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Thousands in B.C. order new HPV mail-in screening tests

B.C. has been a world leader in cervical cancer prevention for decades, said B.C. Health Minister Adrian Dix
Dr. Krista Burton, at Cordova Bay Medical Clinic, with information brochures and the new HPV self-screening test which will remove barriers for people to get tested for cervical cancer. Patients more comfortable with doing the exam themselves are asking for self-screening mail-in tests while others are asking her to perform it. DARREN STONE, TIMES COLONIST

More than 19,000 HPV self-screening kits have been delivered since the province launched the first program of its kind in Canada on Jan. 29.

That was the first date anyone with a cervix — age 25 to 69, asymptomatic, sexually active and due for screening — could order an at-home mail-in human papillomavirus (HPV) kit from B.C. Cancer. Since 2021 only people in pilot areas, including central Vancouver Island, could get the test.

B.C. has been a world leader in cervical cancer prevention for decades, said B.C. Health Minister Adrian Dix when he announced the program, “and we’re at the forefront again as the first Canadian province or territory to offer cervix self-screening at home provincewide.”

HPV is by far the leading cause of cervical cancer, and the self-screening tests — combined with the primary prevention tool of immunization — offer the hope of eradicating this cancer in the next two decades.

Since the launch of the test kits that can be ordered online, B.C. Cancer has received more than 25,000 requests, of which 6,000 were deemed ineligible. Health-care providers ordered 825.

Premier David Eby said this month he has already met people who have benefited from the initiative — including a young woman who said she was ambivalent about getting her upcoming Pap test but gladly did the HPV at-home mail-in exam, which indicated she was at risk of cervical cancer. She has since been successfully treated, he said.

In June, just 61 per of those eligible for a Pap test — recommended every three years — were tested over the previous 42 months, said the Health Ministry.

The HPV self-screening program offers people who don’t have a family doctor, have difficulty accessing one, or are uncomfortable having a cervical exam the opportunity to conduct the test themselves.

The test kit arrives in an unmarked package and includes a long Q-Tip like swab with an insertion mark in a self closing tube, instructions, a requisition, and a prepaid return envelope for drop-off at any Canada Post office — with results within four to six weeks.

Family physician Dr. Krista Burton, at Cordova Bay Medical Clinic, is elated about this advancement for women’s health.

“I’m very, very excited that this option is available for people with a cervix who have barriers to accessing traditional Pap tests,” she said.

Burton says she’s seen an uptick in patients getting the HPV test and says she’s getting more notifications via B.C. Cancer of her patients ordering the at-home test kits online.

Also, for women who had already booked a Pap test and come in but want the HPV self-screening kit, Burton provides them with the swab, instructions and requisition. The instructions are quite clear, she said.

“But often people have been opting for me to still do the swab for the first time,” said Burton. “It is a good opportunity for instruction and they can feel confident doing future swabs on their own at home.”

She’s seeing results come back in as little as three weeks.

The province is ramping up HPV testing as a self-collection or health-care provider-collection option and ramping down traditional cytology tests, which are Pap tests where a physician gently scrapes the cervix looking for cell changes — precancerous or cancerous cells — that may have occurred as a result of the HPV virus, for example.

HPV testing by health-care providers for people age 55 and older began Jan. 29.

Vancouver General Hospital surgical gynecologic oncologist Dr. Lily Proctor, who is the medical director of B.C. Cancer’s cervix screening program, explains the highly sensitive automated testing for HPV — the infection that causes the most common cervical cancer — allows clinicians to find the virus that causes precancerous lesions in the cervix.

“With HPV testing it’s a viral swab, we’re testing for the virus which causes those precancerous changes, so by looking for the virus, which is the root cause of the problem, we’re able to find things earlier and better,” said Proctor.

Going forward there will be two options for women, she said.

The provider collection experience will be the same as the typical Pap test. The provider, using a speculum, will collect cells from the cervix using a liquid-based cytology.

The lab will determine whether the specimen is tested for HPV or cervical cell changes caused by HPV based on eligibility criteria — mainly the patient’s age.

If the person is 55 or older, they will be tested for HPV — “it’s the better test,” said Proctor. The province is introducing HPV testing first to older women to allow this group to take advantage of the superior HPV tests, at least twice, before they age out of the program at 69.

“You can stop cervix screening at age 69 if you’ve always had normal Pap tests,” according to B.C. Cancer.

If the result is positive, that same swab for the person 55 or older can then be tested for cytology or cervical cell changes.

The transition for ages 25 to 54 to primary HPV screening via a healthcare provider will happen over the next three years. If women in this age group prefer to be tested for HPV, they can request a self-screening test from B.C. Cancer. The self-test swabs used in the vagina can only be tested for HPV.

B.C. doesn’t start testing until age 25 in line with the Canadian Task Force on Preventive Health Care recommendations that testing earlier will lead to too many unnecessary diagnostic tests.

HPV infections are common; about 80 per cent of sexually active individuals will have an infection in their lifetime and it will leave their bodies, but in some cases a small number of high-risk HPV infections, if allowed to persist over years, can cause cell changes that can lead to cervical cancer.

If a person gets a positive result from a self-test, B.C. Cancer will refer them for further diagnostic testing — either a colposcopy or Pap test depending on the HPV type — through their family practitioner or a designated physician or community clinic if they do not have one.

A patient who gets a negative HPV result will be asked to test again in five years.

The Canadian Partnership Against Cancer has endorsed a goal date of 2040 for the elimination of cervical cancer through a combination of HPV immunization (free for all Grade 6 students and available up until age 26), stronger screening through HPV testing, and strict adherence to treatment and followup.

Proctor thinks a 15-year goal is reasonable.

“If we can reach target numbers in immunization and we don’t even allow our young people to get infected with HPV and then if — for those who didn’t get vaccinated or for the strains that the vaccine doesn’t cover — we have a really high quality test to screen early that catches things earlier and better, I think it is totally reasonable.”

Proctor says with HPV, early detection allows for a higher chance of cures.

“So ultimately, this is a huge step forward towards the path for elimination,” said Proctor.

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