Will Pap Tests Soon Be a Thing of the Past?

Like many things in the past two and a half years, Pap tests were put on hold to limit close contact. And we can’t say we missed them—hopping into the stirrups and bracing for the cold speculum is no one’s idea of a good time. But just how necessary are they?

Pap smears screen for cervical cancer by detecting abnormal cells in the cervix. Typically, abnormal cervical cells are caused by a human papillomavirus (HPV) infection, and often resolve on their own. If they don’t, these abnormal cells need to be treated or they could cause cervical cancer (1 in 168 women are expected to develop the disease in their lifetime—but it is highly treatable when detected early). Since it takes about five years or longer for abnormal cells to potentially cause cervical cancer, Health Canada changed its recommendation for screenings from every two years to every three years. But, even with this increased time frame, regular screenings are still not feasible for many women. Work obligations, child care burdens, financial restraints, and now pandemics—not to mention embarrassment and fear—are among the many barriers preventing women from getting their Pap tests. Could there be a better way to screen for cervical cancer?

Dr. Gina Ogilvie, affiliate scientist for BC Cancer and one of Canada’s leading experts on HPV, is answering that question with a resounding yes. It’s actually possible to administer a test yourself, in the convenience of your own home, and get accurate results—and some women in B.C. are already doing just that.

Earlier this year, BC Cancer launched an at-home cervix screening pilot project to test what happens when screenings are made more accessible. The agency is targeting a mix of remote and urban areas of the province where there are many people who have never been screened or are overdue for screening. Participants are mailed a self-collection kit that includes a swab and a container (no cold, daunting metal speculum in sight). Then, participants mail their sample to a lab, where technicians determine whether the cells are infected with the specific high-risk strains of HPV that can cause cervical cancer.

We chatted with Ogilvie to learn more about the pilot and how it might help women across the country.

(Related: Questions You Should Ask Your Gynecologist)

Why is it important to test for cervical cancer every three years, and not more often?

A Pap test is a screening—meaning it’s done when there are no symptoms present. We use it to look for changes in the cells that could potentially lead to cancer. The fortunate thing about cervical cancer is that it’s a very slow-growing condition. So we have to balance finding precancerous lesions while not over-calling benign lesions that may look a little funny but that, if we gave them time, would actually resolve. What we’ve found over the years is that by extending the interval from two years to three, we reduce the rate of false positives, so we don’t send women for unnecessary follow-up procedures.

Why can the cervix screening in your pilot be done at home but a Pap smear can’t?

With the Pap, women have to undergo a pelvic examination so the practitioner can see the cervix to get the cells. In contrast, the HPV test can be collected by women themselves because the sample does not have to come from a specific part of their anatomy, but rather from vaginal secretions.

How else does cervix screening differ from a Pap test?

Unlike Pap tests, cervix screenings check for HPV specifically. Like pap tests, HPV testing is recommended every three years. But we’ll soon be able to extend that interval to five years because the HPV test is even better than Pap tests at detecting the potential of developing precancerous and cancerous lesions. When someone has a negative HPV test, we can be confident that, in the next five years, it’s very unlikely they will develop any precancerous lesions. We have very good evidence that, even with the extended screening interval, HPV testing performed better than Pap smears, thereby limiting iatrogenesis illness, which is an illness caused by the health system.

How do women conduct the test themselves, exactly?

It’s like putting in a tampon—insert the cotton swab, twirl it around, get secretion on it, take it out, put it in a container, mail it in, and it’s examined by a lab.

Are there any risks involved with an at-home cervix screening? Is it possible to do it incorrectly?

Women can do this very safely, they can do very accurately. It’s also been rolled out in places like Australia and Wales, so we have even more proof that it works.

What happens if the test comes back positive?

We’re doing this screening to get women who are positive into treatment. If someone’s positive, they would go for a follow-up Pap smear, because that helps us understand whether the HPV has progressed. Alternatively, if they have a certain HPV, like types 16 or 18, they would go right to treatment because we know those HPV infections are very likely to progress to precancerous lesions. Treatment for those would include a colposcopy exam, where a practitioner examines the cervix, looks to see if there’s anything concerning, and, if there is, they remove that tissue.

Would a Pap smear ever be preferred over an at-home cervix screening?

Some folks will choose to go to a practitioner because they want a full genital examination. Or maybe they see something they’re worried about—lesions, bleeding, abnormal discharge. For anything like that, you should always see a practitioner.

A common misconception is that Pap smears also test for ovarian cancer and sexually transmitted infections. Is there concern that, by limiting the need for women to visit their doctor, cases are being missed?

All the important things that happen during a practitioner exam—say, STI testing or reminder about mammograms—still need to happen. You still need your check-ups, and if you’re sexually active, you still need your STI screenings.

Is there a timeline for when the at-home test will be the standard for cervical cancer screening and available across Canada?

We’re first committed to spreading information so people understand this can be done safely and effectively. In B.C., we’re going to continue to expand and offer it and then summarize the data. Then, hopefully, we can use that to inform our provincial policy and to urge other provinces to move forward.

This interview has been edited and condensed for clarity.

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