What are the guidelines for Human Papillomavirus (HPV) screening in British Columbia (BC), Canada?

HPV Screening Guidelines in British Columbia, Canada

In British Columbia, Canada, HPV testing is recommended as primary screening for cervical cancer starting at age 25, with screening intervals of 5 years for those with negative results, as this approach provides superior protection against cervical cancer compared to traditional cytology-based screening.

Current Screening Recommendations

Age to Begin Screening

• Start cervical cancer screening at age 25 (not earlier) 1
• For individuals with HIV infection, screening should begin within 1 year after onset of sexual activity but no later than age 21 1

Recommended Screening Methods

1. Primary HPV Testing (Preferred):

   • HPV DNA testing alone as the primary screening test
   • For positive HPV results, reflex cytology testing should be performed on the same specimen 1
   • Screening interval: Every 5 years with negative results 2

2. Co-testing Option:

   • HPV testing plus cytology (Pap test) for individuals aged ≥30 years
   • Screening interval: Every 3 years with negative results on both tests 1

3. Cytology-Only Option (if HPV testing unavailable):

   • For ages 25-29: Every 3 years
   • For ages ≥30 with 3 consecutive normal results: Every 2-3 years 1

Management of Positive Results

HPV 16/18 Positive:

• Immediate colposcopy referral regardless of cytology results 1, 3
• Endocervical sampling is acceptable at time of colposcopy for HPV 18 due to its association with adenocarcinoma 1

Other High-Risk HPV Types Positive:

• With normal cytology: Repeat testing in 1 year 1
• With abnormal cytology: Colposcopy referral 1

When to Stop Screening

• Screening may be discontinued at age 65-70 if:
  • No abnormal results in the previous 10 years
  • Three consecutive normal screening tests documented 1
• Screening should continue for at least 25 years after treatment for high-grade precancer, even if this extends beyond age 65 1

Special Populations

HIV-Infected Individuals

• Begin screening within 1 year of sexual debut or at diagnosis of HIV, but no later than age 21 1
• Use conventional or liquid-based cytology (Pap test); primary HPV testing is not recommended 1
• Co-testing can be done in individuals aged ≥30 years with HIV 1
• Annual screening recommended; after 3 consecutive normal results, can extend to every 3 years 1
• Lifelong screening is recommended 1

Post-Treatment Surveillance

For individuals treated for high-grade precancer (CIN2+):

• Initial surveillance: HPV test or co-test at 6,18, and 30 months 1
• If using cytology alone: Testing at 6,12,18,24, and 30 months 1
• Long-term surveillance: Testing every 3 years (HPV/co-testing) or annually (cytology) for at least 25 years 1

Evidence Quality and Recent Findings

Recent Canadian research provides strong support for HPV-based screening approaches:

• A 2022 Canadian study showed that women prefer screening every 3 years rather than every 5 or 10 years, with co-testing being the most preferred method among adequately screened women 4

• A 2024 longitudinal cohort study from British Columbia found that the risk of cervical precancer (CIN2+) 8 years after a negative HPV screen was comparable to the risk after only 3 years following a negative cytology test, suggesting HPV screening intervals could potentially be extended beyond the current 5-year recommendation 2

• A 2018 modeling study demonstrated that a negative HPV test at age 55 or older substantially reduced the remaining lifetime risk of cervical cancer, providing stronger reassurance than cytology alone 5

Common Pitfalls to Avoid

1. Starting screening too early: Beginning before age 25 leads to unnecessary procedures for transient HPV infections that would likely clear on their own 1

2. Over-reliance on cytology alone: HPV testing provides greater sensitivity and longer-term protection against cervical cancer 2

3. Stopping screening too early: Continuing surveillance for at least 25 years after treatment for high-grade precancer is essential 1

4. Misinterpreting HPV results: A positive HPV test indicates infection but not necessarily cancer; proper counseling is important to prevent unnecessary anxiety 1

5. Inappropriate screening in adolescents: HPV testing and cervical cancer screening are not recommended for immunocompetent individuals under age 21 due to high regression rates of HPV infections and lesions 1

By following these evidence-based guidelines, clinicians can optimize cervical cancer prevention while minimizing unnecessary procedures and patient anxiety in British Columbia.