# Transitioning from Cytology to HPV Test-Based Primary Cervical Screening in Canada: A Population-Based Survey of Women’s Screening and Information Preferences

## TL;DR

A survey in Canada found that women prefer HPV testing combined with Pap tests, starting at age 21, and receiving information via email to support cervical cancer screening.

## Contribution

The study identifies women's specific preferences for cervical screening methods and communication channels to improve uptake in Canada.

## Key findings

- Women prefer co-testing (HPV and Pap tests) over HPV testing alone.
- Participants favored starting screening at age 21 and screening every three years.
- Underscreened women showed higher preference for self-sampling and gynecologist-administered HPV tests.

## Abstract

In Canada, the Pap test (cytology), used for decades for cervical screening, is being replaced by human papillomavirus (HPV) testing, which can detect pre-cancer more sensitively and allows longer screening intervals. To support this transition, we conducted a national survey to understand women’s preferences for screening methods, starting age, screening intervals, and how screening information should be communicated. We found that women prefer using the HPV test in conjunction with the Pap test, starting screening at age 21, and maintaining screening intervals every three years. They also prefer receiving information by email rather than by postal mail. Women who do not participate regularly in screening showed high preferences for self-sampling and preferred receiving the HPV test from a gynecologist rather than a family physician. Successful implementation of the new screening test requires tailored information and empowering women to use self-sampling to support optimal uptake and progress toward cervical cancer elimination in Canada.

Background: Canada’s cervical cancer elimination plan is challenged by suboptimal screening participation and rising incidence of cervical cancer over the past decade. Cytology, the primary cervical screening method in Canada, is being replaced with HPV testing, which offers superior sensitivity for detecting pre-cancerous lesions and supports initiating screening at age 25 or older and extending screening intervals to five years. Research has shown that women’s insufficient knowledge and negative attitudes toward HPV screening represent a significant barrier to screening uptake. Methods: We conducted a web-based national survey using Best–Worst Scaling (trade off utilities) to quantify women’s preferences for screening test modality, age of initiation, and screening intervals. We also assessed preferences for information sources, provider type, and communication methods. Underscreened individuals were oversampled. Results: Among adequately screened (N = 1778) and underscreened (N = 1570) individuals, preferences favoured co-testing (cytology plus HPV testing), initiating screening at age 21, and three-year screening intervals. Underscreened participants showed relatively higher preference for HPV self-sampling, and as opposed to adequately screened participants, preferred screening by a gynecologist rather than a family physician. Across groups, participants preferred receiving screening-related information and communication by email over postal mail. Conclusions: The misalignment between women’s preferences and current HPV test-based screening implementation plans requires immediate education interventions and modernized, user-preferred communication channels for cervical screening-eligible individuals in Canada.