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British Columbia is making at-home human papillomavirus (HPV) screening available throughout the province as an alternative to the conventional Pap test, which has been the established screening test for HPV and cervical cancer. This initiative, which is a first in Canada, follows the success of a pilot program that indicated the feasibility and acceptability of at-home HPV screening.

Positive Reception

High-risk types of HPV may lead to cervical cancer over time if left untreated, and HPV screening is employed to determine whether a patient has a high-risk type of HPV.

An estimated 1550 Canadian women were diagnosed with cervical cancer in 2023, and an estimated 400 died of the disease, according to the Canadian Cancer Society. In British Columbia, about 200 women develop cervical cancer annually, and about 50 women die of the disease, according to the BC Centre for Disease Control. BC Cancer guidelines recommend that women aged 25-69 years should be screened for cervical cancer every 3 years.

More than 13,000 self-collection kits were returned during the pilot program. The study population included about 3100 patients who had never been screened for HPV or had not been screened for more than 10 years, about 3700 patients who had had their last HPV screening 5-9 years earlier, and about 5700 patients who had had their last screening less than 5 years earlier.

Most participants (about 91%) were HPV negative, a rate that is consistent with the rate in the general population, researcher Gina Ogilvie, MD, DrPH, Tier 1 Canada Research Chair in Global Control of HPV-Related Diseases and Prevention at the University of British Columbia in Vancouver, British Columbia, Canada, told Medscape Medical News.

Participants in the pilot program found self-collection through swabbing for HPV at home to be "highly acceptable." About 90% of participants said that they would be willing to use this type of screening again.

Available on Request

"In our goal to eliminate cervical cancer, I want to see everyone vaccinated as well," said Ogilvie. "So, that's the primary prevention piece, and then we have the secondary prevention, which is [HPV] screening."

Self-collection kits will be provided to individuals who request them so that they can perform at-home screening, said Ogilvie. Individuals can request the kits by phone or online from BC's cervix screening program. After self-collection, the patient places the swabs in the mail and sends them at no charge to the cervix screening program.

Results of swab collection will become available through the mail or online within 4-6 weeks from the time a collection kit is mailed. Results will be sent to the patient and the patient's primary care provider.

If the result is positive, patients will be contacted for further follow-up, added Ogilvie. "There will be a pathway to care with self-collection," she added, noting that patients without a primary care provider will be connected to a clinic in the community to receive follow-up care and support.

At-home HPV screening will also decrease the strain on the healthcare system, noted Ogilvie. "What we anticipate is a lot [of women] are going to choose to do it themselves. That will alleviate pressure and allow women to be served on time for getting their HPV testing."

Expanded Surveillance

The screening at home option offers several advantages, according to Amanda Black, MD, MPH, president of the Society of Obstetricians and Gynecologists of Canada and professor of obstetrics and gynecology at the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

"If you could do a self-administered HPV test, that means the patient does not have to come in" to the clinic, Black told Medscape Medical News. Busy schedules may prevent women from coming in for a Pap test, and the lack of a primary care provider may also mean that women go unscreened for HPV. At-home screening "removes obstacles such as not having access to a care provider, having to travel for medical care, or having to take time off work," said Black. "If there's a history of trauma and someone is worried about having a physical examination, they would probably feel more comfortable performing their own exam."

In addition, cultural barriers may impede in-person screening, said Black. For example, women of certain religious faiths may prefer not to undergo a Pap test. "Recognizing we are in a multicultural society, [at-home HPV screening] gives us the ability to ensure that more women are screened for HPV," said Black.

Vaccination, coupled with at-home HPV screening, will have a significant impact on decreasing the incidence of cervical cancer, she added. "We have the tools at our disposal to eradicate cervical cancer. We have vaccination [against HPV] to prevent cervical cancer, and then we have screening and early detection of HPV, so that we can follow them [HPV-positive patients] more closely and ensure that they do not develop cervical cancer."

Ogilvie and Black reported no relevant disclosures.