Now if we could just get tests for some of these things for MEN. The number of middle aged men who have no idea what hpv is and what it can do, shocks (and disgusts) me every time.
Couple of things here from a BC resident: It turns out it's not actually taking six months to get results, at least not where I live. (I had a Pap smear in May. It took about 6 weeks to get results, which is pretty much what it's always been.) And: In my experience here, Pap tests end up more inconclusive than not. I've been getting "inconclusive" results for five or six years, and have had to go back every six months for monitoring even after having a colposcopy four years ago that didn't find anything. And that means I also had trouble renewing my life insurance because they wouldn't consider me until I was on the 3-year schedule. A more reliable test is huge news, at least for me (and my GP, who's taken to saying "oh, it's THAT time again" when she sees me).
I think it's variable, but there are reports of it taking 6 months. I'd argue that six weeks is unacceptable. I am surprised it is taking 6 weeks to get the HPV results!
There are other tests in Canada such as FIT tests for colon cancer that are a mail in screening available every 2 years to people up to the age of 72 (in Ontario at least). Mamograms are booked months in advance and only available until just over the age of 70 then no more testing. Pap tests here are done until 70, some doctors will still do them over that age. The wait times to see a gyn. here can be 6-12 months and a menopause clinic 20 months (they are only in major cities such as Toronto). The limited amount of family doctors here is getting worse. Urgent care or walk in clinics generally do not do pap tests or order diagnostics other than xrays for fractures/sprains etc. The wait time in an urgent care can be over 4 hours and an ER 24 hours or more. People are relying on ER's for routine medical exams and referrals when there is no follow up care. Our health care is shattered here. We book appointments to do lab work, imaging (can take 3 or more months), family doctor appointments 3 or more weeks wait time and surgery backlogs will take years for some patients. Currently Ontario is not following BC's lead on Pap Testing I hope they do as so many women as you mention do not make the time or do not have a family doctor to provide this test.
As someone who originally trained when annual paps were the standard and HPV testing was at best investigational, it was very difficult to accept that less frequent testing was progress. I never became comfortable with 5 year intervals, and 3 year intervals were still problematic for me at times. If everything came back negative, it was easy. Positive results were more difficult, especially because I really hated to put my patients through a colposcopy if I could avoid it. Management could get very complicated and I frequently referred to my ASCCP app. I didn't see ASCCP listed in your references. I always did cotesting once it became available and agree that home HPV testing is a step forward, but a big concern for me is recording and tracking results. We still don't do a very good job at sharing information, even with EHRs, and 5 years is more than enough time to have had multiple health plans and changed locations. It's easy to see how the next test might be innocently put off one or two or three or more years, and then a postive test could reflect significant pathology.
The difference between the US and Canada is that Canada actually has organized cervical screening. In the US everybody does what they „feel“ is right based on their own perception of risk. The US has no organized screening program, ASCCP can only recommend what screening intervals could be. In Canada the NHS pays for prescribes screening, thus one type of screening basedon guidelines.
Starting screening at age 25 for average risk persons is quite resonable as the incidence of cervical cancer in women under age 25 is so rare as to make screening actually unreliable.
This is based on SEER dara which reports and records deathsdue to cancer.
Self-testing is quite accurate, this still does not however address the lack of colposcopists especiallyin rural areas, in Canada as well as the US. In Texas there are many counties where there are few if any colposcopists and to get an office excisional procedure (LEEP or LEETZ) is even more difficult. So addressing screening is onlythe first step. I wrote an editorial anoit this 20 years ago and things have not improved.
I'm a WHNP, and I never understood how/why the Ob/Gyn MDs didn't understand cotesting q3yrs when the fam. med. people did.
As for follow-up -- well, 1st I must say that I was involved when charts were still paper (at least where I was). That said, I had a file card box in which I kept track of every pt who needed either a rpt Pap at some interval, or colpo, & would routinely go through it to make sure everyone was up to date, or go running after the pt.
What is the accuracy of HPV screenings? A gyn oncologist I went to years ago said it's only 50%,and that's why people like me with chronic or reoccurring HPV have to get screened every 6 mos.
HPV screening is a atually 98% sensitive but not as specific as a Pap. Pap and HPV combined have 98% specificity and sensitivity, meaning if both Pap and HPV are positive there is a high probability of having precancerous cells. Or reversely, if both are negative there is a 98%+ chance that there is nothing. Not sure that your oncologist was up to date on the data…
It's usually more like a month, this year it was six weeks for me (that article was from last January). But also keep in mind that our system is very different, in that everyone who should have a Pap smear can get one (bearing in mind the issues with rural access and the shortage of GPs, both of which were also issues when I lived in the US).
This is really interesting. You wrote “In addition, HPV screening is not recommended for people under the age of 25 as HPV infections are so common in this age range HPV testing can lead to unnecessary follow-up procedures.” Did you mean “uncommon?” Or are you talking about HPV that doesn’t persist somehow and that people can clear themselves?
No, it is so common under 25. I considered going into it in more detail, but worried it would make the post too long. Basically, transient HPV infections are so common under age 25, so if we use HPV screening many more people end up with scares and procedures than are needed. So if the plan is to screen people ages 21-24 then Pap is better. Hope that clarifies it.
A few years ago, I was tested for HPV because of an abnormal Pap result and it was found that I was HPV-16 positive. I received 2 doses of Gardasil and had part of my cervix removed (so unbelievably painful and I was not well-informed on what to expect post-procedure) and now I am HPV negative and the follow-up biopsy came back negative. Literally the only time I’ve ever heard of this happening to women was in my gynaecologist’s office at the clinic, I didn’t really understand the serious link between HPV and cervical cancer before. I think there should be huge campaigns to inform the public. I am so happy screening is offered by mail now and also that kids are vaccinated at school. I live in Québec and I just read that HPV tests are replacing Pap tests, the transition started in 2023. But I don’t think they have mail-in screening yet.
Now if we could just get tests for some of these things for MEN. The number of middle aged men who have no idea what hpv is and what it can do, shocks (and disgusts) me every time.
This is OUTSTANDING news for BC. Now, if the USA would follow suit. Thanks so much for the information and explanations!
Couple of things here from a BC resident: It turns out it's not actually taking six months to get results, at least not where I live. (I had a Pap smear in May. It took about 6 weeks to get results, which is pretty much what it's always been.) And: In my experience here, Pap tests end up more inconclusive than not. I've been getting "inconclusive" results for five or six years, and have had to go back every six months for monitoring even after having a colposcopy four years ago that didn't find anything. And that means I also had trouble renewing my life insurance because they wouldn't consider me until I was on the 3-year schedule. A more reliable test is huge news, at least for me (and my GP, who's taken to saying "oh, it's THAT time again" when she sees me).
I think it's variable, but there are reports of it taking 6 months. I'd argue that six weeks is unacceptable. I am surprised it is taking 6 weeks to get the HPV results!
There are other tests in Canada such as FIT tests for colon cancer that are a mail in screening available every 2 years to people up to the age of 72 (in Ontario at least). Mamograms are booked months in advance and only available until just over the age of 70 then no more testing. Pap tests here are done until 70, some doctors will still do them over that age. The wait times to see a gyn. here can be 6-12 months and a menopause clinic 20 months (they are only in major cities such as Toronto). The limited amount of family doctors here is getting worse. Urgent care or walk in clinics generally do not do pap tests or order diagnostics other than xrays for fractures/sprains etc. The wait time in an urgent care can be over 4 hours and an ER 24 hours or more. People are relying on ER's for routine medical exams and referrals when there is no follow up care. Our health care is shattered here. We book appointments to do lab work, imaging (can take 3 or more months), family doctor appointments 3 or more weeks wait time and surgery backlogs will take years for some patients. Currently Ontario is not following BC's lead on Pap Testing I hope they do as so many women as you mention do not make the time or do not have a family doctor to provide this test.
As someone who originally trained when annual paps were the standard and HPV testing was at best investigational, it was very difficult to accept that less frequent testing was progress. I never became comfortable with 5 year intervals, and 3 year intervals were still problematic for me at times. If everything came back negative, it was easy. Positive results were more difficult, especially because I really hated to put my patients through a colposcopy if I could avoid it. Management could get very complicated and I frequently referred to my ASCCP app. I didn't see ASCCP listed in your references. I always did cotesting once it became available and agree that home HPV testing is a step forward, but a big concern for me is recording and tracking results. We still don't do a very good job at sharing information, even with EHRs, and 5 years is more than enough time to have had multiple health plans and changed locations. It's easy to see how the next test might be innocently put off one or two or three or more years, and then a postive test could reflect significant pathology.
The difference between the US and Canada is that Canada actually has organized cervical screening. In the US everybody does what they „feel“ is right based on their own perception of risk. The US has no organized screening program, ASCCP can only recommend what screening intervals could be. In Canada the NHS pays for prescribes screening, thus one type of screening basedon guidelines.
Starting screening at age 25 for average risk persons is quite resonable as the incidence of cervical cancer in women under age 25 is so rare as to make screening actually unreliable.
This is based on SEER dara which reports and records deathsdue to cancer.
Self-testing is quite accurate, this still does not however address the lack of colposcopists especiallyin rural areas, in Canada as well as the US. In Texas there are many counties where there are few if any colposcopists and to get an office excisional procedure (LEEP or LEETZ) is even more difficult. So addressing screening is onlythe first step. I wrote an editorial anoit this 20 years ago and things have not improved.
I'm a WHNP, and I never understood how/why the Ob/Gyn MDs didn't understand cotesting q3yrs when the fam. med. people did.
As for follow-up -- well, 1st I must say that I was involved when charts were still paper (at least where I was). That said, I had a file card box in which I kept track of every pt who needed either a rpt Pap at some interval, or colpo, & would routinely go through it to make sure everyone was up to date, or go running after the pt.
Wow, that is amazing!!
This is amazing!!! F’ing REVOLUTIONARY!! Hell YES to fewer paps. I’m in the USA, would love to see this happen here.
This is phenomenal news! Question: how often are pelvic exams recommended if a person completely switched from Pap smears to HPV testing?
What is the accuracy of HPV screenings? A gyn oncologist I went to years ago said it's only 50%,and that's why people like me with chronic or reoccurring HPV have to get screened every 6 mos.
HPV screening is a atually 98% sensitive but not as specific as a Pap. Pap and HPV combined have 98% specificity and sensitivity, meaning if both Pap and HPV are positive there is a high probability of having precancerous cells. Or reversely, if both are negative there is a 98%+ chance that there is nothing. Not sure that your oncologist was up to date on the data…
6 months -- GOOD GRIEF! In the US, it takes a week or less (unless the test is part of the random 10% review).
It's usually more like a month, this year it was six weeks for me (that article was from last January). But also keep in mind that our system is very different, in that everyone who should have a Pap smear can get one (bearing in mind the issues with rural access and the shortage of GPs, both of which were also issues when I lived in the US).
This is really interesting. You wrote “In addition, HPV screening is not recommended for people under the age of 25 as HPV infections are so common in this age range HPV testing can lead to unnecessary follow-up procedures.” Did you mean “uncommon?” Or are you talking about HPV that doesn’t persist somehow and that people can clear themselves?
No, it is so common under 25. I considered going into it in more detail, but worried it would make the post too long. Basically, transient HPV infections are so common under age 25, so if we use HPV screening many more people end up with scares and procedures than are needed. So if the plan is to screen people ages 21-24 then Pap is better. Hope that clarifies it.
And the infection is usually transient.
A few years ago, I was tested for HPV because of an abnormal Pap result and it was found that I was HPV-16 positive. I received 2 doses of Gardasil and had part of my cervix removed (so unbelievably painful and I was not well-informed on what to expect post-procedure) and now I am HPV negative and the follow-up biopsy came back negative. Literally the only time I’ve ever heard of this happening to women was in my gynaecologist’s office at the clinic, I didn’t really understand the serious link between HPV and cervical cancer before. I think there should be huge campaigns to inform the public. I am so happy screening is offered by mail now and also that kids are vaccinated at school. I live in Québec and I just read that HPV tests are replacing Pap tests, the transition started in 2023. But I don’t think they have mail-in screening yet.
How often do they recommend? Start at age 25 and repeat when
This is amazing. I hope we get this in the US.