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Human papillomavirus (HPV) is a group of about 100 related viruses. Some types can cause skin warts while other types can cause genital warts (also called condylomata). Common in young women and men, most HPV infections that are spread through oral, anal or genital sex are short-lived and relatively benign. There are, however, several types of HPV that are considered high-risk. HPV 16 is the most carcinogenic HPV genotype and accounts for approximately 55-60% of all cervical cancers. HPV 18 is the next most carcinogenic genotype, and accounts for 10-15% of cervical cancers. They do not usually cause visible warts, but persistent infections have been linked to cervical cancer as well as other less common cancers, such as of the vagina, mouth, throat, penis, and anus. Cervical cancer often does not cause symptoms until it is advanced. Women with advanced cervical cancer may have abnormal bleeding, discharge, or pain.  The HPV test detects the genetic material of the high-risk types of HPV associated with cancer.

Test at a glance

Clinical Utility
​Molecular testing for HPV can be used on its own to detect infection, or as a follow-up to abnormal changes detected with a Pap smear. Guidelines from several organizations now recommend that HPV DNA tests be ordered along with a Pap smear for women 30 to 65 years of age.

Ordering
​Healthcare provider needs to collect the sample (after Pap smear and before colposcopy if performed) and fill out a specialized requisition form provided with the collection kit.

Patient instructions
​The patient needs to drop off the sample with the requisition form at a nearby Patient Service Center.

Turnaround Time
​Test results will be available within two weeks.

Cost
​This test is not currently covered by provincial health plans, but may be covered by the patient’s private insurance.

Healthcare Professional Information

​What is Being Tested?

The HPV molecular  test detects the genetic material of the high-risk types of HPV associated with incidence of cancer.  In our laboratory, testing detects the presence of 13 high risk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68 using nucleic acid hybridization.

A positive result for any of the high-risk types can be closely monitored for any pre-cancerous conditions. A negative test for high-risk HPV can provide peace of mind that the patient is at lower risk for developing cervical cancer.

Patient Frequently Asked Questions(FAQs)

How is it used?

Molecular  testing for HPV can be used on its own to detect infection or as a follow-up to abnormal changes detected with a Pap smear. Guidelines from several organizations now recommend that HPV DNA tests be ordered along with a Pap smear for women 30 to 65 years of age.

When is it ordered?

The American College of Obstetricians and Gynecologists (ACOG), the U.S. Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) now recommend HPV testing as part of routine cervical cancer screening for women 30 to 65 years of age, along with Pap smears, every 5 years.

The HPV test is not recommended for screening women younger than age 30 because infections with HPV are relatively common in this age group and often resolve without treatment or complications. However, it may be used as a follow-up test in women who are 21 years or older who have abnormal results on a Pap smear known as "atypical squamous cells of undetermined significance." Results may be used to determine the need for colposcopy, a procedure that allows a doctor to visually inspect the vagina and cervix under magnification for the presence of abnormal cells.

What does the test result mean?

On a Pap smear, ASCUS and low-grade changes indicate the likely presence of HPV and the need for further testing. A positive HPV DNA test indicates the presence of a high-risk type of HPV, but the test does not specify which type is present. If the HPV DNA test is negative, it is unlikely that there is a high-risk HPV infection. If the Pap smear is abnormal but the HPV DNA test is negative, then routine screening as per age specific guidelines should continue.. Likewise, if the Pap smear is normal but the HPV DNA test is positive, additional testing may be necessary. It is recommended to have another Pap smear and HPV test in one year, at which point the Pap smear will indicate if any cell changes have occurred during that time.

Is there a charge for the test?

This test is largely not covered by the provincial health insurance plans, but it may be covered by patient’s extended health insurance plan. Contact us to find out about the current fee for the test.

Is there anything else I should know?

Although very rare, a pregnant woman may pass HPV to her baby during vaginal delivery, resulting in warts in the throat or voice box. (laryngeal papillomatosis or recurrent respiratory papillomatosis, RRP) There are HPV vaccines available in Canada which can help prevent HPV infections and therefore the diseases associated with some of the most prevalent high risk HPV strains 3, 4.

References:

  1. Saslow D., Solomon D., Herschel WL., et al American Cancer Society, American Society for colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening guidelines for Prevention and Early Detection of Cervical Cancer. J Low Genit Tract Dis. 2012 July;16(3):175-204
  2. Cervical cancer screening with the HPV test and the Pap test in women ages 30 and older , CDC website www.cdc.gov/hpv
  3. Brotherton JM, and Gertig DM. Primary prophylactic human papillomavirus vaccination programs: future perspective on global impact. (2011, August). Expert Review of Anti-infective Therapy. Expert Reviews Ltd.. 9(8):627-39. (PMID: 21819329).
  4. Eggertson L. Provinces weighing HPV vaccination of boys. (2012, February 27). CMAJ (Canadian Medical Association Journal). (Reviewed Edition). Ottawa: Canadian Medical Association (CMA). Epub ahead of print. (PMID: 22371513).

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