首页|Shifting from cytology to HPV testing for cervical cancer screening in Canada
Shifting from cytology to HPV testing for cervical cancer screening in Canada
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NSTL
Cma-Canadian Medical Assoc
Infection with high-risk strains of the human papillomavirus (HPV) is a known prerequisite for developing cervical cancer. Soon, a test for high-risk strains of HPV will replace the Papanicolaou (Pap) test for routine cervical cancer screening in Canada. Unlike the Pap test, which requires a cytopathologist to detect precancerous cervical cells, testing of a cervical sample for HPV subtypes uses polymerase chain reaction (PCR). Australia, the Netherlands and the United Kingdom have adopted the HPV testing model for cervical screening, and it is also endorsed by the American Cancer Society. A recent review by the Canadian Agency for Drugs and Technologies in Health considered available evidence; its report concluded that HPV PCR testing of cervical samples is better at detecting precancer or cancer than Pap testing and would decrease the overall cost of screening. However, shifting to this new screening modality will mean overhauling existing algorithms for age and screening intervals, changing resource allocation and educating physicians and patients. We discuss why and how cervical screening will need to change in Canada with the adoption of the new test. Current screening approaches acknowledge that Pap testing has a high specificity of 96.8%4 but a low sensitivity (55.4%), which means that screening misses almost half of existing abnormalities. A short interval for repeat testing (every 2-3 years, starting between the ages of 21 and 25, depending on the province) mitigates harm, as subsequent testing is likely to detect previously missed pathology in populations with relatively high disease prevalence.
Emily Delpero、Ama Selk
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Department of Obstetrics and Gynecology, Mount Sinai Hospital
Department of Gynecology, Women’s College Hospital, Toronto, Ont.
NSTL
Cma-Canadian Medical Assoc
