‘The common cold of the vagina’: Helping patients with an HPV diagnosis as home tests become more common

Finally, more Canadian provinces are adopting human papillomavirus (HPV) testing as primary screening. Home testing kids are widely available now, and increasingly, they’ll be free, distributed by health authorities, and replace the pap as the first-line test to identify risk for cervical cancer. (And other cancers as well.)That’s good news. But since HPV is one of the most common sexually transmitted infections, with more than 70% of sexually active people contracting HPV in their lifetimes, many people will receive positive test results.“One of my colleagues calls HPV the common cold of the vagina. It’s so common, but the vast majority of these infections will clear,” says Dr. Gina Ogilvie, a public health physician and professor at the University of British Columbia, where she is Canada Research Chair in Global Control of HPV-Related Diseases and Cancer.Patients and doctors will know earlier if someone could be at risk for development cervical as well as as anal, oral or other HPV-related cancers or diseases. And while that’s good for their long-term health, it’s also stressful for the patient—plus entails a whole new approach for follow-up testing protocols for family doctors and ob-gyns. “It adds a layer of complexity for both the provider and the patient that needs to be clear on both ends,” says Dr. Aisha Lofters, a family physician and associate professor at the University of Toronto.“It’s really important that we get the message out there so people don’t panic,” adds Dr. Lofters. “When they hear they have this virus, they’ll think they have early cancer. We tell them to come back in another six months or a year, and that can feel like a long time. They’re panicking and worrying. They think it means something really ominous.”Dr. Ogilvie agrees that patient communication will have to shift. “The conversation is different.” In 2023, Prince Edward Island became the first province to adopt HPV testing as primary screening for cervical cancer. First, patients when to a healthcare provider for a cervical swab and now PEI has added an at-home testing option. As of January, British Columbia followed suit, adopting HPV testing either via home kits or by a healthcare professional.Quebec is rolling out primary HPV testing, with only some regions offering it, while others still rely on Pap tests. Saskatchewan has been combining Pap with HPV reflex testing since 2023. Meanwhile, Nova Scotia has proposed legislation to move to at-home HPV testing. Other provinces, such as Newfoundland & Labrador, appear to be developing programs. Cancer Care Ontario acknowledges the value of HPV screening, but does not yet cover it.Patients in provinces without full coverage can pay out-of-pocket for lab tests, and increasingly find easy access to home swabs. Switch Health ships its $99 kit across Canada while LifeLabs just began offering a $129 test that people in Ontario can order online, along with a $95 version a healthcare provider can requisition.This approach to cancer screening is better in many ways. And while the medical community has appreciated that HPV is behind many cancers for years, putting this approach into practice takes a mindshift. (Dr. Ogilvie says someone joked that her work on HPV was “an overnight sensation that has taken twenty years.”)Self-swab kits should lead to more people getting tested. “For a lot of people, the Pap is not comfortable. For some, it’s a traumatic experience. So it’s very exciting from an equity point of view,” says Dr. Lofters, who has explored this issue in her research. Another benefit: patients don’t need to test again for five years after a negative result, compared to three for the Pap.Dr. Ogilvie—who ran an HPV home testing pilot back in 2021 that yielded successful results, and is tracking the new B.C. program—has been communicating with physicians regarding new testing intervals and follow-up protocols. “We’ve worked very hard on education for patients and practitioners,” she says, and was set to run another webinar for family physicians soon after her interview with the Medical Post.Both B.C. and PEI have comprehensive materials at the ready for healthcare providers, and Dr. Ogilvie says she’s been working with the Canadian Partnership Against Cancer and helped contribute to its HPV Screening and Follow-up Pathway.This is all happening against a backdrop of good news for HPV-related disease. Canada has pledged to eliminate cervical cancer by 2040 by increasing immunization, changing screening and improving follow-up.“Although there’s a conceptual shift, I’m excited to give patients a test that I have even greater confidence in over the Pap,” says Dr. Ogilvie. “By and large, doctors are super excited to have this tool for their clients.”In the short term, doctors should expect to identify more cases of HPV—both those that will eventually clear on their own, and the more risky strains that could lead to serious health conditions.In time, that will shift again, especially as vaccination rates against HPV rise. “We’ll have a lot of people who've been vaccinated, so will they need the same screening? It’s going be a constantly changing landscape for a while,” says Dr. Lofters. “That might feel a bit chaotic, but it's also very exciting.”

‘The common cold of the vagina’: Helping patients with an HPV diagnosis as home tests become more common

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