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Canadians could soon see HPV testing become more accessible — even in their own homes.
The Canadian Medical Association Journal has released new guidelines to public health, including guidelines on cervical cancer screening for those who face barriers. This includes a "strong recommendation" to offer self-testing for the human papillomavirus (HPV).
According to the CMAJ, screening for cervical cancer is "a routine part of care because it seems to be effective at identifying lesions that should be treated, but barriers to screening exist that could be overcome by HPV self-testing."
Quebec announced the change last year, while P.E.I. and New Brunswick followed suit this summer.
The Canadian Cancer Society explained HPV testing is "emerging as the leading approach to cervical screening because it identifies individuals who are at increased risk of cervical cancer earlier than the Pap test and results in significantly lower likelihood of developing cancer."
But what exactly is HPV and what would a self-test look like? Read on for everything you need to know.
What is HPV?
HPV is one of the most common sexually transmitted infections (STIs) in the country — and worldwide, according to Health Canada.
There are many types of HPV and they can lead to very different health outcomes. Most HPV strains cause no symptoms at all, while some can infect areas such as the hands and feet. Others will "target the anogenital area and transmitted during vaginal, oral, or anal sex, or during intimate skin-to-skin contact with someone who is infected," Health Canada explained.
A small portion of people infected with HPV will develop cancer, it added.
The virus causes almost all cervical cancers and is linked to throat, oral cavity, penis, anus, vagina or vulva cancers too.
"It is estimated that as many as 75 per cent of sexually active men and women will have at least one anogenital HPV infection in their lifetime," the federal agency said, adding most people will "eventually clear the infection from their bodies."
How does HPV testing work?
An HPV test "looks at a small sample of cells that have been collected through a swab and tests them for the DNA or mRNA of high-risk types of HPV," according to the Canadian Cancer Society.
The process generally isn't painful, but can be uncomfortable.
A clinician will gently place a speculum in the vagina to separate its walls, so the clinician can see the upper part of the vagina and cervix. Then, the doctor or nurse will use a small brush to gently collect cells from the cervix. The cells are then put into a container and sent to a lab for testing, the CCS explained.
Self-swabs for HPV look and work similar to at-home rapid tests for COVID-19.
Dr. Aisha Lofters, co-author of the CMAJ recommendations, told the CBC at-home HPV testing would mean people don't have to take time off work for a medical appointment, and ease the process of those with a history of sexual trauma.
"This could be a really meaningful alternative to increase screening rates while doing so in a safe and comfortable manner," Lofters told CBC.
Why introduce HPV self-testing?
The CMAJ explained in its guidelines screening for cervical cancer with HPV testing increases the early detection of cervical cancer. Self-testing, furthermore, can increase the screening uptake.
Experts claimed women with disabilities are less likely to attend cervical cancer screening, and Black women are less likely to have screening compared to white women. Those born outside of Canada and members of the 2SLGBTQI+ community are also less likely to be screened.
"A history of sexual trauma can be a barrier to cytologic smear completion," the CMAJ wrote.
The report also added self-testing is "as accurate as clinician sampling," adding its specificity is only about two to four per cent lower.
According to the CMAJ, there should be no financial barriers to HPV testing and thus additional funding from the government may be needed to support the implementation of self-testing.
What does self-collection look like?
Other jurisdictions, like Australia, have already implemented self-swabbing in clinics for some cervical cancer and HPV screening participants.
"A self-collected sample is taken from the vagina so you don't need to worry about reaching the cervix or 'getting the right spot.' All you need to do is insert a swab a few centimetres into your vagina and rotate it for 20 to 30 seconds."
The swab is then inserted into a tube and taken for testing.
What's available for at-home HPV testing in Canada right now?
At-home testing for HPV is now available in Canada, but it currently comes at a cost.
Switch Health, a private healthcare provider, announced on Tuesday it is offering HPV test kits and promises results "in days." It costs $99.
Dr. Gregory W. Taylor, the company's chief medical officer, was quoted on the site saying the kit "allows women to assess their own personal risk for cervical cancer in the privacy and comfort of home. This has the potential to not only increase the number of Canadian women getting tested, but also reduce the burden on our stretched health care systems."