HPV test

The human papillomavirus screening test (HPV test) helps detect cervical cancer. It detects the presence of high-risk HPV, which can lead to the development of precancerous lesions, followed by cervical cancer. Having an HPV test is a personal choice. It is important to learn the advantages, disadvantages, and limits of this screening so that you have all the information you need to make an informed decision (see a list of the advantages, disadvantages and limits below).

In the regions where it is offered, HPV test screening is recommended every five years for eligible persons, including asymptomatic persons who meet the following criteria:

• Are between 25 and 65 years old;
• Have a cervix, regardless of gender identity;
• Have been sexually active (including any genital contact with or without penetration);
• Not presenting symptoms sometimes associated with cervical cancer (see below);
• Be insured by the Québec public health insurance plan.

A delay of three years is recommended between the most recent Pap test screening and the next screening with the HPV test. It is not recommended that you undergo HPV test screening right away if your most recent screening was less than three years ago.

For immunocompromised persons, a delay of one year is recommended between the most recent Pap test screening and the next HPV test screening.

Health professionals recommend to people over 65 years old that they continue or stop screening depending on their particular situation and the results of their most recent screening tests. Those who are not eligible are encouraged to read about the measures for preventing the spread of HPV and other sexually transmitted and blood-borne infections (STBBIs).

Those who present symptoms sometimes associated with cervical cancer (for example, vaginal bleeding, particularly after sexual intercourse or abnormal vaginal discharge) are not part of the target population for this screening program. They must contact a doctor and undergo a medical follow-up based on their situation.

The screening must be conducted by a health professional during a gynaecological exam. It only takes a few minutes. The health professional first inserts a speculum in the vagina to hold the vaginal walls apart. This makes it easier for the health professional to see and reach the cervix at the upper end of the vagina. Using a small brush, the health professional lightly swabs the surface of the cervix to take some cells. These cells are placed in a tube filled with a liquid. The sample is then sent to the laboratory for analysis. When the HPV test is positive (in about 10% of cases), a more detailed analysis of the sample cells is needed. The same sample can be used for the HPV test and the follow-up test on the cells. Once the results are received, the health professional provides the appropriate follow-up (see the Screening results section).

It is important to learn the advantages, disadvantages, and limits of screening so that you have all the information you need to make a decision. Having the screening done is a personal choice. Each person can make an informed decision on whether to undergo screening, according to their values and preferences. It is normal for some people to accept, while others refuse or wait to undergo screening. Here are a few things to think about while making your decision. You can talk to a health professional about them, if needed.

People aged 25 to 65 years old who have an HPV test every five years can:

• reduce the risk of developing cervical cancer;
• reduce the risk of dying from cervical cancer because it allows for the detection of abnormal cells or cancers at an early stage. If necessary, it is then possible to remove the affected part of the cervix.

However, there are some disadvantages for the people aged 25 to 65 years old who have an HPV test every five years:

• waiting periods and worry, for example, when additional tests are needed to confirm the screening results, such as a colposcopy. However, most of the time the results of the colposcopy are normal;
• discomfort (ex., insertion of the speculum) or light bleeding during screening, and sometimes pain caused by additional tests (ex., colposcopy);
• possibility of overdiagnosis. Overdiagnosis is discovering a cancer that never would have been detected without the screening, and that never would have had an impact on the person’s health or life. For example, a cancer that develops very slowly or an indolent cancer. Since it is not yet possible to distinguish indolent cancers from fatal cancers, they are all treated. Therefore a person who undergoes screening might:
  • have to live with a cancer diagnosis,
  • have frequent medical appointments to ensure that the cancer does not reappear,
  • feel anxiety about this cancer;
• possible overtreatment. A person who undergoes screening might:
  • receive treatments that might not have been necessary,
  • experience side effects of additional tests and treatments;

  The colposcopy can reveal the presence of abnormal cells. These cells could develop into cancer, but not necessarily. Since it is impossible to know in advance, the part of the cervix containing abnormal cells must be removed as a precaution. Therefore, some people might have a part of their cervix removed “for no reason.” This situation most often affects younger people. Removing part of the cervix can increase the risk of premature birth in subsequent pregnancies. For example, a person who has undergone this procedure might give birth before the 34th week when a full-term birth is between 37 and 42 weeks. One in every 100 people who have had this procedure is at risk of premature birth.

Participating in cervical cancer screening does not guarantee that:

• all cervical cancers will be detected;
• all people who have this cancer will survive it.

Some of the people who receive a normal result on the screening test or on additional tests will develop cancer anyway. This situation can arise if:

• the cancer was invisible or was not detected;
• the cancer had not yet developed at the time of screening.

It is impossible to know, at the time of screening, exactly who will experience advantages or disadvantages.

To get an HPV test in the regions and establishments where it is offered, consult a health professional. Family medicine groups (GMFs), local community service centres (CLSCs) or clinics offer this service. Contact these resources to find out if you can go there to get an HPV test. Their contact information is in the Finding a resource section.

Self-sampling for an HPV test is not available in Québec.

Two main results are possible:

• Negative result: the screening did not detect an abnormality that requires specific follow-up. If you are still eligible, it is recommended that you have another FPV test in five years.
• Positive result: the screening detected the presence of HPV and abnormal cells. This does not mean that you have cervical cancer. This result means that follow-up or additional tests are needed to clarify the results. The choice of additional tests and follow-up can vary for each person.

A health professional might also recommend that you repeat the HPV test if the results are invalid or inconsistent, or that you repeat the HPV test in one year.

The results are available from the health professional who performed the test, in your Québec Health Booklet  after at least one month or in your medical file in the institution where the test was performed.

• a biopsy: when a lesion is observed during the colposcopy, the doctor will proceed with a biopsy. This procedure consists of taking a small sample (3 to 5 millimetres) of the surface of the lesion. The sample is then analyzed in a laboratory to determine whether it contains precancerous or cancerous cells.