HPV screening and follow-up pathway

Step 2: HPV primary screening and self-sampling

The recommendations outlined in these steps are intended to be actioned by decision-makers responsible for the delivery of cervical cancer screening and follow-up care.

Learn more about intended audiences and accountability.

HPV testing devices

Recommendation: Collaborate with lab partners to ensure HPV collection devices, assays and associated equipment have been appropriately validated for HPV primary screening. 

Key evidence and implementation considerations:

• When selecting a collection device, jurisdictions may consider whether the device can be used to perform tests beyond the primary HPV test. The four most common type of tests performed are HPV partial genotyping, liquid-based cytology, p16-Ki67 immunostaining and methylation.¹ (For more detail on these tests, see table 5 of the HPV Primary Screening Environmental Scan.)
  • Partial genotyping for HPV+ 16/18 allows for the identification of the highest risk strains and can inform triage pathways.¹ Jurisdictions may also consider HPV tests that identify other common, high-risk HPV subtypes that may be prevalent in the population.¹
  • Cytology can be included only as part of the primary screening test with clinician-collected samples. For HPV self-sampling, participants will need to see a clinician for cytology testing as required.
• Consider different sample collection devices (e.g., dry cotton swab, flocked swabs, brush) and the use of liquid media.
  • When self-sampling, dry samples are easier for participants to use as they do not require participants to handle liquid media. User instructions should clearly indicate how long the participant has to complete and submit the test for optimal results. Samples returned in liquid media may need specific handling, which can lead to longer delivery times and more expensive packaging.²
    • Please note that the landscape of approved HPV devices in Canada is evolving; refer to Health Canada for complete information on devices approved for use in Canada.

Recommendation: Monitor HPV test characteristics to optimize test performance.

Key evidence and implementation considerations:

• Update existing cervical screening quality assurance guidelines (or set up quality assurance guidelines where none exist) to ensure HPV testing for cervical screening remains stable and consistent over time.
  • Identify quality indicators specific to HPV testing. Some quality indicators to consider include sensitivity, specificity, negative and positive predictive value, positivity rate, and percentage of unsatisfactory/indeterminate HPV tests.