FAQ: Cervical Screening Updates

Why is this change happening?

Ontario Health is replacing primary cytology with primary HPV testing due to the following advantages:

• HPV testing has a higher sensitivity, which means it is better at detecting cervical pre-cancer or cancer than cytology testing alone.
• HPV testing is objective, which means results are highly consistent and reproducible.
• HPV testing has a high negative predictive value, which means it is more likely that negative results will correctly identify people who do not have a cervical pre-cancer or cancer and who will not develop a cervical cancer in the next 5 years.
• HPV testing allows for earlier and more appropriate discharge from colposcopy.

For more information, see this letter (PDF 205 KB) from Ontario Health (OH) to care providers and question one of this abridged FAQ (PDF 298 KB) from OH.

Read more about the progress across Canada in implementing HPV primary screening from the Canadian Partnership Against Canada.

What does the new screening process look like for client care?

This guide (PDF 394 KB) from Ontario Health features an algorithm of the screening process with follow up actions and referrals based on screening results.

Is cervical screening for HPV included in the Ontario Laboratory Regulation for midwives?

Yes. Schedule 2, Section 18 (Requisition by Midwife) of the Laboratory and Specimen Collection Centre Licensing Act includes “cervicovaginal specimens.” 

Are the screening recommendations different during pregnancy?

No, cervical screening recommendations and indications for referral to colposcopy are the same, regardless of pregnancy status.  

• Cervical cancer can be diagnosed in pregnancy, so providers should discuss cervical screening when clients come for prenatal care. However, pregnancy does not increase someone’s risk of developing cervical pre-cancer or cancer, so pregnant people do not need to be screened unless they are at the recommended timing for cervical screening based on their history. 
• Cervical sampling is safe during pregnancy. However, instruments should not enter the cervical canal during sampling, so either use the broom or the plastic spatula without the endocervical brush. Screening may be deferred to the postpartum period if there are risk factors for preterm labour or bleeding, or if the client would prefer to defer testing.
• Cervical screening is usually avoided after 24 weeks of pregnancy because it can be uncomfortable, but it can be resumed as early as six weeks postpartum. 

How do I order HPV screening?

There is a new requisition form (PDF 1.6 MB) that providers should begin using on March 3rd 2025.

This new form is the only requisition that providers offering cervical screening can use to order an HPV test for clients as part of the Ontario Cervical Screening Program (OCSP). This form is different from the Ministry of Health (MOH) laboratory requisition. Requisitions from the MOH, public health or hospitals will not be accepted. ONLY the OCSP requisition can be used.

Providers should add the new OCSP HPV and cytology test requisition form to their inventory of test request forms, either printed or in their electronic medical records (EMR). Ontario Health is working with OntarioMD to integrate this requisition into main EMR platforms.

Ontario Health has also provided instructions (PDF 127 KB) on how to complete each section of the new HPV and cytology requisition form for cervical screening. 

Can I start ordering HPV instead of cytology before March 3rd?

No. The new requisition form has been published in advance of the launch for reference only. Please do not fax/submit requisitions until HPV testing launches on March 3rd 2025.

How do I collect an HPV sample?

HPV specimens are collected by a care provider using a broom-like device or an endocervical spatula-brush combination (see image below). Both collection devices are acceptable, and either method can be selected based on care provider preference.

The Ontario Cervical Screening Program (OCSP) uses the ThinPrep® system for cervical sample collection in cervical screening and colposcopy. Any specimens collected using SurePath™ will be rejected.

Read this guide (PDF 938 KB) about specimen collection for detailed information about the devices, sample collection technique, and additional instructions for sample collection during pregnancy, for people with a double cervix and for collecting a sample from the vaginal vault.

Image source: OCSP "How to Collect a Cervical Sample" document.

What are some tips to avoid cervical sample rejection?

• Check the expiry dates of all equipment being used including the sample vial and collection device.
  •  Cervical samples collected using expired medium will be rejected by the laboratory.
• Avoid certain types of lubricant or use water to lubricate.
  • Using too much lubricant or using lubricants that  contain carbomer or Carbopol® polymers (thickening agents) may cause an invalid test result.
• Ensure no part of the collection device (e.g., head of the broom) is left in the collection vial.
  •  Unlike some other systems for cervical sample collection, the ThinPrep® system  does not allow any collection devices to be left in collection vials. Samples with devices left inside the vial will be rejected by the laboratory.
• Label your sample using legible writing or adhere a printed label.
  • Complete all required parts of the label (client first and last name, date of birth, date of sample collection).
• Pair all cervical samples with a corresponding requisition.
  • Make sure label on the sample vial and on the requisition have matching information.
• Tightly close specimen vial to prevent leaking.
• Ensure the sample is sent promptly to lab.

Do I need to send specimens to a new/different laboratory?

No. For most health care providers, your lab service provider will not change as the result of HPV testing launch (unless requested).

The following 3 labs will perform all OCSP-related screening and follow-up tests in colposcopy (HPV testing and cytology):

• LifeLabs (1-877-849-3637)
• Dynacare (1-800-565-5721)
• North Bay Regional Health Centre (1-888-418-6430)

All other community labs will support the program with supply delivery and courier services:

• Alpha Labs (416-449-2166)
• Bio-Test (1-800-409-1942)
• Med-Health (416-256-7278)
• Medical Laboratories of Windsor (519-258-1991)

Please contact the lab directly with questions about lab services or to arrange courier services.

What about self-collected HPV screening?

Self-collected human papillomavirus (HPV) testing is available in Ontario, however it is not currently insured by the Ontario Health Insurance Program (OHIP), and is not currently recommended by the Ontario Cervical Screening Program.

Other areas in Canada, such as British Columbia as of January 2024, have transitioned to routine self-collected HPV screening recommendations.

Self-screening can improve access for people who may not have previously participated in screening by enabling individuals to collect their own sample at a time and place of their choosing, bringing care closer to home and supports culturally safer cervical screening, and supports access to care for those without a regular healthcare provider and increasing comfort and safety for people with a history of trauma. (1)

1.    Canadian Partnership Against Cancer. HPV self-screening is enabling choice. Available from: https://www.partnershipagainstcancer.ca/topics/eliminating-cervical-cancer/hpv-primary-screening-follow-up/hpv-self-screening/

Are there any resources for clients?

On the (HPV) Testing in Ontario: Implementation Resource Hub website at the very bottom of the landing page you will find a fact sheet providing high-level information on the Ontario Cervical Screening Program for cervical screening participants and the general public. It is available in 28 languages (see the drop-down menu). 

You can also direct clients to the public-facing Cancer Care Ontario website for more information about cervical screening in general.

Are there any educational opportunities for providers about this change?

upcoming WEBINAR

Ontario Cervical Screening Program (OCSP) HPV testing implementation overview for cervical screening

Feb. 4, 2025 | 7:30-8:30 a.m. | Register
Feb. 13, 2025 | 5-6 p.m. | Register

REGIONAL CONTINUING EDUCATION

Check with your institution or regional cancer program to see if there are care provider learning opportunities specific to your area.

• Ontario Health (Cancer Care Ontario) will offer an accredited continuing professional development module on the implementation of HPV testing and the new OCSP cervical screening recommendations. This module will be available regionally through face-to-face and virtual presentations hosted by regional clinical leads. To learn more about the accredited continuing professional development module presentations, providers should contact their Regional Cancer Program (list of Regional Cancer Programs).

Some additional opportunities include:  

• Waterloo Wellington Regional Cancer Program in-person or virtual offerings on Feb 13, Feb 25 & Mar 5, 2025.
• Recorded webinar (video 56 min 34 sec) from the Central East Regional Cancer Program “Getting ready for the implementation of human papillomavirus (HPV) testing in the Ontario Cervical Screening Program (OCSP)” recorded on January 17th 2025.
• Providers in the Central East Region (Scarborough, Durham, Northumberland, Peterborough, Kawartha Lakes & Haliburton, etc.) can request in-person HPV education & competency training. Trainings scheduled based on demand/interested. Facilitated by Dr. Nathan Roth, Cervical Screening & Colposcopy Lead.

I have more questions!

Check out the Ontario Health FAQ for cervical screening providers, a comprehensive list of over 80 frequently asked questions about this change.

You can also contact Ontario Health toll free at 1-866-662-9233 from 8:30 a.m. to 5 p.m. Monday to Friday or by email at cancerinfo@ontariohealth.ca.