Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations

Abstract

The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made.

2023 Canadian Colposcopy Guideline: A Risk-Based Approach to Management and Surveillance of Cervical Dysplasia

“…For the purpose of this guideline, an immediate risk of actionable histology of 5% or greater has been determined as an appropriate threshold for immediate referral to colposcopy. For further information and discussion on entry to colposcopy, please see the complementary guideline ‘A Canadian guideline on the management of a positive HPV test and guidance for specific populations’ [ 4 ].…”

“…Primary HPV screening is superior to cervical cytology in detecting pre-invasive disease and is the topic of a complimentary guideline [ 4 ]. Once high-risk HPV (HR-HPV) is detected, reflex cytology is used to triage the person’s immediate and 5-year risk of a high-grade squamous intraepithelial neoplasia or cancer and the need for colposcopy.…”

2024 Updates to Cervical Cancer Screening in Canada

“…13 In Canada, the recommended triage tests are HPV genotyping for high-risk strains, followed by reflex liquid-based cytology. 3 In addition to these, other types of triage tests are actively under investigation. 3,10 As outlined in the 2023 CPAC/GOC/SCC guideline on management of a positive HPV test, if primary HPV testing produces a positive result, genotyping and/or reflex cytology should be performed to determine whether testing should be repeated at a predetermined interval versus direct referral to colposcopy.…”

“…3 In addition to these, other types of triage tests are actively under investigation. 3,10 As outlined in the 2023 CPAC/GOC/SCC guideline on management of a positive HPV test, if primary HPV testing produces a positive result, genotyping and/or reflex cytology should be performed to determine whether testing should be repeated at a predetermined interval versus direct referral to colposcopy. (Table 1) 3 There is currently no recommendation to modify screening based on vaccination history.…”

“…To help guide this transition, CPAC has collaborated with the Gynecologic Oncology Society of Canada (GOC) and the Society of Canadian Colposcopists (SCC) to release two open-access, evidence-based guidelines in June 2023. These guidelines address how to manage a positive HPV screening test, 3 and colposcopy in the context of primary HPV-screening. 4 This paper will outline the evolution of cervical cancer screening in Canada along with the rationale behind the transition to HPV testing.…”