Access to health care - To eliminate cervical cancer in Canada, nationwide funding of self-sampling for human papillomavirus is needed - Editorial

Sep 21, 2026

Upload by Ivy

Cervical cancer is described as largely preventable and curable when detected early, yet prevention efforts are not reaching those at highest risk. The editorial argues that Canada should fund nationwide HPV self-sampling to increase uptake among underscreened and never-screened populations by reducing barriers such as privacy concerns, convenience issues, avoidance of invasive exams, and the need to travel. Evidence from modeling, guidelines, pilots, acceptability studies, and meta-analyses supports sensitivity and feasibility comparable to clinician-collected testing, alongside improved participation and cost-effectiveness.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Access to health care

Need for nationwide funding of HPV self-sampling

Barriers and benefits for higher-risk groups

Evidence on test performance and feasibility

Program results and cost-effectiveness

Recommendation for integrating self-sampling nationwide

Editorial Access to health care To eliminate cervical cancer in Canada, nationwide funding of self-sampling for human papillomavirus is needed Shannon Charlebois MD, Sarah Kean MD n Cite as: CMAJ 2024 June 3;196:E729-30. doi: 10.1503/cmaj.240722 See related [article at www.cmaj.ca/lookup/doi/10.1503/cmaj.231682](article at www.cmaj.ca/lookup/doi/10.1503/cmaj.231682) Cervical cancer is almost entirely preventable and is curable if detected early. In related research, Pataky and colleagues model strategies for the elimination of cervical cancer in British Columbia and find that the greatest gains would come from increasing selfsampling uptake among underscreened populations.1 Increasing uptake in hard-to-reach populations could be achieved by reducing barriers to accessing self-testing, or self-sampling. Guidelines from the World Health Organization published in 2022 recommend that self-sampling for human papillomavirus (HPV) be included in cervical cancer screening.2 The Canadian Partnership Against Cancer’s 2019 action plan to eliminate cervical cancer in Canada stated this as an immediate goal.3 British Columbia has led Canadian jurisdictions by integrating self-sampling as an option in its screening program as of January 2024. That cervical cancer accounts for 1.3% of all new female cancers and 1. 1% of all female cancer deaths in Canada, yet is preventable, should prompt all health systems in Canada to fund self-sampling without delay.4 Although its incidence is relatively low, cervical cancer predominantly affects young people and contributes disproportionately to years of life lost to cancer.5 Moreover, the incidence of cervical cancer has been rising in Canada and the United States, with diagnoses being made both in younger age groups and at later stages of disease.6,7 Invasive cervical cancer disproportionately affects equity-seeking populations. Yet, those most at risk are the least likely to be screened, including 2SLGBTQI+ people, immigrants, those with a disability, Black and Indigenous people, and victims of sexual trauma.8–10 It is the most common cancer among females living with HIV.11 Programs of HPV vaccination alone will not eradicate cervical cancer in the foreseeable future. Even if coverage and efficacy were 100%, the earliest vaccinated cohorts will not reach the average age of cervical cancer diagnosis for many years; uptake of HPV vaccination remains suboptimal, with most recent available data across Canadian jurisdictions (for school year 2017/18) demonstrating vaccine coverage of 57.1%–91.3% for girls and 57.5–91.3% for boys.11 Canada has been slow to move from traditional cytology (Pap smear) to universal HPV testing as first-line screening to support earlier detection of cervical cancer and lower the rate of invasive cervical cancer, despite implementation in countries with comparable health systems such as the United Kingdom, Australia, and the Netherlands.12–14 Human papillomavirus testing for cervical intraepithelial neoplasia (CIN) grade 2 or 3 offers a sensitivity of 94.6%(95% confidence interval [CI] 84.2%–100.0%) compared with 55.4%(95% CI 33.6% –77.2% ) for cytology.15 Human papillomavirus self-sampling can raise rates of screening by addressing privacy, convenience, avoidance of an invasive exam, cultural concerns, and the need to travel.16 A vaginal swabis taken by the patient in the setting of their choice and returned by mail, similar to integrated programs for colon cancer screening. Human papillomavirus self-sampling may therefore increase reach among those most at risk for invasive cervical cancer: the underscreened and never-screened. Accumulating evidence shows that self-collected samples analyzed by high-sensitivity polymerase chain reaction assay areas sensitive as physician-collected samples. A meta-analysis of 56 studies comparing self-sampling with clinician-based screening found the relative sensitivities of self-sampling were 0.96 (95% CI 0.90–1. 03) and 0.9

FAQs

Why is nationwide HPV self-sampling funding needed in Canada?

Cervical cancer is preventable and curable if detected early, but people at highest risk are least likely to be screened. Funding self-sampling is proposed to increase screening uptake among underscreened and never-screened populations.

How does HPV self-sampling help address screening barriers?

The editorial states that self-sampling can improve reach by addressing privacy, convenience, avoidance of invasive exams, cultural concerns, and travel requirements.

What evidence supports self-sampling effectiveness and feasibility?

Guidelines recommend including HPV self-sampling, pilots show higher return rates when offered, and studies including a meta-analysis report sensitivity and specificity comparable to clinician-based screening. Cost analyses also indicate self-sampling can be substantially cheaper.

Sep 21, 2026

Upload by Ivy