Performance of human papillomavirus testing on self-collected versus clinician-collected samples for the detection of cervical intraepithelial neoplasia of grade 2 or worse: A randomised, paired screen-positive, non-inferiority trial. The Lancet Oncology. 2019; 20(2): 229-238. https://doi.org/10.1016/s1470-2045(18)30763-0