Quebec gynecologists say they were not consulted on the province’s plan to replace Pap tests with HPV tests as the primary screening tool for cervical cancer.
Health Minister Christian Dubé made the announcement earlier this month, saying the new health plan aims to improve the patient experience, including “moving away from the typical intrusive test”.
While gynecologist Dr. Celine Bouchard welcomed the news of this new measure, she was surprised by the announcement.
“We doctors on the ground were not informed at all,” she said.
One of her colleagues, Dr. Isabelle Levesque, was also caught off guard by the government’s announcement.
“Patients came into my office the day after the announcement to ask if they would get the new test. I told them no. There are a lot of things that need to be put in place, and the labs are not ready for a flow like this,” she says.
Bouchard thinks she and her colleagues should be the first to learn about such a change in their practice. But she doesn’t expect any quick changes at the hospitals just yet.
“The time it takes to implement this in a disorganized system like we have now will be very long,” she said, adding that implementation could take up to a year or even longer.
First a pilot project
The HPV test, which detects high-risk types of human papillomavirus, will be offered to women between the ages of 25 and 65 every five years.
The HPV test is more sensitive than the Pap test, which is currently used to detect HPV and precancerous lesions. Undetected, these lesions can lead to cervical cancer. HPV is the cause of almost all cases of cervical cancer.
According to Bouchard, nearly 25,000 women in the Quebec region have not been screened in the past year alone because of the pandemic.
She said the delay in screening during the pandemic and the slow implementation of the announced new tests could have serious consequences for hundreds of women in Quebec.
Gynecologist Isabelle Levesque says there are many factors that need to be put in place, and labs are not yet ready to take on this level of screening. (Radio-Canada)
“I inform my patients that unfortunately they still have to get the old Pap test, which is less sensitive. It detects 50 percent fewer lesions,” she said.
For its part, the Quebec government says it was clear from the announcement that the introduction of the new HPV tests would take time.
The health ministry says all the parameters of this new program, from screening to diagnosis, will need to be determined over the next few months, with a timetable for implementation at each stage.
In addition, before deploying HPV testing in Quebec, the government would like to conduct a pilot project in several health institutions.
The ministry is currently working on the new clinical pathway linked to the new research. This would require a complete reorganization of the province’s laboratories, it said, which are already under great strain from COVID-19 samples.
Protection at a cost of $700
In addition to rapid screening, vaccination is the only prevention tool to avoid HPV-related complications, according to gynecologists. The only vaccine available is Gardasil, but one dose costs about $220 and three are needed for maximum protection.
“It’s very expensive and women who have less money often refuse the vaccine because they can’t afford it,” said Bouchard, who would like to see the drug covered by the Régie de l’assurance maladie du Québec (RAMQ) .
The impact of HPV has been felt most by women aged 30 and over since the HPV vaccination program was introduced in 2008 in Quebec.
Bouchard recommends vaccination for men and women who believe they are at risk of contracting HPV due to, for example, divorce or frequent sexual partner changes.
“At this point, the vaccine will work very well, at about 98 percent,” she said.
Breaking taboos
Three out of four sexually active Canadians will come into contact with HPV in their lifetime, but gynecologists say people with the infection often face stigma because it is mainly sexually transmitted.
In Canada, it is estimated that one in 168 women will develop cervical cancer in her lifetime.
“It’s very taboo, but at least the patients we see are a little more informed because their kids in elementary school are getting vaccinated,” Levesque said.
Bouchard notices the psychological impact of a diagnosis every day, especially for young women.
“They feel dirty, they feel really separate from others when they’re not separate from others,” she said.
“They are in the fraction of cases that occur and that need to be treated.”
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