New HPV testing in cervical cancer screening: What you need to know

As of Monday, March 3, 2025, Ontario has adopted testing for human papillomavirus (HPV) - the leading cause of cervical cancer - as the new standard for cervical cancer screening, replacing the traditional pap smear. 

The HPV test sample is collected using the same method as the pap smear and is available at all the same places the pap smear was available. If you have a cervix, the starting age for screening eligibility is also the same - 25 years old. What’s changing happens in the lab.  

Here, gynecologist Dr. Robert Di Cecco explains the shift to HPV testing and how people will benefit. He is Regional Lead for Cervical Screening for the South West Regional Cancer Program and Medical Director of the Colposcopy Clinic at St. Joseph's Health Care London. 

What is the difference between a pap smear and the HPV test?

For patients the process of having the HPV test will be the same as that of the traditional pap smear, as both involve the collection of cells on the cervix. However, the difference is in what the test actually looks for at a cellular level.

The pap smear looks for cell abnormalities and is not as sensitive or specific as the HPV test. The pap smear also requires subjective analysis by a person examining the cells in the sample to determine whether they are abnormal or not.

The HPV test specifically detects evidence of cancer-causing strains of HPV in the sample using advanced molecular techniques, providing a more accurate assessment of cervical cancer risk.

“The HPV test is objective and doesn’t require someone’s interpretation of whether there is an abnormality,” says Di Cecco. “The test identifies a patient’s risk of developing cervical cancer by looking at whether there is evidence of cancer-causing strains of HPV in the sample. The test helps determine a person’s risk of developing something or changes to the cervix who need to be followed.”

If the result of the test is negative for HPV, then an individual’s next screening test would be in five years, adds Di Cecco.

“But if the result is abnormal, then next steps could include more frequent testing, or a referral to a colposcopy clinic for follow-up.”

Why is the test changing?

“We have seen that the HPV test is more sensitive and specific than the pap smear. From that standpoint, the results are more accurate as to an individual’s actual risk of abnormality,” Di Cecco says.

The HPV test identifies those cancer-causing strains and, as a result, helps better identify those patients more at risk and who need to be followed more closely by health care providers.  

“The HPV test is a better test than the pap smear and it avoids subjecting people to the anxiety of an abnormal test that may be a false positive. We are better able to streamline patients who are at risk and those not at risk of developing an abnormality with the HPV test,” shares Di Cecco.

Other countries have implemented this test for many years and now Ontario is using it as the primary screening test.

Di Cecco notes that while regular HPV testing is key to early identification of cervical abnormalities, the HPV vaccine can help to fight many of the major cancer-causing strains of HPV which can decrease the incidence of abnormalities developing on the cervix.  

“Getting the HPV vaccine is an intervention that might decrease the incidence of cervical abnormalities because it can help an individual to fight an HPV infection in the first place,” he says. 

“We are always acquiring new information as time goes on and that may modify how we do things for the better,” adds Di Cecco. “The hope with implementing the HPV test as the primary screening test is it will allow us to more accurately identify those at risk of developing abnormalities and therefore allow us to intervene before they can develop into an actual cancer.”

If you would like more information about cervical screening and the HPV test, please visit the HPV testing fact sheet from Ontario Health (Cancer Care Ontario).

Pop-in for cervical screening

St. Joseph's Health Care London will hold its next cervical screening clinic (Pop-up Pap Test Clinic) on March 24, 2025, from 9 to 12 pm in the Colposcopy Clinic located at St. Joseph's Hospital.  No appointment necessary. This clinic will feature the latest and best in cervical screening with Ontario’s shift to HPV testing.

Cervical cancer can almost always be prevented with a regular screening and follow-up. If you are age 25 and older and have not had a pap test in the past three years, don’t miss this important cancer prevention opportunity. Details available here.