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Cervical Screening

The HPV FOCAL Study is being conducted to find out if a test for the Human Papillomavirus (HPV) can enhance cervical cancer screening for women in British Columbia.

Please note, we are no longer accepting new participants into the FOCAL study. 

Update July 2016: British Columbia has updated its Cervical Cancer Screening policy. The following changes will be in effect:

  • Increasing BC's cervical cancer screening start age to 25 years
  • Increasing the routine screening interval to 3 years
  • Decreasing the length of conservative management of low grade abnormalities through repeat cytology testing to 12 months

 Read more here.

See the end of the page for information about current participants.

The study

The BC Cancer Agency is conducting this study in collaboration with hundreds of healthcare providers across the province. Over 25,000 women from Metro Vancouver and Greater Victoria consented to participate in the study.

What is the study?

The BC Cancer Agency has been running the Cervical Cancer Screening Program since 1949 and has decreased cervical cancer rates in BC by over 70%. 

Regular cervical cancer screening with the Pap test can prevent about 7 out of 10 cases of cervical cancer in British Columbia. However, new kinds of tests exist that may further enhance screening for cervical cancer or pre-cancerous lesions.

It is now known that cervical cancer is caused by certain types of Human Papillomavirus (HPV), a virus that is transmitted by sexual contact. There are more than 100 types of HPV, and about 40 of these can infect the genital area. Some HPV types cause genital warts and are called "low risk" and others are "high risk" and have been associated with cervical cancer. The Society of Obstetricians and Gynaecologists of Canada have prepared an HPV information sheet for women that provides additional useful information.

HPV is the most common sexually transmitted infection in the world. Most adults will have had an HPV infection at some point in their lives but it usually goes away on its own without a person even knowing they have had it. However, for some women HPV will not go away. Over time, long term infection with a "high risk" HPV type may cause abnormal cervical cells that can progress to cervical cancer. For HPV to cause cervical cancer, it has to be present for many years - but it is important to know that not everyone with "high risk" HPV will get cervical cancer.

HPV testing may offer a different way to screen women for cervical cancer. HPV testing is taken the same way the Pap smear is and has been proven to be safe and effective at detecting what it's meant to detect.

The HPV FOCAL Study is comparing HPV testing to the Pap test for cervical cancer screening.

Over 25,000 Metro Vancouver and Victoria women have participated in the HPV FOCAL Study. Most of the women in the study are now in the final phases of participation and only need to attend their final study cervical screen visit with their health care provider. The study is expected to complete sometime in late 2016. 

As a participant, after you've been to the doctor for the cervical screen appointment, it will take a few weeks before the results are known. The doctor's office will inform you of the sample results. If your screen result is negative (normal), you will not need another cervical screen for at least two years.

If the results do not look normal, you may be referred for a colposcopy. A colposcopy is similar to having a Pap test taken except that a special microscope, called a colposcope, is used to examine your cervix more closely.

If you are told that HPV has been found in your sample, your healthcare provider will give you more information about HPV and what the results mean for you. In addition, the Society of Obstetricians and Gynaecologists of Canada have developed a website: http://www.hpvinfo.ca/ that is very helpful. Your doctor will also provide you with an information sheet on what it means to be HPV positive.

For your health and safety, it is important that you follow all instructions given by the study doctors. You will be told what kind of follow-up appointments you will require, and when these appointments should be made.
 
 
 

HPV & testing FAQs

 

FAQs about HPV & HPV testing

What is HPV?
It stands for Human Papillomavirus, a sexually transmitted infection (STI). It is the most common STI in the world and is transmitted by skin to skin contact. Anyone who is sexually active is at risk for HPV and about 80% of people who have had any sexual contact will have an HPV infection at some point in their lives, but it often has no signs or symptoms. HPV can cause genital warts, cervical cancer, or its precursors, and has also been associated with anal, vaginal and head and neck cancers. It is estimated HPV is the cause of approximately 5% of all cancers worldwide; however, not all HPV causes cancer, and having HPV doesn't mean a person will develop cancer. Most times, HPV clears on its own, within about two years, without a person ever knowing they had it. It is only long-term persistent infection with a cancer causing type of HPV that may lead to cervical cancer if left undetected and untreated.

There are about 100 types of HPV, and about 40 of them can infect the genital region. There are "low-risk" and "high-risk" types of HPV. Low-risk types are commonly associated with genital warts and do not cause cervical cancer. The two most common low-risk types are HPV 6 and 11. There are 13-15 high-risk types that are associated with cervical cancer. HPV 16 and 18 are the most common types and cause about 70% of cervical cancer cases around the world.

How do you catch HPV?
HPV is transmitted through sexual contact and not just sexual intercourse or penetration. It can be transmitted through skin to skin contact, touching, oral, vaginal or anal sex and through contaminated sex toys. Condoms may provide some protection against HPV but condoms don't cover all skin areas and cannot offer complete protection.

There are three vaccines available that protect against the most common high-risk HPV types that are attributable to cervical cancer in women. Two of these vaccines also protect against two of the most common low-risk types that cause genital warts. Refer to: "What is the HPV Vaccine and who can get it" question for more information.

Is HPV the only cause of cervical cancer?
HPV is the cause of cervical cancer.  HPV types 16 and 18 are responsible for about 70% of cervical cancer cases alone. Most of the time HPV goes away on its own about two years after the infection  when the body's immune system fights it off. It's only when high-risk (cancer causing) types of HPV persist for many years (usually 10 or more) that cancer may develop. However, presence of HPV alone is not sufficient to cause cancer. Some factors that may put people at risk for developing cancer after long term HPV infection are: smoking, having multiple sex partners, or having a weak immune system. It is not possible to predict who will develop cancer as a result of an HPV infection.

Why do I need HPV testing?  Or  Why change from the Pap test?
The Pap test has been very successful in decreasing cervical cancer rates in areas where Pap testing is widely available. However, now that it is known that the cause of cervical cancer is HPV, tests have been developed to detect the presence of HPV. Pap testing detects changes to the cells on the cervix once they have already occurred. Whereas, HPV testing detects for the presence of HPV, which is the virus that causes cell changes to the cervix, giving us the ability to identify women at risk for having changes to the cells of the cervix, often before they develop.

HPV has always caused cervical cancer, but when screening first started this wasn't known and previously the ability to test women for HPV wasn't available. Since we now know what causes cervical cancer, technology has advanced so that HPV testing is available to detect this virus that is the cause of cervical cancer.

Screening programs are planning to eventually move away from the Pap test as the first method of screening for cervical cancer for women of certain ages, and will start to use HPV testing which is very good at identifying women at risk for having cell changes that may lead to cervical cancer. If you have ever had any sexual contact you should receive cervical cancer screening. 

What's the difference between Pap and HPV testing?
The Pap test identifies changes to the cells of the cervix that can lead to cervical cancer. The Pap test may sometimes miss detecting abnormal cells, as it is not always 100% accurate. To enhance the performance of the Pap, women are recommended to have a Pap every two or three years, not because cervical cancer grows quickly.

HPV testing identifies the presence of the virus that causes abnormal cells that lead to cervical cancer. It's very good at detecting HPV if it is present. If a woman tests negative for HPV, the chances she has HPV or changes to cells on her cervix are very low. As a result, women can go longer between negative HPV tests, than they can between negative Pap tests. This means that cervical cancer screening with HPV will happen less frequently than cervical cancer screening with Pap smears, but it is safe and at least as accurate. If a woman tests positive for HPV, then additional testing can be done to determine next steps.

Is it safe to go for 4 or 5 years without another screen?
Due to the differences between Pap and HPV testing, and the accuracy of HPV testing, it is safe to go longer between screens than you are used to with Pap testing. If you test negative for HPV, the chances of having or being at risk for cell changes that cause cervical cancer are very low. Some studies have shown that one negative HPV test every 5 years is at least as safe as having a Pap smear every 3 years.  Also, it's important to remember that HPV is very common in the population and most times, when people get an HPV infection, it goes away on its own, without a person even knowing they have it. If you test for HPV too often, or in women too young, it is possible HPV infections will be detected that would otherwise go away on their own, and this could lead to anxiety and or treatment that is unnecessary.

Why shouldn't younger women (under 30 yrs) get HPV testing?
HPV is very common in people under the age of 30 but it usually goes away on its own without causing any health problems. If HPV testing is done in younger women, it will detect infections that the body will fight off on its own, leading to follow-up and management that may not be necessary. It's also important to recognize that cervical cancer is very rare in women under the age of 30.  As women get older, new HPV infections are less common, and it's more likely that HPV found may be an infection caught years ago that the body did not clear on its own. Therefore, only doing HPV testing in women over 30 allows us to identify those at higher risk for having cell changes on the cervix that need to be followed more closely.

This does not mean younger women should NOT be screened for cervical cancer. Cervical cancer screening with the Pap test is recommended for women of screening age, not yet eligible to receive HPV testing. Ask your care provider what the cervical cancer screening guidelines are in your region.

If the test shows I'm HPV negative, but then I'm exposed to HPV shortly after that, shouldn't I have another test sooner than later?
It is not necessary to have HPV testing more frequently than is recommended. It's important to remember that HPV is very common in the population and most times, when people get an HPV infection, it goes away on its own, without a person even knowing they have it. If you test for HPV too often, it is possible HPV infections will be detected that would otherwise go away on their own and this could lead to anxiety and or unnecessary treatment. It's only persistent HPV infections that last many years (usually more than 10) that may cause cell changes on the cervix that could lead to cervical cancer. HPV testing has been shown to be very safe (one HPV test every 5 years is at least as safe as a Pap smear every 3 years) and is not necessary to have HPV testing more often than recommended by the screening program, regardless of if you are exposed to HPV shortly after a negative test. 

I have been with the same partner for many years, why do I need HPV testing?
Cervical cancer screening is recommended for all women of screening age, who have had any sexual contact, regardless of how many people you have had sexual contact with, or how long in the past or how recent sexual activity has been.

Should I get HPV testing every time I have a new partner?
It is not necessary to have HPV testing more often than recommended, even if you have new sexual partners. It's important to remember that HPV is very common in the population and most times, when people get an HPV infection, it goes away on its own, without a person even knowing they have it. If you test for HPV too often, it is possible HPV infections will be detected that would otherwise go away on their own and this could lead to anxiety or unnecessary treatment. It's only persistent HPV infections that last many years (usually more than 10) that may cause cell changes on the cervix that could lead to cervical cancer.

It's important to know that HPV testing does NOT check for other sexually transmitted infections. If you have concerns about other STIs or have questions, please discuss with your health care provider or refer to the following website:

I haven't been sexually active for many years, why do I need HPV testing?
If you are a woman of screening age, and have ever had any sexual contact, regardless of how far in the past that contact was, it's important to receive cervical cancer screening as recommended by the screening program.

I have had genital warts, so I know I'm HPV positive, why do I need HPV testing?
There are two types of HPV: "low" and "high" risk types. The types of HPV that cause genital warts are called "low-risk" types and are not associated with cervical cancer. HPV testing does not detect these "low-risk" types. HPV testing detects the high-risk strains that are associated with cervical cancer. Therefore, all women should have cervical cancer screening, even if you have had, or been exposed to genital warts.

I suspect I have been exposed to genital warts. Can I get HPV testing to see if I will get them?
There are two types of HPV: "low" and "high" risk types. The types of HPV that cause genital warts are called "low-risk" types and are not associated with cervical cancer. HPV testing does not detect these "low-risk" types. HPV testing detects the high-risk strains that are associated with cervical cancer. Being screened with HPV testing will not show if you have or will develop genital warts.

What's the cure for HPV (or) How is HPV treated?
There is no cure or treatment for HPV itself. HPV is very common, and most times a person can clear an HPV infection with their own immune system; however, this does not mean you are then immune to HPV. It is possible to catch HPV again if you are exposed in the future.

Although there is no treatment specifically for HPV, treatment can be aimed at problems associated with HPV infection. If there are abnormal cells on the cervix you may require a colposcopy, which is a procedure that allows the doctor to have a closer examination of your cervix than can occur during routine screening. Depending on the findings at colposcopy, treatment may be required to remove the abnormal cells from your cervix. 

For more information on abnormal Pap test results, please visit the BC Cancer Agency Screening Program website: http://www.screeningbc.ca/Cervix/Results/AbnormalResults.htm

What is the HPV vaccine, and who can get it?
HPV vaccines are highly effective at protecting against genital warts and several of the HPV types that are responsible for cervical and other cancers. There are now vaccines available that protect against 2, 4, or 9 HPV types. In Canada, HPV vaccination is approved for females (9-45yrs) and males (9-26yrs). HPV vaccines have been researched and used for many years and are safe. Across Canada, HPV vaccination is offered to girls through school based immunization programs. In some provinces, boys may also receive the vaccine in school. Outside of these school based programs, individuals must pay for the HPV vaccine themselves. The best time to receive the HPV vaccine is before any sexual activity has occurred. However, even if you have been exposed to one or more types of HPV, the vaccine may still be of benefit to you.

If you would like to know if you are a candidate for HPV vaccination, speak to your health care provider who can answer any of the questions you have and discuss your options.

Comprehensive information available on HPV vaccination in Canada can be found on the following websites:
Please speak to your health care provider for HPV vaccination guidelines and information specific to your province. 

How can HPV be prevented?
Total abstinence, with no sexual contact of any kind is the only way to completely prevent HPV infection. However, there are steps that can lower your risk of getting HPV.
1. Vaccines: Other than abstinence, HPV vaccination is the best protection against HPV infections.
2. Reduce the number of sexual partners you have: The less sexual partners you have the less chance you will be exposed to HPV. If you have sexual contact with a partner who has had many sexual partners, you increase your chances of catching HPV.
3. Wear condoms: Although condoms won't completely eliminate the risk of HPV transmission they can reduce the risk and are effective protection against other sexually transmitted infections.
4. Do not smoke: Smoking may impair the body's own ability to fight off HPV and other infections.
5. Go for cervical cancer screening as recommended.

Should my boyfriend/husband get HPV testing?  
At this time, there is no approved test for HPV in men.  Serious health complications related to HPV in men are rare; therefore, there are no general HPV screening recommendations for men. In the absence of such screening, it is important men see their health care providers for regular check-ups or to have any specific signs and symptoms investigated. 

How can I tell if a partner has HPV?
It is not possible to tell when someone has HPV unless you can visibly see genital warts. HPV usually has no signs or symptoms. It's important to remember the HPV is very common and over 75-80% of sexually active people will have an HPV infection at some point in their lives.

I've had the HPV vaccine, why do I still need cervical cancer screening?
HPV vaccination is highly effective at protecting against several types of HPV but not every type; therefore, it is still important to be screened for cervical cancer as recommended by the screening program.

If I have an HPV test, can I still get a Pap test every year?
It is not necessary to have Pap tests in addition to HPV testing for cervical cancer screening. HPV testing screens for the presence of the virus that causes cervical cancer. Pap testing identifies changes on the cells of the cervix caused by HPV, once these changes have already occurred. If you are HPV negative, it is unlikely the cells of your cervix have any abnormalities, and you can safely wait until you are due for another HPV test as recommended by the screening program.

Useful resources for women:
2. Society of Obstetricians and Gynaecologists of Canada: http://sogc.org/
3. Government of Canada:  www.healthycanadians.gc.ca (HPV)
5. BC Cancer Agency, Cervical Cancer Screening Program: http://www.screeningbc.ca/Cervix/default.htm
7. Centres for Disease Control Atlanta: http://www.cdc.gov/hpv/index.html
Positive results FAQs

 

FAQs about receipt of HPV positive results


Do I have/am I going to get cervical cancer?
Being positive for HPV does not mean you have or will develop cervical cancer. You have tested positive for a "high-risk" type of HPV that if left undetected or untreated could lead to cancer over time. However, HPV does not cause cancer in all people and most times, HPV goes away on its own within about two years without a person even knowing they have it.

Knowing that you are HPV positive allows doctors to monitor you more closely to determine what steps may be needed. Depending on the results of other tests, you may require a colposcopy to examine your cervix more closely to determine if treatment is needed, or you may only require another cervical screen in about a year.

How do I know when I caught HPV?
It is not usually possible or necessary to determine who gave you HPV or when you caught it.  HPV may be detected right away, or not for many years later. HPV is very common in the population and most people who have HPV do not know they have it.

I never have risky sex/sleep with many partners, how could I have caught this?
Having HPV is nothing to be ashamed of, does not indicate promiscuity, nor does it mean you have a disease. Anyone can get HPV, even if you've only had sexual contact with one person. HPV is the most common sexually transmitted infection and most sexually active people will have an HPV infection at some point in their lives. HPV can be detected early or years after exposure, making it very difficult to determine exactly when you caught the virus. 

I have been with the same partner for many years. How could I be HPV positive?
Testing positive for HPV does not mean the infection is new, or that your partner has been unfaithful.  HPV can persist for years, and HPV can be detected right away, or not for many years later. 

What do I tell my partner? Do I need to tell my partner?
Whether or not you tell your partner about your HPV test result is your own personal decision.  It is more than likely that you and your partner have both been exposed to the virus by the time your HPV was detected. If you are in a monogamous relationship, you and your partner have likely shared a strain of the virus. When telling a partner, it's important you have some basic information to convey to your partner so that you can have an open dialogue with no judgement or distress. The more you know about HPV the less worry both you and your partner will have.
HPV is the most common sexually transmitted infection and most sexually active people have been exposed to HPV
It is not usually possible to determine who gave you HPV and having HPV does not indicate promiscuity or infidelity. You may have been exposed to HPV months or years earlier
If your partner is male, serious HPV related health problems in men are rare, and there is no approved test to detect HPV in men

What's the treatment for HPV?
There is no specific treatment or cure for the virus, however there are treatments for health issues that can arise from having an HPV infection. Depending on your cervical cancer screening results, you may require another screen in about 12 months to reassess your status or you may be referred for a colposcopy to have a closer exam of your cervix to see if treatment is required.  It is important to follow the recommendations given to you by your health care provider to monitor your HPV status.

One of the best ways to prevent complications associated to HPV is to ensure you receive routine cervical cancer screening according to the guidelines in your province.

Should my partner get treated?
Serious HPV related health problems in men are rare, and there is no approved test to detect HPV in men. It is not necessary for your male partner to get tested or treated.

If your partner is female and receiving routine cervical cancer screening, HPV or cervical abnormalities will be detected if present, and appropriate follow-up will be prescribed.

After I've received treatment for HPV, can I catch it again?
There are many types of HPV and it is possible to be infected with another type of HPV that you were not previously exposed to. It is not possible to completely eliminate your risk of being infected again, but there are measures you can take to protect yourself and your partner:
1. Vaccines: Other than abstinence, HPV vaccination is the best protection against HPV infections.
2. Reduce the number of sexual partners you have: The fewer sexual partners you have the less chance you will be exposed to HPV. If you have sexual contact with a partner who has had many sexual partners, you increase your chances of catching HPV.
3. Wear condoms: Although condoms won't completely eliminate the risk of HPV transmission they can reduce the risk and are effective protection against other sexually transmitted infections.
4. Do not smoke: Smoking may impair the body's own ability to fight off HPV and other infections.
5. Go for cervical cancer screening as recommended.

Should I get the HPV vaccine now that I know I'm HPV positive? 
Ideally, to receive the maximum benefit from HPV vaccination, it should occur before someone becomes sexually active and exposed to HPV.  Even if you are HPV positive, the probability of being infected with all HPV types protected for in the vaccine is rare, so the vaccine can still be of benefit to you. To determine if HPV vaccination is right for you, speak with your health care provider to discuss your options.

Will having HPV affect my ability to get pregnant in the future?
Having HPV will not affect your ability to get pregnant in the future.

Can I pass HPV on to my baby?
The HPV testing used for cervical cancer screening detects for the presence of high-risk, or cancer causing HPV. There is no evidence to show that these high-risk types of HPV can be passed on from mother to the baby during pregnancy or childbirth.

The types of HPV that cause genital warts are called "low-risk" types of HPV, and they are not detected with HPV testing for cervical cancer screening. If a woman has genital warts there is a very rare chance that she may pass the virus on to the baby during childbirth which may cause complications in the air passages of the baby. The incidence of this condition is very rare.

I've never had an abnormal Pap test result. How can I be HPV positive?
The Pap test identifies changes to the cells on the cervix once they have started to develop. HPV testing identifies women who are positive for HPV, but this does not necessarily mean you have changes to the cells of your cervix. Additional testing is done on your sample to see if you have changes to the cells on your cervix. If you don't have any cell changes, you will be asked to return for another cervical screen in about a year, and if there are cells changes, you may require a colposcopy.

It is not known if your HPV infection is newly acquired, or something you have had for years. It is only long term (many years) infection with high-risk types of HPV that can lead to cervical cancer. Your HPV infection may go away on its own within about two years. The important thing is to ensure you attend screening and or follow-up appointments as recommended by your health care provider.

I thought only young people caught HPV, how could I have it?
HPV infections are generally more common in women under the age of 30, but women of any age can get HPV. HPV may be detected shortly after infection or many years later, so it is not known when you caught your HPV. It is very important for all women of screening age to ensure they follow cervical cancer screening guidelines and recommendations from the health care provider.

Useful resources for women:
2. Society of Obstetricians and Gynaecologists of Canada:  http://sogc.org/
5. BC Cancer Agency, Cervical Cancer Screening Program: http://www.screeningbc.ca/Cervix/default.htm
7. Centres for Disease Control Atlanta: http://www.cdc.gov/hpv/index.html
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