Cervical cancer is the fastest increasing cancer among Canadian women and can be deadly if caught too late. Only 19 per cent of patients whose cervical cancer has spread to other parts of the body survive five years. For those whose cancer is diagnosed early, however, the five-year survival rate is 91 per cent. Testing saves lives.
Even better, screening methods across Canada are improving. Canadians can now self-test for human papillomavirus (HPV), which causes cervical cancer, affording them more choice around how and where they test.
Among the provinces, only British Columbia and Prince Edward Island pay for such tests. Elsewhere, public health systems largely refuse to pay for a simple test that will save lives and avoid suffering.
It’s a shocking example of the inertia of Canadian health care, when even a solution as obvious as this one hasn’t been picked up consistently across the country. Instead, the implementation of self-sampling is plagued by phased approaches, pilot projects and logistical hurdles in some of Canada’s most densely populated provinces. Thus, where a select few are leading, the rest are falling behind.
The good news is if somebody wants to be screened for cervical cancer in Canada, it’s generally doable for those who can visit a clinic. The bad news is that self-test kits, the most accessible form of screening, are only available free of charge to residents of two provinces and leaders elsewhere have yet to set a clear date for implementation.
The right to speak and the right not to listen
Canada has a goal to eliminate cervical cancer by 2040 and the implementation of self-testing should be a key component in its success. In 2023, around 1,550 people were diagnosed with cervical cancer and another 400 died from it, according to the Canadian Partnership Against Cancer.
Traditionally, cervical cancer screening has meant getting a pap smear, which involves a clinician inserting a speculum into the vagina and collecting cells from the cervix. The speculum, which has a controversial history of its own, is a cold, metal instrument that makes the intimate test generally an unpleasant experience. Especially when done by a stranger, which would be the case for about 15 per cent of Canadians who don’t have a regular health care provider.
While a transition away from the pap smear and towards HPV testing for cervical cancer is currently under way nationwide, both tests still require the use of a speculum if done by a health care provider.
For patients, self-testing can offer both convenience and the comfort of privacy. For clinicians, it can save valuable time and allow them to prioritize appointments with patients who may not be able to physically complete an HPV test on their own.
But most importantly, for all Canadians, it has the potential to save lives.
While self-testing places the onus on the patient to perform the swab correctly, studies have shown that samples collected by patients are comparable in accuracy to those collected by physicians.
In January, 2024, B.C. became the first province to offer cervix self-screening, as part of its transition from the pap smear to HPV testing. Similar to putting in a tampon, self-testing involves inserting a swab into the vagina and rotating it for 20 seconds to collect a sample. That swab is then sent to a lab, where it’s tested for HPV.
In B.C., the test can be ordered online and done at home or at a health care provider’s office. If done at home, the kit comes with a prepaid return envelope. In P.E.I., self-sampling is available but must be done in a clinical setting.
It’s choice and convenience bundled together.
Yet, more than a year later, Ontario only recently made the transition from the pap smear to HPV testing, and self-screening wasn’t part of that move. Instead of following B.C.’s lead and introducing the two changes simultaneously, the province is rolling out a self-test option in a phased approach to select primary care sites – which it has not disclosed.
In the meantime, the self-test currently available for purchase in Ontario is not one of the select few that has been approved by Health Canada, meaning that a patient may end up being retested by a physician.
Self-testing is an existing tool available to deploy now. Provincial leaders who are yet to pay for it owe Canadians an explanation and a clear date for when they can expect this to change. Lives are at stake.