Nova Scotia plans to change how it screens for cervical cancer

Nova Scotia plans to follow the lead of other provinces in the way it screens for cervical cancer, but the switch from Pap smears to testing for HPV is at least two years away, the legislature’s health committee heard Tuesday.

Dr. Robert Grimshaw, the medical director of Nova Scotia Health’s Cervical Cancer Screening Program, told the committee the efficacy of the human papillomavirus test in cervical cancer screening is one of the main reasons for making the change, but it will take time.

“We have an active planning process that’s looking at the transition,” said Grimshaw. 

Untreated persistent HPV infections cause 95 per cent of all cervical cancers, according to the World Health Organization. HPV is a common sexually transmitted disease that affects most sexually active people at some point, though it often occurs without symptoms and clears up on its own.

The Canadian Cancer Society says two high-risk types — HPV16 and HPV18 — are to blame for 70 per cent of cervical cancers. An HPV test can detect those high-risk types.

British Columbia and P.E.I. previously announced plans to transition to HPV testing as the primary method of screening for cervical cancer, a disease in which abnormal cells in the cervix — the organ that connects the uterus to the vagina — become cancerous. In B.C., eligible patients can request an at-home screening kit with a vaginal swab that can be dropped in the mail for processing. 

Grimshaw said home testing will be an option offered in Nova Scotia, although he could not say how big a part it will play in overall screening. 

“That depends on the uptake,” he said. “We know from initial information in B.C. that about 30 to 40 per cent of people might be interested in [at-home tests].”

“For a woman who has lost their family doctor, like my wife, she’s probably very interested in it,” he continued. “For a woman who has a good relationship with a family practitioner and is seeing them for other things, they may not be so interested in it.”

The HPV vaccine is offered to students in Nova Scotia through the provincial school immunization program. Grimshaw said the HPV test is “a better test to screen women who have been vaccinated in the school-aged program.”

Grimshaw said the hope is that the new testing will be done every five years instead of every three years, which is recommended for Pap tests.

He said the “five or six labs” that currently process up to 60,000 Pap tests a year would see their workload drop to about 3,000 to 4,000 tests a year. The plan is for those Pap smears to be handled at a single testing centre.

The growing shortage of technologists who can read Pap tests is among the reasons for switching to HPV testing, said Grimshaw, who noted there are only two schools left in Canada training those professionals.

The machines used for handling HPV tests still have to be purchased and sites chosen for those testing centres, Grimshaw added.

New Democrat committee member Susan Leblanc urged the province Tuesday to move as quickly as possible to make the change.

“Obviously I would like to see the program begin as soon as possible,” Leblanc told reporters following the meeting. “I buy that there are a lot of things that have to go into the program, but I also know that we put our dollars where the government decides to.”