As Canada moves to modernize cervical cancer screening, a new study suggests most women do not yet understand or trust the shift from the Pap test to human papillomavirus (HPV) based screening.
The national survey, published in Current Oncology, examined women's preferences for cervical screening - including how they want to be screened and how they want information communicated - as Canada transitions from Pap tests to HPV testing.
"We now have better tools to prevent cervical cancer, but if people don't have confidence in the change, they may delay or avoid screening," said senior author Dr. Zeev Rosberger, Associate Professor in McGill's Department of Oncology and researcher at the Lady Davis Institute for Medical Research (LDI).
Although cervical cancer is almost entirely preventable through HPV vaccination and screening, in Canada, HPV vaccine uptake is suboptimal and screening participation has slipped.
From Pap to HPV testing
The HPV test detects the virus behind most cervical cancers before abnormal cells develop, making it much more accurate and effective than a Pap test. Under the new guidelines, HPV testing is recommended every five years starting at ages 25 or 30, instead of Pap tests every three years beginning at 21.
Canadian provinces began rolling out HPV-based screening in 2023, as part of an effort to eliminate cervical cancer by 2040. Recommendations for cervical screening still vary widely by province, and most still rely on Pap tests.
Why more isn't always better
Of more than 3,000 women and people with cervixes surveyed, most said they would prefer to be screened more often and starting at a younger age than the new guidelines for HPV testing recommend.
As being screened less often may seem counterintuitive - and because of potential anxiety around testing for a sexually transmitted infection - researchers say building public confidence will be a challenge.
"When an HPV test is negative, the risk of developing cervical cancer over the next five years is extremely low," said lead author Dr. Ovidiu Tatar, postdoctoral Research Fellow in McGill's Department of Psychiatry and a Research Associate at the LDI. "That's why longer screening intervals are safe."
As for the later starting age for screening, he notes HPV is very common and most infections clear on their own, especially in young, healthy people with a cervix. "Screening too early can lead to unnecessary worry and follow up," Dr. Tatar said. "It typically takes 10 years or more for HPV to progress to precancer."
Notably, those hesitant about getting screened showed interest in at-home HPV self-sampling. Expanding access to this option could help reach under‑screened populations, where cervical cancer is most often detected, he added.
Communication 'critical' to public buy-in
Learning from countries that have already made the shift will be important as more provinces adopt HPV testing, said the authors. They point to Australia's rollout, where women received a one-page notice, and confusion over the changes led to a petition signed by more than 70,000 people.
"That experience underscored just how critical communication is," said Dr. Rosberger, noting the success of any new screening program depends not just on the science behind it, but on how well it reflects and responds to people's needs and concerns.
The research team is now looking to develop new ways to help women better understand cervical cancer screening and feel confident taking part.
About the study
"Transitioning from Cytology to HPV Test-Based Primary Cervical Screening in Canada: A Population-Based Survey of Women's Screening and Information Preferences" by Ovidiu Tatar and Zeev Rosberger et al., was published in Current Oncology. The study was funded by the Canadian Institutes of Health Research.
