B.C. hopes to eradicate cervical cancer with self-tests. One doctor wants to see the 'rest of Canada follow suit'

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New steps to eradicate cervical cancer are underway in British Columbia, and a Canadian doctor says it's an initiative she hopes the rest of the country will soon adopt.

On Tuesday, B.C. Premier David Eby announced the province is planning to implement an at-home self-screening option for cervical cancer — a first of its kind in Canada. The new alternative to Pap tests, which B.C. will begin phasing out later this month, will include mail-in kits involving a small swab you can use yourself.

"If we look at our goal of eradicating cervical cancer, I think this is a great step towards that," Dr. Amanda Black, president of The Society of Obstetricians and Gynaecologists Canada, shares.

Since roughly 95 per cent of cervical cancers are caused by human papillomavirus (HPV), primary prevention focuses on HPV vaccines. But secondary prevention against cervical cancer includes screening, which for most parts of Canada, means a trip to your health-care provider for a Pap test.

Opening up access to more people

B.C.'s new self-test option expands the limits of those screenings, according to Black, who explains to Yahoo Canada this can reach "populations that may not otherwise have been previously well served because of barriers and access to care for a variety of reasons."

For instance, she says these self-tests will benefit patients who aren't able to see their health-care provider, whether that's because they live in remote areas, can't book time off work or simply don't have a primary care provider. Moreover, this is an option that may reach many people who haven't been able to be reached in the past.

"The other thing that's really important to remember is patient's who have a history of trauma, they just avoid examinations all together with health-care providers," the professor of obstetrics and gynecology at The Ottawa Hospital notes. "This allows them to have control of their own cancer screening, as well."

According to the Provincial Health Services Authority (PHSA) in B.C., each kit will include a swab, step-by-step instructions, lab requisition and packaging to return your sample within a prepaid return envelope.

They'll become available on Jan. 29 at no cost for people between the ages of 25 and 69 who are due for a routine cervix screening. That includes people who have not received a Pap test in three or more years, or for those who haven't completed HPV testing in five or more years.

The results will be returned within four to six weeks, where the patient's health-care provider will also receive the information. If the patient does not have a health-care provider and requires further care, they'll be linked to a community clinic, according to the government.

If no HPV is detected from a self-test, then a patient can go five years before screening again, as opposed to getting a Pap test every three years. "Cervix self-screening is highly effective at finding those at risk of cervical cancer. This means that you can safely go longer between screenings," says the PHSA.

A 'pretty self-explanatory' tool

A 2021 pilot project showed the at-home screenings for HPV are more effective at finding pre-cancerous lesions, according to B.C. Premier David Eby at Tuesday's news conference.

The at-home screenings are meant to be quick and reliable self-tests, where a patient will take a small Q-tip-like swab out of their kit and use it to swab the inside of their vagina for 20 seconds. While Black says it's "always possible" the user could make a mistake while using their kit, she notes, "I think for the most part, it's pretty self-explanatory."

Black adds she hopes to see the "rest of Canada follow suit" when it comes to preventing cervical cancer.

"I do think we're seeing this transition to HPV testing rather than Pap smear testing," Black shares, while also noting the success of the initial pilot project will likely push the rest of the country to make similar moves.

How does HPV testing differ from Pap tests?

Even though B.C. is the first province to begin implementing HPV self-tests, other province have been adopting them through health-care providers. In July, Prince Edward Island was among the first provinces in Canada to take up HPV testing after using Pap tests for decades. Quebec was the first in June 2022, and New Brunswick was the third to follow suit in August.

It's a route that Ontario gynecologist Kim Alexander previously told Yahoo Canada is more effective in determining the level of risk for cervical cancer.

While both HPV and Pap tests have health-care providers check for cervical cancer in a similar way, there's a slight difference in what each one looks for.

Pap tests check for abnormal or precancerous cells in the cervix that could lead to cancer if left untreated. On the other hand, HPV tests check for high-risk types of HPV — where there are more than 100 types of the virus, most of which go away on their own — in cells from the cervix.

The HPV self-test kits in B.C. won't cost patients anything, but HPV testing in other parts of Canada might not be covered by a provincial or territorial health program, meaning people may have to pay out-of-pocket.

Still, HPV testing is a better option over Pap tests when it comes to detecting cancer. Alexander says HPV testing comes positive on average 15 years before a cancer develops, while a Pap test may never show up positive. "HPV testing missing rate is close to zero ... it's very effective in determining your risk," she adds.

In September, the Canadian Medical Association Journal released new public health guidelines, including a "strong recommendation" to offer self-testing for HPV, noting it's a routine part of care.

"I think we have the tools to eradicate cervical cancer," Black says. "So let's do it and make sure that no one gets left behind and that everybody has the opportunity to do screening."

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