Canadian Family Physician

Uptake and feasibility of HPV self-sampling among patients of a Canadian family medicine clinic

To determine the uptake and feasibility of human papillomavirus self-sampling (HPV SS) offered to patients in a family medicine clinic. Implementation study. Community family medicine clinic in Edmonton, Alta, with a cervical cancer screening rate of 80%. Patients 25 to 69 years old with a cervix who had not received a Papanicolaou (Pap) test in 2.5 years or more. Exclusion criteria included being pregnant; experiencing colposcopy care or having been discharged from care within 11 months; having history of invasive cancer; experiencing abnormal vaginal bleeding or current menstruation; identifying as transgender; and having abnormal results on the last Pap test. Eligible patients were opportunistically offered HPV SS in the clinic (September 2024 to November 2024) as the first phase of the Alberta Cervical Cancer Screening HPV SS pilot program. The primary outcome was the proportion of patients who completed HPV SS. Secondary outcomes were factors associated with completing HPV SS, HPV SS results, patient preferences, physician perspectives, and environmental impact. Overall, 226 patients were offered HPV SS. Characteristics of patients included the following: the median age was 43 years (interquartile range [IQR]=32 to 56); 89% lived in urban areas; 14% were immigrants; 4% were Indigenous; 58% were panelled (ie, attached to a family physician); and the median number of months since a last Pap test was 37 (IQR=32 to 45). Overall, 81% completed HPV SS: 165 had negative results, 17 were positive, and 2 were indeterminate, resulting in 7 Pap tests and 10 direct colposcopy referrals. Among patients who completed HPV SS, 98% preferred to have HPV SS as an option for future screening. Family physicians supported its use and HPV SS has the potential to decrease carbon impact by up to 20%. The study suggests that HPV SS may be the preferred cervical cancer screening approach for patients attending a family medicine clinic. Screening programs should consider improving access to HPV SS for this population.

Are we ready for human papillomavirus testing?

To determine patient knowledge and preferences about primary human papillomavirus (HPV) testing. Cross-sectional survey. Two family practice clinics (urban and suburban) and the social media platforms of 2 hospitals in the greater Toronto area between January and February 2023. A total of 413 Ontario residents aged 25 to 69 years, with a cervix, who qualified for Papanicolaou (Pap) screening and could communicate in English. Electronic survey containing questions about knowledge of, and preferences for, cervical cancer screening, including types of screening and screening intervals, and about education related to HPV and screening intervals. Of 441 potential participants, 426 were eligible and consented to participate in the study; ultimately 413 provided completed or partially completed surveys (96.9% response rate). Of those who completed a recent Pap test, 57.8% (208 of 360) knew of HPV testing. Initially, 27.8% thought HPV testing was better than Pap testing for cervical cancer screening. After learning HPV tests exist and have self-sampling options, most participants preferred HPV testing (self-sampling 46.3%, provider sampling 34.1%). Annual cervical cancer screening was preferred by 50.1% of participants despite knowing that, for most people, Pap tests should be conducted every 3 years (74.8%). After learning about HPV testing, participants were more likely to prefer 5-year screening intervals (43.8%); however, those in the family practice group were still more likely to prefer 3-year intervals compared with those in the social media group ( Participants in this study identified a preference for HPV testing and self-sampling options. Concerns were raised about extended screening intervals and the safety of self-collected samples that need to be addressed in public health education initiatives during rollout of new screening programs.

Comprehensiveness of care for women with depression

To explore comprehensiveness of care in patients with depression by examining associations between a diagnosis of depression, frequency of primary care visits, and Papanicolaou test completion. Cross-sectional retrospective survey using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network. Primary care practices in Ontario. Women aged 21 to 69 eligible to receive Pap tests in 2015. Associations between 2 predictors (depression and number of primary care visits in 2015) and Pap test completion were measured. Overall, 125,258 women were included: 20.5% completed a Pap test and 16.4% had a diagnosis of depression. Having a diagnosis of depression was associated with lower likelihood of Pap test completion (adjusted odds ratio [AOR]=0.92, 95% CI 0.88 to 0.95). A greater number of primary care visits was associated with a higher likelihood of Pap test completion; this association was stronger in women with a diagnosis of depression (AOR=4.9, 95% CI 4.16 to 5.69) than in those without (AOR=3.4, 95% CI 3.25 to 3.60). While depression was associated with fewer completed Pap tests, women with depression who saw their family doctors more often were more likely to be screened for cervical cancer. More primary care visits for depression treatment may be associated with an improved likelihood of screening for cervical cancer.

Clinician acceptability of self-collected human papillomavirus swabs as a primary cervical cancer screening method

To determine knowledge and acceptability of and opinions about human papillomavirus (HPV) self-screening as an alternative to Papanicolaou testing among Canadian primary care providers (PCPs: family physicians and nurse practitioners) and obstetrician-gynecologists (OB-GYNs). Descriptive, cross-sectional, anonymous, online pilot survey. Two academic teaching hospitals in downtown Toronto, Ont. Staff physicians and nurse practitioners in the Department of Family and Community Medicine and the Department of Obstetrics and Gynecology at Women's College Hospital and St Michael's Hospital. Recommended patient groups for, potential advantages and disadvantages of, and likelihood of recommending HPV self-sampling for cervical cancer screening. The overall response rate was 30.9%. More than three-quarters of survey respondents were female PCPs. Slightly more than half of clinicians had poor knowledge of HPV self-sampling. However, more than three-quarters would recommend it if there were adequate collection of cervical samples, high patient acceptability, and high sensitivity (almost 100% of respondents), followed by high specificity and cost-effectiveness (more than 80% of respondents). Primary care practitioners were more likely than OB-GYNs to agree that HPV self-sampling made screening easier and less embarrassing for patients. Although not statistically significant, OB-GYNs tended to be more concerned than PCPs were about patients failing to follow up on abnormal HPV results and missed opportunities to address other health issues. Although knowledge of HPV self-sampling for cervical screening was poor, it was generally acceptable to clinicians if certain screening test conditions were met. However, the potential for missed opportunities to visualize pathology and address other health concerns were raised. These and other clinical practice and health systems issues must be addressed before broad implementation of HPV self-sampling in Canada.

The pandemic and cervical cancer screening

Approach to cervical polyps in primary care

To provide primary care providers (PCPs) with an approach for diagnosing and managing endocervical polyps, detailing a procedural technique for cervical polypectomy and outlining key information on when to refer to a gynecologist. This review and approach are based on the second author's clinical practice and available literature from 1994 to 2023. Cervical polyps are commonly asymptomatic and benign, but can cause intermenstrual and postcoital bleeding. Cervical polyps alone are unlikely to be associated with dysplasia or malignancy; routine Papanicolaou and human papillomavirus tests remain the most important factors in identifying cervical dysplasia. For symptomatic patients, the lack of available literature to guide PCPs can result in unnecessary referrals to gynecology, long wait times, and associated costs to the health care system. Symptomatic endocervical polyps can be easily and painlessly removed by primary care clinicians in office using a ring-forceps polypectomy technique. Cervical polyps are common and generally do not require intervention if asymptomatic. Patients with cervical polyps should still participate in routine cervical cancer screening. Symptomatic cervical polyps in appropriate patients can be removed by PCPs and sent for histologic examination to avoid long wait times and unnecessary referrals to gynecology.

Afrocentric screening program for breast, colorectal, and cervical cancer among immigrant patients in Ontario

Black and immigrant populations across Canada have lower screening rates than Canadian-born white populations, predisposing them to increased cancer morbidity and mortality. Effective interventions are required to increase cancer screening rates among these populations. To improve breast, colorectal, and cervical cancer screening rates at TAIBU Community Health Centre, which has a mandate to provide primary health care services to the Black and immigrant community in the greater Toronto area. An Afrocentric quality improvement program was developed and implemented, consisting of provider audits, cancer screening education programs, a patient call-back program, and a mammography promotion day. TAIBU Community Health Centre's continuous quality improvement approach was successful in engaging health care providers and patients to increase cancer screening participation sustainably in a racially and socioeconomically diverse setting. Rates of breast, colorectal, and cervical cancer screening offered to eligible patients increased from 17% to 72%, 18% to 67%, and 59% to 70%, respectively, between 2011 and 2018.