P.E.I. to replace Pap tests with HPV tests — but COVID is delaying the switch

Changes are coming to cervical cancer screening for Island women, with a move from the traditional Pap smear to HPV testing — but it's being delayed because of COVID-19. 

The newer type of HPV test detects precancerous cells through a DNA analysis of a cervical swab, as opposed to analyzing changes in cells. It's something Health P.E.I. had hoped to rollout early in 2022. But officials say it's been hard to plan for changes at the provincial lab when it's already so busy processing COVID-19 tests. 

"The HPV screening is very analogous to the screening we're doing for COVID using PCR right now," said Dr. Michael Gardam, CEO of Health P.E.I. 

"Essentially you get specimens in, those specimens are then run through the machine, and you get a result at the end of it. And so it's a much more efficient way of doing the screening. But the added bonus, of course, is that it's also much more accurate. You're getting a much more detailed look of what's actually going on."

Once HPV testing is introduced, Islanders can expect shorter turnaround times for cervical cancer screening, increased sensitivity for cancer detection and longer intervals between tests. 

In an emailed statement, the Society of Obstetricians and Gynaecologists of Canada said the shift from Pap tests to HPV testing is welcome news, but it's still concerned for the "significant number of patients" in Canada who are overdue for cervical cancer screening.

"HPV testing offers many advantages, including reducing the number of at-times uncomfortable examinations, a higher detection rate of treatable pre-cancers, and a shorter turnaround time in processing laboratory results," it said.

"The transition to HPV testing is a major shift in how millions of Canadians are screened, but Canadians cannot wait any longer. We strongly encourage provincial governments across the country to make funded HPV testing a reality."

Sending to labs off-Island to clear backlog

Gardam said in anticipation of this change two of the four staff at the provincial cytology lab, who analyze Pap samples, have already left for other opportunities — which he calls "entirely appropriate" considering the hope was to have already made the switch to HPV testing.

But in the meantime, with only two people doing the work of four, analysis of Pap tests on P.E.I. is currently delayed. 

"That is why in order to clear through the delays in the screening, the lab is looking at sending these out to labs off the Island, to be able to catch up with the backlog," said Gardam.

Officials with Health P.E.I. confirmed Pap tests from October and November have been sent off-Island for analysis and it's expected to take 30-60 days to clear the backlog. 

"They've also told me that this is not unique to P.E.I.," said Gardam. "That there's a backlog in cytology across the whole country, and it likely speaks to just all of the disruption that's been going on over the last two years." 

Hoping to make the switch before end of 2022

He said P.E.I. hasn't seen the same delays in preventative screening procedures that other provinces have so far.

As the province navigates the current wave of COVID-19, work will continue on securing the funding and staffing required to make the switch to HPV testing for cervical cancer screening.

"The actual process is basically identical," said Dr. Gardam. 

"There's a swab taken around the cervix. It's just that the lab is looking for human papillomavirus, not looking under the microscope for abnormal cells. That's the big difference."

Gardam is hopeful that the switch will be made before the end of 2022. 

He said there are no plans to close the cytology lab completely, once cervical cancer screening moves to HPV testing. as there will be a continued need for capacity locally to analyze cells.