Cervical cancer screening

Persistent human papillomavirus (HPV) infections cause almost all cervical cancers. These very common infections are contracted during sexual contact (including all genital contact with or without penetration).

HPV vaccination and cervical cancer screening are the two most effective ways to prevent this cancer.

Cervical cancer screening aims to prevent this cancer and to reduce the mortality and impacts attributable to it. This screening detects cancer precursors (pre-cancerous lesions) or early-stage cancer, before the appearance of symptoms, which increases the chance of recovery.

Two tests are used in Québec for cervical cancer screening: the Papanicolaou test (Pap test) and the HPV test.

The Pap test aims to detect abnormal cells and pre-cancerous lesions on the uterine cervix.

The HPV test aims to detect the presence of human papillomavirus (HPV). HPV infections occur before the appearance of abnormal cells or pre-cancerous lesions.

When a test is used as the main screening test (Pap test or HPV test), it is referred to as a primary screening test. The Pap test was the primary screening test for cervical cancer in Québec until 2023. Following a recommendation by the Institut national d’excellence en santé et en services sociaux (INESSS) in 2022, the replacement of the Pap test by the HPV test as the primary screening test for this type of cancer began in 2023 and is ongoing in the various regions. However, the Pap test may continue to be used as a complementary test (co-test) in some particular clinical situations. 

Pap test as the primary screening test

This screening test is offered from the age of 21 years until 65 years.

Primary HPV test

This screening test is offered from the age of 25 years until 65 years.

Before 25 years of age, the HPV screening test has more disadvantages than advantages for the following reasons:

• most HPV infections resolve on their own, without causing either symptoms or cancer in people younger than 25 years
• even if an HPV infection were detected, no treatment would be necessary
• the detection of transient infections has negative effects such as:
  • the stress caused by receiving an abnormal result
  • unnecessary medical appointments
  • additional tests and unnecessary procedures
  • complications from these tests leading to avoidable procedures.

Pap test as primary screening test

A Pap test is recommended every two to three years.

Primary HPV test

A primary HPV test is recommended every five years.

The five-year interval was established based on the specific characteristics of the HPV test and the long delay between HPV infection and cancer development, which can be from 15 to 20 years.

An interval of three years is recommended between your most recent Pap test and the next HPV test. It is not recommended to have an HPV test immediately if your most recent screening test took place less than three years ago.

For people who are immunocompromised, an interval of one year is recommended between their most recent Pap test and their next HPV test.

Screening earlier than recommended or more frequently could cause more harm to participants, including risks such as:

• unnecessary follow-up
• overdiagnosis
• overtreatment
• potential complications
• additional stress or anxiety

To find out more, see the advantages, disadvantages and limits of screening.

The cervical cancer screening is available throughout Québec. The type of screening test you can get may vary according to the region where you get screened. The regions will gradually start offering access to the HPV test as the primary screening test and stop offering the Pap test. Even in regions where an HPV test is available, a Pap test may still be offered in certain situations. Don’t hesitate to ask to a healthcare professional which test is being used.

The table below summarizes the implementation status of the HPV test by region and by the date this page was updated (as shown at the bottom of the page).