Cervical cancer, being among the top five most commonly diagnosed cancers among women aged 25-44 in Ontario, could become a disease of the past with screening options that are women-centred and culturally appropriate.
However, the provincial government’s current screening strategy has left many structurally marginalized women on the sidelines. This is a serious public health issue in Ontario that demands urgent attention from policymakers and health-care providers alike.
HPV screening is crucial to preventing cervical cancer
Cervical cancer, primarily caused by human papillomavirus (HPV), the most common sexually transmitted infection (STI), is now the fastest increasing cancer (up 3.7% per year since 2015).Current estimates indicate that 660 women in Ontario will be diagnosed and 150 will die from cervical cancer in 2024.
Although early detection through screening can save lives, Pap test uptake remains extremely low among structurally marginalized women, such as racialized immigrants, Indigenous people, 2SLGBTQI+ individuals, and sex workers.
These equity-deserving groups face systemic barriers to screening services, including geographic isolation, the lack of culturally safe care, a history of trauma, mistrust of the health-care system, service accessibility issues (distance, transportation), service availability (e.g. lack of a family physician, inconvenient clinic hours, long wait times) and limited education about cervical cancer and screening.
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Adopting culturally sensitive practises to promote women’s health
Overcoming these barriers requires a concerted effort from both health-care providers and policymakers to take immediate action. Investing in culturally sensitive outreach and sexual health education is an important first step to raising awareness about the benefits of HPV screening.
Additionally, implementing innovative and effective population-based HPV screening can bridge the gap to life-saving preventive care. This screening method, which identifies the viral cause of cervical cancer, can be enhanced by offering the option of self-collection, a safe and effective alternative to clinician-collected samples.
This allows women to perform the procedure at both a time and a place that are convenient for them.
Ontario must accelerate the transition to HPV primary screening
The HPV test offers several advantages over the traditional Pap test for cervical cancer screening.
It detects high-risk HPV strains, the primary cause of cervical cancer, with greater sensitivity and accuracy. A negative HPV test allows for a longer screening interval of five years compared to three years for the Pap test, reducing the frequency of testing for most women.
It also allows the option of self-collection that is not possible with the traditional Pap test.
Although Ontario will adopt HPV as the primary test for cervical cancer in spring 2025, it has already lagged behind other Canadian provinces in transitioning to HPV primary screening. P.E.I. adopted the strategy in May 2023 and Quebec has launched HPV primary screening in select regions, with full implementation expected in 2025.
When it comes toHPV primary screening with sample self-collection, British Columbia is the first and only province that has both implemented primary HPV screening and made the option of self-collection available to all screening-eligible individuals with a cervix.
The response to their self-collection option has been overwhelmingly positive, with 30,000 self-screening kits requested in the first two months of the program. More importantly, 30% of those requesting a kit had never been screened before.
Ontario remains in the planning phase, and it is yet to be determined if the self-collection option will be available. In the meantime, women across the province must wait, and screening disparities for women continue.
It is time for government and health care professionals in this province to commit to primary HPV screening, including the self-collection option, and to support dedicated community education efforts to ensure access to care for all Ontarians with a cervix.
We urge policymakers and health-care leaders to prioritize this issue and take swift action to ensure equitable access to HPV screening and close this unacceptable gap in preventive care. The time for change is now.
— Mandana Vahabi, PhD, RN, FCAN, is a professor at the University of Toronto — Lawrence Bloomberg Faculty of Nursing and Women’s Health Research Chair at Unity Health — St. Michael’s Hospital