2024 Updates to Cervical Cancer Screening in Canada

Abstract

The landscape of cervical cancer screening in Canada is about to undergo a major shift from cytology-based screening to testing directly for the presence of high-risk strains of the human papilloma virus (HPV), the persistence of which is known to be a prerequisite for the development of almost all cases of cervical cancer. In 2018, the World Health Organization declared a call to action for the worldwide elimination of cervical cancer by 2040. Subsequently the Canadian Partnership Against Cancer (CPAC) released an action plan outlining the necessary steps for Canada to reach this goal. One of the 3 major priorities identified in the action plan is the transition to primary HPV testing. This transition from screening to testing represents a major shift in infrastructure and also a shift in mindset for clinicians, policymakers, and the public. To help guide this transition, CPAC has collaborated with the Gynecologic Oncology Society of Canada (GOC) and the Society of Canadian Colposcopists (SCC) to release two open-access, evidence‑based guidelines in June 2023. These guidelines address how to manage a positive HPV screening test, and colposcopy in the context of primary HPV‑screening. This paper will outline the evolution of cervical cancer screening in Canada along with the rationale behind the transition to HPV testing. Also included is a discussion on the broad recommendations from the 2023 CPAC/GOC/SCC guidelines, as well as recommendations for age and interval of screening and special populations. Readers of this article in e-journal format can access the Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations here. Readers may also access the 2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia here.