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Cervical screening

Ontario now uses a primary HPV test — which replaced the Pap test — for people with a cervix, from age 25, who have ever been sexually active. The sample is collected the same way many people remember from a Pap test.

Who it is for
People with a cervix, age 25 or older, who have ever been sexually active and have no symptoms.
The test
A healthcare provider collects a small sample from the cervix to test for HPV. This is different from a Pap test, although the sample is collected in a similar way.
How often?
Usually every 5 years after a negative result from a provider-collected HPV test. Certain immune-system conditions or treatments mean a 3-year interval instead.
When to stop
Many people can stop after a negative result between ages 65 and 69. Others continue through age 74. Your provider checks your history before advising you to stop.
A different care plan
Abnormal results, follow-up after colposcopy, some immune-system conditions, and self-collected tests need a different plan. New symptoms need assessment.
On this page
  1. What this page helps with
  2. Who the routine guidance is for, and who needs another pathway
  3. How to access it in Ontario
  4. Potential benefits and limitations
  5. What the test involves
  6. What happens after an abnormal result
  7. Questions to ask your provider

What this page helps with

Cervical screening — which many people still call a Pap test or Pap smear — now looks for high-risk types of HPV, the virus that causes almost all cervical cancer, in people without symptoms. Ontario uses the HPV test rather than the Pap test for routine screening because it is better at identifying who needs follow-up. The sample is collected in a similar way. This page explains who Ontario's routine program is for, how often the test is done, how stopping is decided, and how to get it. It cannot tell you whether you are due or what a result means.

Symptoms are different from screening. If you have new or concerning symptoms, see a healthcare provider rather than waiting for a screening test. Severe or life-threatening symptoms: call 911 or go to the nearest emergency department. Otherwise a provider, a walk-in or urgent care clinic, or Health811 (811) for advice on where to go.

Who the routine guidance is for, and who needs another pathway

Routine screening is recommended for people with a cervix, age 25 and older, who have ever had sexual activity such as genital skin-to-skin contact, oral sex or penetrative sex (with a partner of any gender), and who have no symptoms. HPV vaccination does not remove the need for screening. A hysterectomy does not always remove the cervix — ask your provider if you are unsure.

Interval. After a negative provider-collected HPV result, most eligible people are screened again in 5 years. People who meet Ontario’s immunocompromised criteria generally screen every 3 years after a negative result. Certain conditions or treatments qualify; not every immune concern or medication does. Your healthcare provider can confirm which interval applies.

Stopping. Many people can stop after a negative provider-collected HPV result between ages 65 and 69. People who meet the immunocompromised criteria continue screening through 74, even after a negative result at 65–69. People still advised to screen every 2 years after discharge from colposcopy also generally continue through 74 until the program’s criteria for returning to routine screening are met. People not screened at 65–69 generally continue through 74. Positive or uncertain results need the appropriate follow-up pathway. Your provider confirms when you can stop from your actual results and history, not age alone.

When you need a different plan. A previous positive HPV test, abnormal cells, or colposcopy follow-up mean your schedule is set by your clinician or the program, not the routine interval.

If your cervix was removed. Routine cervical screening usually does not apply, but some people need follow-up after treatment for cervical disease. Follow any plan from your healthcare team and ask whether you need further testing. Not everyone who has had their cervix removed needs vaginal testing.

How to access it in Ontario

The sample is collected by a healthcare provider — a family doctor, nurse practitioner, or a clinic. If you do not have a provider, Health811 (811) can help you locate an appropriate clinician or service; it does not perform the test. Walk-in clinics, community health centres and sexual health clinics may offer screening. The routine intervals on this page refer to Ontario’s provider-collected cervical screening test. A self-collected vaginal HPV test uses a different follow-up pathway. If you have used one, ask a healthcare provider to review the result and confirm your next step; do not automatically apply this page’s five-year interval or stopping rule.

Potential benefits and limitations

Finding high-risk HPV allows changes to be found and treated before cancer develops; cervical cancer is largely preventable with screening. Limitations: most HPV infections clear on their own, so a positive test often leads to monitoring rather than treatment; follow-up can cause anxiety; and no test finds everything. Screening does not replace assessment of symptoms such as unusual bleeding.

What the test involves

A provider inserts a speculum and takes a small sample of cells from the cervix with a soft brush — usually a few minutes, sometimes briefly uncomfortable. The sample is tested for high-risk HPV. If high-risk HPV is found, the laboratory automatically examines cervical cells from the same provider-collected sample (reflex cytology) to help determine the appropriate next step.

What happens after an abnormal result

A positive HPV result does not mean cancer. Depending on the HPV type and the cell findings, the next step may be a repeat test in a shorter interval or referral for colposcopy (a closer look at the cervix). The program and your provider guide this; this page cannot interpret your result.

Questions to ask your provider

  • When was my last test, what was the result, and when is the next one due?
  • Does an immune-system condition or medication change my interval?
  • I have had a hysterectomy — do I still have a cervix?
  • I am 65–69 with a negative result — can I stop?

Sources

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