Ontario Adopts HPV Testing as Primary Cervical Screening Method
On March 3, 2025, Ontario will transition from Papanicolaou (Pap) testing to human papillomavirus (HPV) testing as the primary method for cervical cancer screening through the Ontario Cervical Screening Program (OCSP). This transition aims to improve early detection and prevention of cervical cancer by leveraging HPV testing’s higher sensitivity.
HPV Testing
HPV testing offers greater sensitivity than cytology alone, significantly improving the detection of cervical pre-cancer and cancer. Furthermore, a negative HPV test result provides longer-term reassurance, allowing for extended screening intervals.
HPV testing is recommended for all individuals aged 25 to 74 years (subject to specific cessation criteria) who have ever been sexually active (defined as any sexual contact using the hands, mouth or genitals with another person’s genitals, and includes the sharing of sex toys) and have a cervix, regardless of their prior HPV vaccination status. This recommendation includes:
- Women
- Two-Spirit people
- Transmasculine individuals
- Nonbinary individuals
- Pregnant individuals
- Post-menopausal individuals
- Individuals who have had a subtotal hysterectomy and retained their cervix
Certain populations are more commonly missed in cervical screening and follow-up care after an abnormal test result. These include individuals from more materially deprived neighborhoods, newcomers, and racialized populations, particularly those facing language barriers or lacking healthcare navigation support. Additionally, OHIP coverage is required to access the HPV test free of charge, potentially exacerbating existing health inequities.
Adopting a proactive approach can help close these gaps. Consider reaching out to patients belonging to equity-denied groups, including individuals experiencing poverty, newcomers, Indigenous peoples, people who are racialized, and gender-diverse individuals, to ensure they are up to date on their screening.
Screening Procedure Changes
Sample collection
The HPV test involves collecting cervical cells using the ThinPrep® method, which is then tested for oncogenic types of HPV. This is not a self-testing method - self-testing for HPV is not currently available in Ontario -however self-testing may be introduced in the future to improve accessibility.
Positive screening results
If a patient tests positive for HPV, the lab will perform reflex cytology on the same sample to detect abnormal cells. Based on the findings, you may refer the patient for colposcopy or repeat the HPV test within a specified interval.
Screening intervals
- For patients with a negative HPV test result, screening will generally be conducted every five years.
- For patients who meet the Ontario Cervical Screening Program (OCSP) criteria for immunocompromise, screening is recommended every three years.
Updated requisition form
Please review instructions for the requisition form that will ensure a streamlined and integrated approach with laboratory services. Of note, HPV testing does not allow for simultaneous STI testing from the same sample; therefore, additional swabs must be submitted separately for STI screening as needed.
Physician & NP Resources
- HPV and Cytology Tests Requisition Form and instructions, Cancer Care Ontario
- HPV Testing Implementation Resource Hub, Cancer Care Ontario
- Guide to Cervical Screening, Cancer Care Ontario: see criteria in table on pg. 3, footnotes.
Patient Resources
- Information on Cervical Screening, Cancer Care Ontario
- Champlain Screening Outreach Program for screening access to individuals without a family doctor. Patients can self-refer to the Champlain Screening Outreach by calling 1-833-551-4125 or by booking an appointment online. to get screened for cervical, breast, colorectal, and lung cancer.
Emil Prikryl, MD, MSc, FRCPC
Associate Medical Officer of Health, Ottawa Public Health
Christine Gloade, RN (EC), BScN, MN
Public Health Nurse Practitioner
Ottawa Public Health
Jenna Bennett, RN, BScN, MPH, CCHN(C)
Nursing Project Officer
Ottawa Public Health