Michele D’Elia
Executive Director of Medical & Scientific Affairs, Roche Diagnostics Canada
François Drolet
Executive Director of Access, Policy & Government Relations, Roche Diagnostics Canada
With all the new health care infrastructure the COVID-19 pandemic response has provided, could HPV screening and cervical cancer prevention be the natural next step?
The past year and a half has been a battle, and one of the underappreciated victories has been the rapid and successful roll-out of a tremendous new capacity for molecular testing. But the big question that people are just beginning to ask is: What are we going to do with all that new capacity as the need for COVID-19 testing eventually decreases?
Because of COVID-19 testing, labs have been buying more instruments since they needed to run more samples than they typically would,” says Michele D’Elia, Executive Director of Medical and Scientific Affairs at Roche Diagnostics. For the time being, COVID-19 testing remains key to overcome the pandemic as we face different waves due to new variants. However, these same instruments are also capable of performing a number of molecular tests, such as the HPV test.
A molecular test in the fight against cervical cancer
Widespread molecular HPV testing presents a unique opportunity to safeguard the health of Canadians due to the prominent role of the virus in the development of cervical cancer, which kills over 400 Canadian women each year. “Cervical cancer is caused by an HPV infection that has modified the cervical cell lining,” explains D’Elia. “Historically, we’ve collected the cells and looked at them under a microscope to find out if there was a change, but the root cause of that change is an HPV infection. The technology today allows you to directly detect that clinically relevant HPV infection.”
The World Health Organization recommends a cervical cancer prevention policy that sees at least 90 percent of women vaccinated against HPV, 70 percent screened for HPV, and 90 percent with pre-cancer receiving treatment. Canada has set an even more ambitious screening target at 90 percent. “Unlike most other cancers, most of these cervical cancers are totally preventable,” says Roche Diagnostics Executive Director of Access, Policy, and Government Relations, François Drolet. “If we want to eliminate cervical cancer, HPV vaccination alone won’t achieve it. We need a three-pronged approach, with screening, vaccination, and treatment.”
Bringing screening to the unscreened
HPV Global Action advocates for equitable access to best practices for cervical cancer prevention through appropriate screening policies Canada-wide. “The switch to HPV testing from Pap testing as primary cervical cancer screening is safer, will provide more effective protection, and will save health care resources,” says a representative at HPV Global Action. “HPV testing access must be tailored according to the needs of the diverse populations that exist across Canada. Further, to ensure that this transition is met with acceptance by the general public, we need to assure widespread education about this innovative cervical cancer screening method to empower and engage people with a cervix in demanding HPV testing.”
Cervical cancer screening, traditionally done through the Pap test, has long been a powerful tool in our prevention arsenal. But, as testing technology has become more advanced, and especially as the installed base of molecular testing equipment has exploded over the course of the pandemic, Canada is ready to enter a new era of primary screening, particularly for those with access issues. “The Pap test has been a good test, but we’re probably at its limits in terms of how successfully we can fight cervical cancer through that technology,” says Drolet. “The HPV DNA test is a more accurate test, and it catches the disease earlier, providing more options.”
One of the most exciting possibilities of the molecular HPV test is its ability to bring effective screening to populations that were previously unscreened. The opportunity for self-sampling particularly, where the test can be performed at home and sent into a lab for analysis, is a big potential win for Canadians in remote communities or facing other access barriers. Though self-sampling is not yet an approved collection method in Canada, it has had success in other countries such as Australia and the Netherlands, and Drolet reports that several provincial health ministries have expressed interest in studying it further. Access to the test currently varies by province and insurer.
Regardless of how we move forward, one thing is clear. This incredible new base of molecular testing equipment has provided a rare opportunity to rethink how diagnostics intersect with care in Canada. And cervical cancer prevention is a major health issue that’s overdue for just such a transformation.
