Updates to routine screenings clinicians need to know about

Home-based HPV testingThe big news in routine screening is the adoption of home-based human papillomavirus (HPV) tests. Kits that allow patients to self-swab are now available in a number of provinces, and soon may be used as the first-line test for cervical cancer. The home-based test could improve access to screening, especially in populations reluctant to undergo a sample collection in the clinic.The only drawback is that positive tests will need followup, monitoring and good patient communication. When they get a positive result, patients will need to know not to panic, Dr. Aisha Lofters, a family physician and associate professor at the University of Toronto, told the Medical Post. Canadian guidelines on how to manage positive tests were published in Current Oncology in June 2023. Over time, the number of positive tests could dwindle as Canada has pledged to eliminate cervical cancer by 2040 by promoting immunization, testing and followup.Dual HIV and syphilis testingIn 2023, Health Canada approved a point-of-care test that checks for both syphilis and HIV in one go. The approval was thanks to a large study conducted by researchers from the University of Alberta and Unity Health in Toronto. They tested 1,526 people with two point-of-care tests and compared the results to blood tests. The point-of-care tests take about five minutes and require only a finger prick. The study looked at the Multiplo TP/HIV test made by MedMira Inc. from Halifax, which has not yet been approved, and the newly approved INSTI Multiplex HIV-1/HIV-2/syphilis antibody tests made by bioLytical Laboratories Inc. in Richmond, B.C.The study found that both point-of-care tests had a sensitivity of 100% and specificity of 99.6% for HIV. The Multiplo had a sensitivity of 86.1% and specificity of 99.5% for syphilis, while the INSTI Multiplex had a sensitivity of 76.1% and specificity of 99.8% for syphilis. Using these point-of-care tests means that a person with a positive syphilis test can get immediate treatment, instead of waiting for results from a serology test. A person who tests positive for HIV can get a referral for followup care. “These extremely rapid point-of-care tests for the diagnosis of syphilis and HIV are much needed and a game changer for Canada. We were able to save costs associated with an additional clinic visit, reduce the number of cases lost to followup and prevent ongoing disease transmission,” said Dr. Ameeta Singh, the study’s principal investigator and an infectious disease physician with the University of Alberta. The study results were published in Clinical Microbiology and Infection in 2023. Dr. Singh is now heading a project that studies the utility of the tests in a First Nations community that has seen a rise in syphilis cases.Breast density and mammographyA number of provinces are now funding more frequent mammograms or ultrasounds for women with dense breast tissue. In all provinces and territories, breast densities are included in the mammography report mailed to the person (although in Quebec, people have to ask for this). Another screening modality may be in the future. Dr. Jean Seely, head of breast imaging at the Ottawa Hospital, is an investigator in the large Tomosynthesis Mammographic Imaging Screening Trial which investigates the use of 3D tomosynthesis mammography to screen in people with dense breast tissue or other increased risks of breast cancer. The purpose is to see if it reduces the need for additional imaging or treatment compared to regular mammography.Meeting them where they are: cancer screeningWith so many Canadians without a primary healthcare provider, some people aren’t up to date in their preventive cancer screening. Enter a new program in Ottawa that has hired a nurse practitioner, Sarah Junkin-Hepworth, to coordinate screening services for those without family doctors. Within the first three months of the program, Junkin-Hepworth ordered 185 screening tests, 20% of which were for people who had never had cancer screening and 54% for people who were overdue for screening, according to the Globe and Mail. The program screens for four cancers: breast (mammogram), cervical (Pap test), colorectal (FIT) and lung cancer (low-dose CT scan). Patients can call Junkin-Hepworth for a referral, and she can perform Pap smears in her office. The program is run through the Champlain Regional Cancer Program and the Ottawa Hospital.The future of preventive screeningThe clinic of the future will still focus on evidence-based tools to screen for mental illness, smoking, alcohol use, food security, sexual activity and other conditions, although AI will help streamline these, hopefully making them more accurate. As always, a solid clinical history is key to good preventative screening.

Updates to routine screenings clinicians need to know about

Register for free access or login.

Related Topics