#11 HPV: Prevention, Screening and Cervical Cancer

HPV is one of the most common sexually transmitted infections, yet it remains widely misunderstood. What is HPV? Who is at risk? Can it be prevented? And what does it really mean if you test positive?

In this episode of The Vulvalution, we're joined by Laurie Smith, RN, to answer the most common questions about HPV and provide clear, evidence-based information on prevention, screening, and care. We discuss the different types of HPV, how the virus is transmitted, its connection to cervical and other cancers, and the important role of HPV vaccination in preventing disease.

We also cover cervical cancer screening, what to expect after a positive HPV test, common myths and misconceptions, and the questions women ask most often about HPV, relationships, and long-term health.

🎧 Whether you've recently received a positive HPV test, want to better understand cervical cancer screening, or are simply looking for reliable information about HPV prevention and care, this episode is for you.

Episode Resources: 
General HPV info:
https://smartsexresource.com/sexually-transmitted-infections/stis-conditions/human-papillomavirus-hpv/

SOGC Canada, HPVinfo.ca
www.hpvinfo.ca
https://hpvinfo.ca/resources/
https://www.hpvinfo.ca/wp-content/uploads/2019/12/SOGC-HPVBrochure-EN-f-web-1.pdf

Cervical Screening:
Cervical screening in British Columbia:
https://www.bccancer.bc.ca/screening/cervix

***For specific recommendations for other provinces/jurisdictions, search for your own provincial guidelines:
For example, in Ontario, Cancer Care Ontario establishes cervical screening guidelines. https://www.cancercareontario.ca/en/types-of-cancer/cervical/screening and

In Alberta, Alberta Health Services establishes cervical screening guidelines. https://screeningforlife.ca/cervical/

Outside of Canada, speak to your clinician or ensure you are look at credible resources for cervical screening guidelines where you live.

HPV Vaccination:
For information about the HPV vaccine in British Columbia
https://www.healthlinkbc.ca/healthlinkbc-files/human-papillomavirus-hpv-vaccine

Immunize Canada:
https://www.immunize.ca/human-papillomavirus-hpv

For those outside of British Columbia, consult your regional/provincial vaccination program for details regarding eligibility, cost etc.

Resources regarding HPV and cervical screening results:
BC Cancer Cervix Screening program:
https://www.bccancer.bc.ca/screening/cervix/how-it-works/understanding-your-results

Chapters: 
00:00 Intro
07:03 What Is HPV and How Common Is It?
09:21 Types of HPV
10:25 HPV and Cancer
18:20 Prevention and Vaccination
30:48 Screening and Testing
36:00 I Tested Positive for HPV—What Should I Do?
40:00 What Women+ Really Want to Know 
44:24 True or False?
46:00 Common HPV Myths
46:51 Resources
49:00 Conclusion

Transcript

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Laurie 0:01

most sexually active people will be exposed to HPV at some point in their lives. what exactly is HPV and how common is it? And so for our listeners who may not know, can you tell us what exactly a Pap smear is and what it looks for? An HPV infection does not mean you have or will get cervical cancer for sure. what are the main ways people can reduce their risk of getting HPV?

Sabrina 0:26

how would someone know if they should be getting a Pap smear versus HPV testing?

Mathilde 0:32

what are the next if someone's screening test comes back positive

Laurie 0:37

for anyone that has HPV detected, it really is their personal choice if they choose to notify a partner. I think I'd also like people to remember that cervical cancer can be eliminated. We can actually eliminate a cancer, about yourself and how you ended up working in the HPV and cervical cancer space? Mm-hmm. I think I might be one of those examples where you just never really know where your career is gonna take you. So for many years, I worked as an RN in the acute care setting in the hospital, and I was working in critical care, and this opportunity to work in the clinical trials research office came to me, and I moved into that position, and I never really thought about research before, but once I was in that role, I was really intrigued by research. I found it quite fascinating that the potential research had to improve and change the way we did things. And when you think about it, everything we were implementing in medicine began in research. So all research kind of leads to evidence-based medicine. Um, fast-forward a few years, I saw this posting for a trials manager for a study evaluating improved ways to screen women for cervical cancer, and although it was kind of out of my, my current scope, I applied for it. I was always really passionate about women's health and prevention, so that's

Mathilde 1:10

hello, vulva squad

Sabrina 1:13

vulva squad Welcome back to another episode of the Vulvalution with your two best friends, Sabrina and Mathilde. We're back. Yay. Oh my God. Today was a really good episode on HPV and cervical cancer. Yes. We learned so much, whether it was about vaccination, the different kinds of screening available. We talked about the Pap smear, um, if it's scary or not. Yes Also, the different screening that you can do. There's new options, which is great. Mm-hmm. Yeah, a little bit about a vaccine and how common HPV is. Yes, and we learned so much about how HPV

Mathilde 1:45

HPV is,

Sabrina 1:45

is, like, different and considered differently than other STIs, like chlamydia or gonorrhea,

Mathilde 1:50

like chlamydia

Sabrina 1:50

and I feel like that distinction was so interesting, and I think you'll wanna hear about it. Yeah, and I think one main key takeaway from this episode is that if you get HPV positive, it doesn't mean that you have cancer necessarily. No, not at all. So, yeah. You're gonna learn more about this disease. Yep. So let's get into it.

Mathilde 2:14

Okay. Okay. Are you good to go? Yep. All right.

Sabrina 2:15

Welcome

Laurie 2:15

Back to the Vulvolution. Today we're diving into HPV and cervical cancer prevention, a topic that can feel confusing, intimidating, or even a little awkward, but truly affects so many of us. To guide us through it today, we're joined with someone very special, Laurie Smith, which has been at the heart of HPV research and cervical cancer elimination efforts in British Columbia for nearly two decades. Laurie is the program manager of the Global Control Pro-

Sabrina 2:44

HPV Related Diseases Research program at

Laurie 2:48

Gram at the woman

Sabrina 2:48

Health Research Institute.

Laurie 2:50

She has dedicated her career to improving cervical cancer prevention, supporting both clinicians and patients in advancing public health policy. She's also an RN with certified practice in reproductive and sexual health and practices at Options for Sexual Health. So we are so excited to have you here today, to talk all about HPV screening, vaccination, stigma, and how people can protect themselves. So welcome to The VaLVeLution.

Sabrina 3:11

stigma, and how people can protect themselves. So welcome to the Vulvolution

Laurie 3:15

Well, thanks for having me. Thank you. So to start off, would you mind sharing a little bit about yourself and how you ended up working in the HPV and cervical cancer space? Mm-hmm. I think I might be one of those examples where you just never really know where your career is gonna take you. So for many years, I worked as an RN in the acute care setting in the hospital, and I was working in critical care, and this opportunity to work in the clinical trials research office came to me, and I moved into that position, and I never really thought about research before, but once I was in that role, I was really intrigued by research. I found it quite fascinating that the potential research had to improve and change the way we did things. And when you think about it, everything we were implementing in medicine began in research. So all research kind of leads to evidence-based medicine. Um, fast-forward a few years, I saw this posting for a trials manager for a study evaluating improved ways to screen women for cervical cancer, and although it was kind of out of my, my current scope, I applied for it. I was always really passionate about women's health and prevention, so that's what attracted me to this position. Um, I applied. I was hired. Yay. So that was, that was great. Uh, and that's really what catalyzed my career in, in this path. And it's when I started working with, uh, Dr. Gina Ogilvie, who really is a, you know, a rock star, a leader in cervical cancer research in Canada, and I feel fortunate to be able to work with her still for, for many, many years. And over the years, our, our research has, um, grown, and our program really focuses on cervical cancer prevention. So we've led numerous trials over the years in, in cervical cancer prevention, and so I guess that's where we are today. Fantastic. Mm-hmm.

Sabrina 5:23

thank you. You're doing very important

Laurie 5:25

Great. Well, thank you. You're doing very important work. And thanks for sitting-

Sabrina 5:26

sitting with us today and answering our questions and our listeners'

Laurie 5:29

nurse questions, 'cause I

Sabrina 5:30

we mentioned at the beginning, it's a

Laurie 5:32

as we mentioned at the beginning, it's a very taboo subject and people don't really know what it is. Mm-hmm. is. Right. So what exactly is HPV and how common is it? So that's a great way to start our conversation. Human papillomavirus or HPV is very, very common. There are about 200 genotypes or strains of HPV, about 40 of them can infect the anogenital region, and those are the ones we focus on in, in our work. Anogenital HPV types are sexually transmitted through intimate skin-to-skin contact. So they're not transmitted through bodily fluids, say like chlamydia and gonorrhea are. HPV can af- affect anyone regardless of s*x or gender, and most sexually active people will be exposed to HPV at some point in their lives. And people are usually exposed to HPV within a few months or within a few years of first becoming sexually active. The thing about HPV is that most infections are harmless, and the body's own, immune system will control that infection. Within a couple of years' time, that person might not even ever know they had an infection. There'll be no symptoms. So because of that as well, HPV is transmitted frequently throughout the population 'cause people don't know they have it

Sabrina 6:49

Okay.

Laurie 6:51

And we often hear that there's many different types, as you just alluded to. Can you explain the difference between low-risk types or that cause like genital warts, and high-risk types that can potentially lead to cervical cancer? Mm-hmm. Okay. Well, I'm glad you asked that question 'cause I do think it's important for people to have that differentiation. So the lower types, as you said, cause genital warts. They are not associated with any of the HPV related cancers. So I think a lot of people know what genital warts are, but they might not know that they're caused by HPV. So all warts are caused by HPV, but not all HPV causes warts. So the high-risk types or oncogenic types can potentially lead to various cancers. The HPV-associated cancer we're all most familiar with is cervical cancer. However, high-risk HPV can lead to other HPV-related cancers like vulvar, vaginal, anal, and a subset of head and neck cancers. Now, I actually just read a recent paper, and they estimated the global burden of HPV-related cancers is about 7.5%. So this equates to over one million cases of HPV-related cancers. And as I mentioned, cervical cancer is the most common type, but we are seeing increasing rates of anal and head and neck cancers attributed to HPV. If I could also add here, I think one thing people may not realize is that cervical cancer actually is almost entirely preventable through HPV vaccination and through screening. And because it can be prevented and because there's still quite a high global burden of cervical cancer around the world, jurisdictions around the world are sort of on this path to eliminate cervical cancer. And so there are strategies a- across Canada in the different jurisdictions to try to move the needle towards elimination.

Mathilde 8:43

Mm-hmm. Okay. So let's say someone gets diagnosed with

Sabrina 8:46

one of the higher risk

Mathilde 8:48

HPV, is that preventable to get cancer after or what?

Sabrina 8:52

you have this higher risk, then you're like-

Laurie 8:55

Ye- yeah, um, no. If you have an HPV infection, it doesn't necessarily mean you're gonna get cancer. Okay. And we maybe can get into that m- more later when we talk about testing, but, um, an HPV infection does not mean you have or will get cervical cancer for sure. Okay. Yeah. That's a good clarification. Yeah. Okay, so in cases where HPV infection does progress- Mm-hmm um, how long does it take-

Sabrina 9:20

take for an infection to develop into a cervical cancer?

Laurie 9:24

Right. Okay. So with the most HPV infections, even with those highest risk types, our immune system can mount a really robust response and control that infection within about one to two years. And again, the infection would cause no problems, no symptoms. For a high-risk type of HPV to lead to pre-cancer or invasive cervical cancer, it needs to persist for many years. We're talking 10 to 15 years or more, but also go untreated. So this is because it takes very long for that HPV infection to sort of move through the layers of epithelium skin to cause those changes that lead to cervical cancer. So essentially, the long and short of it is that it takes many years for an HPV infection to lead to cervical cancer, and it needs to go untreated. Okay. So now that we understand a little bit more what HPV

Sabrina 10:15

a little bit more what HPV

Laurie 10:17

is, we're gonna move on to prevention and vaccination. So first off, could you tell us a little bit about prevention? So what are the main ways people can reduce their risk of getting HPV? Well, aside from complete abstinence, the main, uh, way to prevent an anogenital HPV infection is with vaccination.

Sabrina 10:38

Okay.

Laurie 10:39

And what exactly does-

Sabrina 10:42

HPV vaccination protect against? Mm-hmm.

Laurie 10:46

Right. So the currently available vaccine that we have in British Columbia is called the nonavalent vaccine. It protects against nine types of HPV infection. So it, it protects against types 6 and 11, which are the two most common low-risk types that lead to genital warts. It protects against 16 and 18, the two that are most associated with cervical cancer. And then the other types prevented in the vaccine are the other high-risk types. So with the nonavalent vaccine, a person would have about 90% protection against cervical cancer. But it doesn't just protect against cervical cancer. HPV 16 in particular, is associated with other cancers like the head and neck and the anal cancer that I mentioned before. So the vaccine has the potential to protect against other HPV-related cancers as well. Okay. And you alluded to it there, but just to, to really nail it home, how effective is this vaccine? Yeah. Great question, uh, also important. So because it can take that 10 to 20 years for an HPV infection to lead to disease, it takes a long time for us to see the effects of vaccination on a population level. So we're at about 20 years now into wide-scale implementation of the vaccine around the world. And I was looking at a paper, it's a 2024 Cochrane review, and the Cochrane reviews are sort of like a, a gold standard of evidence-based medicine. So Cochrane reviews are held in high regard. And this Cochrane review reported long-term outcome data from different countries, from different study designs, that consistently report a decrease in cervical cancer and pre-cancer in places where girls are vaccinated at early adolescence. And we're also seeing actually a decrease in prevalence of genital warts across various populations as well. I think as more time goes by, we will see the effect of HPV vaccination on other HPV-related cancers. When the vaccine first rolled out, there were questions about its safety. I think a lot of people thought it was a new vaccine, it's not safe. So because we've also been vaccinating for so many years, not only do we have effectiveness data, we have safety data, and it is an incredibly safe vaccine. Millions and millions of doses have been administered around the world, and the, the safety data is as overwhelming as the efficacy data.

Sabrina 13:20

Fantastic. Okay.

Laurie 13:20

So it's safe, it's effective, prevents not only against cancer but also with, against genital warts. Mm-hmm, mm-hmm. So it's like everyone should get it. Yep, definitely. Okay. So everyone should get it, yeah. So actually, who should get the vaccine, and who is currently eligible for free vaccination- Mm-hmm in, vaccination in, uh, BC currently?

Sabrina 13:29

Yeah. So actually, who should get the vaccine, and who is currently eligible for free vaccination in BC, Canada? Right.

Laurie 13:37

So last year in July our, our BC government expanded coverage of the free vaccine, which was fantastic news. So there's actually a, a pretty long list now of folks who are eligible for the free vaccine. Right now kids in grade six are offered the vaccine in the school-based immunization program, and the vaccine is free for anyone, regardless of sex or gender identity from age nine to 26, and there are other groups that are also eligible, and I don't want to forget any of them, so I think maybe what we could do is link the list- Totally to your, to your listeners 'cause I- Mm-hmm there are several different groups and, and folks that could get the vaccine for free over the age of 26. Okay. Mm-hmm. And let's say you had the vaccine at age nine- Mm-hmm do you have to get the vaccine again later on in life? No. No. We're seeing, again, this efficacy data is showing that, that the vaccine has long-term efficacy. So as of where we are right now, I, personally am not aware of any trials that show you need booster data. And now in school-aged children, they get one dose of the HPV vaccine in school. The BC government and policymakers

Sabrina 14:47

encourage HPV vaccination to school-age children.

Laurie 14:51

So why is it that the timing of when the vaccine

Sabrina 14:54

is offered, like why is that important? Yeah,

Laurie 14:56

that is, that is really important, and a couple of reasons really. The vaccine is most effective when it's given to people before they're ever exposed sexually to HPV. And just in, in school-age children, they're getting other vaccines as well. So that's reason number one. Reason number two is that our immune systems are most robust when we are younger, so kids under the age of 15 have that really robust immune system. So this isn't to say that it's not effective for people beyond early adolescence. A lot of people get the vaccine after grade six or over the age of 15 with benefit as well. Okay, and the vaccine is now recommended for both boys and girls. When did that change happen, and what was the reason behind it specifically?

Sabrina 15:42

extending vaccination to boys? Because it was before-

Mathilde 15:46

just- Mm

Sabrina 15:46

just, uh,

Laurie 15:46

Just girls Yes, it was just for girls in the early days. So it expanded in, I think, 2017 to boys, and really because we want to protect everyone from HPV-related diseases. The vaccine isn't just a cervical cancer vaccine, so we can now offer protection to boys against HPV-related diseases. And the other reason is the more people you vaccinate against something, then the more chances we have for herd immunity, meaning, the more people are vaccinated, the less disease we have circulating in the population. So the more people are vaccinated against HPV, the less HPV will be transmitted between people.

Sabrina 16:28

Yes, and ideally, we can just wipe

Laurie 16:29

Yes. And ideally, we can just wipe it right out. Yeah. Okay. Is it ever too late to get vaccinated? Um, Well, the manufacturer on label recommendation for upper age limit is

Sabrina 16:39

age

Laurie 16:40

age 45. But there are some instances where people can get the vaccine over the age of 45. So for example, I mentioned that list of other people who can get it for free. So women undergoing treatment to their cervix for pre-cancer can get the vaccine for free at their treatment, and they can be any age for that. And if a person is just really... If they wonder if they're eligible for the vaccine or if it's a good idea for them, that they can speak with their healthcare provider and make that decision together.

Sabrina 17:10

Okay. Let's

Laurie 17:11

Let's say someone gets vaccinated, are there any other

Sabrina 17:14

things that this person could do

Laurie 17:16

things that this person could do to avoid getting HPV? So is there any other lifestyle or behavioral factors that may influence HPV risk? Mm-hmm. Great question. So vaccination is definitely, number one strategy. Always recommend that. As I mentioned, HPV is transmitted through intimate skin-to-skin sexual contact, so there's a place for people to wear condoms with new sexual partners. That's going to decrease the risk of transmission. It's not gonna fully eliminate it, but it will decrease it. I think there are also other reasons why people should be wearing condoms. It'll help decrease transmission of other STIs. The more sexual partners a person has, the more chances they will be exposed to different HPV. And smoking is a big factor, so if people smoke, we recommend they stop smoking or don't smoke. That can decrease your chances of clearing an infection.

Sabrina 18:06

Interesting. So

Laurie 18:08

let's move on to screening and testing, another big- Mm-hmm area within HPV. So historically, the main screening test available for cervical cancer was the

Mathilde 18:18

Pap

Sabrina 18:19

smear. And so for our listeners who may not

Laurie 18:21

Pap smear. And so for our listeners who may not know, can you tell us what exactly a Pap smear is and what it looks for? Right. Such a great question. I think a lot of people know they need a Pap, but they don't really know why or what- Yes it's actually doing. So when we get a Pap smear, you have to go see a healthcare provider, have a pelvic exam. A small sample of cells is taken from the cervix, where it's sent to the lab and assessed for cervical abnormalities. Now the Pap over the years has done an amazing job at decreasing cervical cancer incidence in, in our population. So we really owe a lot to the Pap, you know? It's done an amazing job. In my experience at the clinic, I think a lot of people think that a Pap smear might also be checking for other STIs or ovarian cancer or whatever other reasons. But I, I think it's important for people to know what we're looking for is, like I said, the cervical cells. It's called cytology. It's the more technical term. It's purely a cervical cancer screening tool.

Mathilde 19:23

Mm-hmm. Yeah.

Sabrina 19:23

So if you're looking to get tested for other STIs-

Laurie 19:26

Yeah do that separately. Yeah, and I'll just also add, too, that, you

Sabrina 19:26

have to do that separately. Yeah. And I'll just also add too that, you know,

Laurie 19:30

cervical screening, be it the Pap or otherwise, is recommended to everybody with a cervix regardless of their gender identity. Mm-hmm. I remember when I was growing up, I was hearing that everyone should get a Pap smear by the age of 21 or at the age of 21. And now the recommended age has changed, um, to... Could you tell us what age and why did it change? Right. Right. So you're right. Originally, it was starting at age 21 or three years after you first started sexual activity. And in about 2016, this changed to the starting age was 25, and the reason for that is that cervical cancer rates are very low in people under the age of 25, and in fact, screening at earlier ages, can lead to unnecessary treatments and identifying HPV infections that would otherwise resolve on their own. The highest prevalence of HPV is in folks under 25, and so this is one of those cases where screening more often or doing something more often isn't actually better. So you don't want to screen for people for something that would ultimately lead to maybe further testing and treatment that they don't need. Right. Interesting, 'cause you, you mentioned If you're under 20

Sabrina 20:44

25, there's a high risk that

Mathilde 20:46

that you have

Sabrina 20:47

you

Laurie 20:47

HPV, but it's, remember, it's transient and most of them our immune systems will control it eventually. And because it takes so long to develop- Correct. Yeah, exactly

Sabrina 20:56

about catching it

Laurie 20:57

into cancer, you're worried about

Sabrina 20:58

Okay.

Laurie 21:00

catching it early. For sure. Yeah. screening is for people that are asymptomatic. So cervical screening for average risk folks is for people that have no symptoms. We're trying to identify people at risk for disease before they have any symptoms. If someone has any kind of abnormal symptoms like bleeding between periods, bleeding after s*x, bleeding after menopause, or anything they're concerned about, that's not screening. They should definitely see a healthcare provider to have that checked out. Yeah.

Sabrina 21:26

That's an important

Laurie 21:27

That's an important clarification. Mm-hmm. Okay. Um, so here in BC-

Sabrina 21:30

in large part to your work we now have we now have both Pap smear as well as HPV testing options. So can you explain how HPV screening works and how it's different from a Pap test?

Laurie 21:43

This is a question I get all the time, so thank you for asking me. So we touched on it a little bit before of what the Pap is actually doing. You need to see a clinician, have a pelvic exam, and we're identifying changes to the cells of the cervix after they've already started. So the Pap identifies things once they're already happening. The Pap has a relatively high false negative rate as well, so it, it's a good tool, but it's not the best tool we have in our toolbox. So to improve its performance, It used to be done every two, two years, then it moved to every three years. Now, with HPV testing, we are just looking for the presence of high-risk HPV. Is it there? Yes or no. So we're not looking for abnormal cells. So HPV samples can be taken from the cervix or from the vagina. We don't necessarily need to take a sample of HPV from the cervix. HPV testing identifies people at risk for cervical changes, often earlier than the Pap might. Also HPV testing has a much lower false negative rate, so we have a lot more confidence in an HPV result where no HPV is detected. One way to think about HPV screening is that it's enhanced technology. You know, over time, technology always improves, and maybe one way to think it is HPV testing is like the iPhone 17- Mm-hmm and the Pap is, I don't know, iPhone 8? 12? Yeah. Mm-hmm. Yeah.

Mathilde 23:15

Mm-hmm.

Sabrina 23:15

Yeah, no, that's a great

Laurie 23:16

No, that's a great analogy. Things get better- Yeah as we evolve with, with the technology. Yeah, yeah. So could you explain a little bit what the test is, the HPV test? Mm-hmm. So it is a provider collected or patient collected. So if a patient collects the swab themselves, it's a vaginal swab. So it's not a blood test or anything like that. If a healthcare provider collects it, It can be done the old-fashioned way, like a Pap was, with a cervical sample, or it can also be collected vaginally by the provider as well. Okay. Okay, great. And how often should people be screened

Sabrina 23:50

for cervical cancer, and does it depend on

Laurie 23:53

for cervical cancer, and does it depend on whether they're getting a Pap test or an HPV test? Mm-hmm. Mm-hmm. Yeah, great question. There are differences between the two. So because of the improved performance of HPV testing for the average risk person it's every five years if no HPV is detected in their sample. For, a person getting cytology or the Pap test, it's every three years because of that higher chance of a false negative rate. I think a lot of patients that I see think cervical cancer happens quickly because they were used to getting tested so frequently, as I said, every two years and now every three years with the Pap. So people are quite concerned when they think about this five-year interval. But when we give them information about the differences between the tests and the improved confidence we have in HPV testing, that gives them some reassurance about that extended interval.

Sabrina 24:45

Yeah. I honestly just... I love the HPV option cause I think people are often scared to go for their first Pap smear. Yes. Yeah, for sure And they don't know what's gonna be on it. And I think we'll talk about that a little bit, but it's so nice that you can do it at home or with your provider- Mm-hmm and it's a much less invasive test, so. Absolutely. Yeah. So thankful to- Yeah all of the work you guys have been doing at CCPO. Okay. So how would someone know if they should be getting a Pap smear versus HPV testing?

Laurie 25:12

Excellent question. I do think there's some confusion around this. Essentially, people aren't choosing the test that happens at the laboratory. What they're choosing is how they want their sample collected. So if a person collects the sample themselves, the vaginal swab, HPV testing is conducted on that swab. If a person chooses to see a provider, maybe they're more comfortable with that. They don't feel comfortable collecting it themselves. 'Cause some people still will prefer to see a provider. It depends on what, collection device that provider uses. So the provider could also do a vaginal swab, or they can do cytology or the Pap. We're at a time right now in British Columbia where we're moving through this transition to full HPV screening. And just for folks to realize that eventually, in the coming year or so, HPV screening will be our primary tool regardless of whether the provider collects it or the patient collects it. There may still be a place for cytology, so if people are HPV positive, depending on the type, the next step might be cytology testing or that, that Pap. Okay.

Mathilde 26:22

But

Sabrina 26:22

moving away from the Pap

Mathilde 26:24

smear

Sabrina 26:24

smear. As our main tool, correct. Mm-hmm.

Laurie 26:26

But we're moving away from the Pap smear. As our main tool, correct. Yeah. Okay. That's great news for a lot of people. Yeah. Yeah, people have choice right now. Yeah. Yeah. It's better to have options. Yeah. You'll reach more people. Yeah. Mm-hmm. Yeah.

Sabrina 26:33

Yeah. You'll reach more people. So we're talking a lot about HPV screening or HPV testing specifically, which is available on PC, but is it available on available across Canada? Can you talk- Mm-hmm

Laurie 26:44

So not at all Yeah, so cervical screening across Canada is managed provincially or jurisdictionally. As far as I know, British Columbia, PEI, Quebec, and

Sabrina 26:55

PEI,

Laurie 26:56

Ontario have transitioned to HPV primary screening, and other provinces are in various stages of planning for implementation. But outside of Canada, HPV screening is the main approach in places like Australia. They've been doing it for many, many years, um, Denmark, the Netherlands, Sweden. I could, you know, list off a whole bunch of them. So it's not like we're just the Wild West here in, in BC. Okay. So- This is... Yeah, the science is overwhelming about HPV screening as a, an enhanced tool to help identify pre-cancers earlier and better. So around the world, people are making that shift. Even in, in places where there isn't as much access and infrastructure. So in the low-middle-income setting, HPV self-screening is being offered to really help improve cervical cancer rates there as well.

Sabrina 27:45

Fantastic. Well, it's great to hear that it's, it's getting across Canada 'cause I think the last time I looked at this it was like BC was ahead of the curve and- Yeah everyone was waiting. So it's good to see it's progressing. Yeah.

Laurie 27:57

I'll say the question again. I'm so sorry. Okay.

Mathilde 27:57

What would you say to someone who feels nervous or intimidated about the HPV screening to help them feel more comfortable getting tested?

Laurie 28:03

So that's a great question. Historically, people may have avoided the Pap test because it requires a visit to a provider, a pelvic exam, and this can be very intimidating or traumatizing to some people. Or maybe people don't have a doctor, or they can't access or take time off work to go. And it's, you know, no one's favorite thing to, to do, quite honestly. But I think we're at a really great time in screening, not just in BC, but everywhere, where there is this choice in how people can have their sample collected. So I think the important thing is to make sure people know, that they should get screened, and that, again, starting at age 25 or if they're unsure to speak with their provider. But because we now have this choice in how the sample can be collected, if someone prefers to collect it vaginally in the privacy of their own home. That can reduce some of that nerves and, and maybe fear of the unknown. Most people that I've spoken to who have done self-collection find it very simple. It's painless, it's easy, maybe not as scary as they thought. And just sort of to, to emphasize, when a person self-collects, they're not trying to reach their cervix like the doctor would've. They're just doing a vaginal swab. But for folks that don't mind seeing a provider, or if that is their preference, there's that choice as well. So I think these options are really improving access to screening and making it more of an equitable approach.

Sabrina 29:34

Absolutely. I feel Absolutely. I feel like in general, in health as a field, there's limited women's health always great as a field, there's limited options, so it's always great to see expanded options- Mm-hmm and people just having more ways to prevent cancer- Right and other things- Yeah, definitely across the board. Yeah. Mm-hmm and people just having more ways to prevent cancer and other things- Yeah across the board. Outside cervical cancer of cervical cancer screening, can someone request HPV screening if they're just curious

Laurie 29:56

HPV screening if they're just curious- Mm-hmm about their HPV status? Yeah. Well, yeah, that's a question I get a lot in clinic, and it often arises when, say a patient may have had a partner disclose to them that they had genital warts, and so they come in wanting to get HPV testing. So the HPV testing we're talking about today for cervical screening is not to be confused with any kind of STI testing. Yes, HPV is sexually transmitted, but it is not STI testing that we're doing, so it's not to be confused with that. HPV screening is conducted purely for cervical cancer screening, and at this point in time, there is no other HPV screening outside of cervical screening.

Sabrina 30:35

Okay.

Mathilde 30:36

Now, what are the next if someone's screening test comes back positive for step if someone's, um, screening test comes back positive- mm-hmm mm-hmm ...HPV? I know some people that got, uh- Oh, yeah Oh yeah. -and it's very

Laurie 30:46

a call, and it's very- Uh-huh stressful- Definitely uh, when you get a call back if they said that it's positive. Right.

Mathilde 30:52

So what would be the

Laurie 30:53

next step? Yeah, I think as we're just starting HPV screening in the province, people have never been exposed to this before this testing approach. So it is... it can be nerve-wracking. So first and foremost, which we talked about before, having an HPV type detected in the sample does not mean that person has or is going to develop cervical cancer. If high-risk HPV is detected it really depends on which type as well as what the next steps will be. So if it's 16 or 18, again, those two that are most associated with cervical cancer, that person will usually be recommended for something called colposcopy, not to be confused with colonoscopy. But colposcopy is where, a person goes to a clinic and a gynecologist trained in colposcopy does a closer look of the exam and takes a tiny little sample for tissue biopsy and then next steps, treatment recommendations will be based on that. If it... the HPV type detected is not 16 or 18, then they may need to come back to have a Pap smear, and that's when we'll start to look for those abnormal cells. So again, it doesn't mean that person has or will develop cervical cancer. It just means this is someone that let's watch them closely- Mm-hmm for a little while. And also, the person might not be recommended to re-screen for HPV in a year or so because remember, it can take a while, like a year or two, for our immune system to mount a response to HPV. So we don't wanna test people too frequently for these infections that might go undetected the next time.

Mathilde 32:29

Okay. So they might need to go in, get a Pap smear. Yeah. And then wait a few years and then go back Yeah, I, you know, I probably I won't go into the whole algorithm, but there are just different paths depending on the, the combination of results. The most important thing is that that person is being identified and followed closely. And I think, again, I can never say this enough, HPV is highly common. It's very prevalent. Most people will be exposed to HPV at some point in their lives. So it's likely, now that we're starting HPV testing, that a lot of people will have an HPV detected in their sample. But I guess a good thing to highlight is that a lot of people also now won't have to have a Pap smear at all if they're tested this way. Yeah, yeah. And more people will test negative than positive, and again, virtually everyone is exposed to HPV, but not everyone develops cervical cancer, so that's another way to look at it as well.

Laurie 33:23

If HPV is detected and the immune system mounts a response, it's possible that throughout our lives we'll go through phases of HPV detected or not detected. So we are sometimes seeing in older women, an HPV result may show that it's detected, and that might be they don't have a new infection, but they might have had an infection years ago, and their immune system's just a little less robust now, and that infection has come back.

Mathilde 33:48

Yeah. Mm-hmm. So if you have have

Sabrina 33:50

a call that says that you're HPV

Laurie 33:52

Being positive doesn't mean that you have cancer. No. It's really important. And if you need more answers, talk to your healthcare provider, reach out to the cervix screening program. There's also tons of going to the right places. information available online- Yeah as long as you're going to the right places. As we all know, there's a lot of- Yes not good information- Misinformation out there, so yeah. Yes. We're fighting it with the podcast. You are, yes. And we're, we're gonna link-

Sabrina 34:14

gonna link the resources in our, um- Mm-hmm.

Mathilde 34:17

Yes. So if someone tests positive for HPV, is it important for them

Sabrina 34:25

like, when did they

Laurie 34:26

to know from who- Mm-hmm they got it from and, like, when did they get the infection? Yeah, I love this question. This comes up all the time, so I think it's important for your, for your listeners to know this. So the short answer for this is no. Well, you might not even know who you caught it from or- when. 'Cause it's so common. 'Cause it's so common, and because that infection might have been caught years ago. So it's, it's not even really feasible a lot of the time to know when or from whom you got the HPV infection, and it's, it's not necessary. When HPV is detected in the screen, again, it might've been caught so long ago. It doesn't mean it was from the current partner that you have right now. And again, in these discussions with people, I really emphasize that prevalence of HPV in the population. And this, it's not realistic to think that you'll never be exposed to HPV. It's more realistic to think, "I might have an HPV infection at some point." That's really interesting 'cause it is contrast to other STIs. Yeah. Where we do encourage people to

Sabrina 35:21

trace it back because

Laurie 35:22

to trace it back because those are less common. Yeah, yeah. And well, it's, it's bec- it's not just because they're less common, but say, for example, chlamydia and gonorrhea. That's a bacterial infection, and we can treat that and you want to test and treat the partners of someone with a chlamydia or gonorrhea infection so that they're not continuing to spread it. We know HPV is sexually transmitted, but it's just not in that bucket of the other STIs.

Sabrina 35:45

We're, again, just focusing on HPV as a cancer risk. Right. Mm-hmm. Okay. Okay, so because HPV can sometimes linger at low levels, as we've talked about, and show up years after someone first contracted it. Mm-hmm. Um, a new diagnosis could create a lot of confusion, especially in someone who's in a long-term relationship. Like, have you been cheating? Mm-hmm. Mm-hmm. Something like that. How can you explain this in a, the context of a relationship so that it doesn't create fear or blame or embarrassment? Yeah. You know, there's a lot in that question and a lot to answer there. But especially in these early days of HPV screening where this is new for everybody and people are just learning about HPV infections, they're learning that they have HPV detected in their sample. There are a few possible reasons for this, and I, I probably haven't explained this yet. But, so a person may have an HPV infection that has never been detected before, so that's, you know, what we might call a new HPV infection. HPV detected in a sample could also be from partner deposition. So the person may have had their HPV sample taken shortly after a sexual act, and you're just picking up the partner's HPV status, and that person doesn't have an actual HPV infection. Or this may be re-detection

Laurie 37:06

redetection of an infection they had many, many years ago. But we might not know that because this is their first HPV infection. So first and foremost, this really doesn't mean the partner has not been faithful because there are so many... Again, goes back to not knowing when or from whom you got the HPV infection. So, making sure people understand this is going to be really helpful to, to navigate those conversations. I also find that this is when partners want to ask about their own HPV status and typically sexual partners share HPV types back and forth. So by the time that person's HPV test result has come back, those partners have already shared their HPV type back and forth. And again, it's, very, very prevalent. If a person with HPV detected has a partner with a cervix, I would always recommend that they make sure their partner is following the regular or the routine cervix screening guidelines. For male partners, as I said, There's no medically approved or available tests for males for HPV. HPV screening is specifically for cervical cancer screening. This I guess also just goes back to the HPV vaccination topic. I think everyone can benefit from the HPV vaccine. If people are in new relationships or out there sexually active, the HPV vaccine is a good idea to help prevent future infections. HPV vaccination is not gonna protect you against a strain that you might already have or cure an HPV infection. But HPV vaccination could protect you against future infections. Okay. So making sure that-

Sabrina 38:46

that you got your vaccine

Mathilde 38:48

is the first

Laurie 38:49

Yeah And also no blame. Don't worry about cheating No in your relationship if HPV is detected Yeah or anything

Sabrina 38:56

explanations, and it could be an old infection.

Laurie 38:58

and it's really for anyone that has HPV detected, it really is their personal choice if they choose to notify a partner. They don't need to contact all their previous sexual contacts and let them know. Again, it's not to be lumped in the same category as- Mm-hmm as STI notification for testing and treatment. That's very interesting. Yeah. I, I don't think I've like thought about that, I think in my own mind- Oh, okay. Yeah putting that together. It makes a lot of sense though, because there is no, like, let's say, cure or treatment that you need to give to those partners- Yeah in contrast to gonorrhea and chlamydia or other- Yeah examples like that. Yeah. When we treat women for cervical pre-cancer, we're not curing that HPV per se, we're treating the abnormal cells. We're removing those abnormal cells. Right. Or even aside from cervical cancer, with genital warts, if we are offering treatment in the clinic for genital warts, that's just treating the visible effects of that HPV infection. It's not necessarily curing the HPV infection. Wow. Very interesting. Okay. So now that we know more about what HPV is, a little bit about the screening and testing and the vaccines, now we're moving on to our section, What Women Really Wanna Know. So this is a section where our listeners are asking questions on our social media. Mm-hmm. So the first question from our listener is: How long is HPV-

Sabrina 40:19

contagious for?

Laurie 40:21

If you have an HPV infection then you can transmit it. But again, we don't know when we have HPV infections, so, you could have HPV detected in a sample today, and a month from now it might not be there. Maybe That question is rooted in if an HPV result comes back positive, should they refrain from sexual activity until their next result is HPV negative? Not necessarily, particularly if that person's in a relationship, they've already been exposing it back and forth to one another. Again, maybe going back to using condoms for new sexual partners. Okay. Yeah. That's, it- I don't think there's a black and white answer to that question. Yeah. Yeah. No, it's interesting to think about because I think people might feel like blame- Yeah

Sabrina 41:06

sharing it with someone else,

Laurie 41:07

that they may be sharing it with someone else, but in reality, they're all going around anyway- Yeah

Sabrina 41:10

case. Another question from a listener is how long can HPV be dormant before positive test?

Laurie 41:18

A positive test? Mm. Again, we, we just don't know the answer to that question, but it could be many, many years. Because of those different reasons why HPV is detected, it could be that you had an HPV infection, I'm gonna just say when you're 20, and then, The, the immune system controls it for many years, and then you're 52 and an HPV infection is detected again. So our immune system can control it, and so maybe that's what they mean by dormant. So if your immune con- system is controlling it, it's not causing any harm. And we're not sure if HPV ever really absolutely clears from our bodies, but if the immune system is controlling it, it's not causing any harm, causing any symptoms, it doesn't really matter. Mm-hmm. Okay. If that makes sense.

Mathilde 42:03

Yeah.

Sabrina 42:04

Another question from our listener is, any advice

Laurie 42:07

for someone having their first pap smear, and what can they expect? All have it. Yeah. One more time. Here we go.

Mathilde 42:10

Another question from our listener is, any advice for someone having their first pap smear, and what can they expect? Right. So again, this is where I think that choice is really important. So I think for people having their very first cervical screen, and that's, I think, what I like to refer to it is it's cervical screening 'cause it can be HPV or cytology right now.

Laurie 42:26

They just need to figure out what they're most comfortable with. Would they prefer to have a provider collect their sample? Would they pref-prefer to go to a clinician and have the sample taken there? Or would they prefer to take it themselves at home via a vaginal swab and not undergo the speculum exam? So that I think is just maybe one of the first things is knowing there's choice for them, and that if they are petrified about going to a provider to have a speculum exam, then maybe the vaginal swab is for them. Maybe I should also add here, too, that it's important that people realize that if you have any medical concerns, you should see a doctor for those. So the vaginal swab at home isn't a replacement to see clinician for your other medical reasons. There are times where what helped physicians do follow-up on people is they would bring them in for the Pap, and they would do other health checks on them as well. So there's... There's still a need for those to occur. Having the vaginal swab option at home doesn't replace seeing a provider for your other medical issues. I think it's less scary

Mathilde 43:32

now with podcast, people can understand a little bit more what it's for the pap smear and the testing too,

Laurie 43:38

and you alluded to the fact that people have choice

Sabrina 43:41

in HPV screening versus Pap

Laurie 43:43

smear across, as we mentioned, most of the provinces now. Oh, sorry, let me just add. Yeah. Um, not all provinces are implementing or starting to implement the self screening. Okay. So HPV primary screening has rolled out in those provinces I mentioned. So again, HPV testing can be collected on the vaginal swab or on a cervical swab. So not all provinces are rolling out with the self-screening option. Oh. But HPV testing, because of its superiority, is replacing cytology- Okay or the Pap. But the self-swab test, do you know where else that is available? I believe Ontario is doing it as well. Okay. I'm not exactly sure about Quebec and PEI. Okay.

Sabrina 44:23

PEI

Laurie 44:23

That's an interesting clarification. Mm-hmm. Mm-hmm. Okay, we wanna move on to a quick round

Sabrina 44:28

of true or false

Laurie 44:29

of true or false rapid fire. So HPV only affects women and

Sabrina 44:34

with a cervix.

Laurie 44:35

individuals with a cervix. False. I think we talked about that HPV affects anybody regardless of s*x or gender identity. Yeah. HPV is the most common sexually transmitted infection in the world. True. Mm-hmm. I can't have an HPV infection if I don't have any symptoms. False. Very false if you're already sexually active, the vaccine isn't worth it. Definitely not true. Yeah. Mm-hmm. Um, okay, and most HPV infections clear on their own without treatment. Yes, very true. But again, just to, to add to that with that caveat, HPV infections are as we know, controlled by the immune system. They may not 100% clear, but they're managed and cause no harms, but they may come back later. Good clarification. Mm-hmm. Okay. I got the vaccine, so I don't need screening. That is false in all caps. Yeah. Okay. Yeah. And that's because the vaccine protects you, but it's not 100%. Correct. Yeah. Yeah. Yeah, definitely. If my cervical screen is

Sabrina 45:38

abnormal, it means I have cancer.

Laurie 45:40

Abnormal, it means I have cancer. No. No, I think we answered that question, yeah. It's very clear. The HPV vaccine is very safe and effective. That one is true in all caps.

Mathilde 45:50

caps. Yes.

Laurie 45:51

Fantastic. Okay, I think that was a good summary of what we went through today. Mm-hmm. Are there any other common myths about HPV that you'd like to bust while you have the microphone? I think I just want folks to walk away with that HPV is nothing to be ashamed of. There should be no stigma associated with it. I, you know, sound like a broken record, but It's more likely we're gonna be exposed to HPV than not exposed to HPV. And I think I'd also like people to remember that cervical cancer can be eliminated. A lot of people do not realize this. We can actually eliminate a cancer, which is very exciting. Yeah.

Sabrina 46:31

So get vaccinated.

Mathilde 46:32

So get vaccinated.

Laurie 46:32

Are there any trusted resources or organiz-

Sabrina 46:35

you recommend for our listeners?

Laurie 46:37

Mm-hmm. There's a lot. Um, the BC Cancer Cervix Screening Program has a lot of really useful information on their website. The BCCDC has a lot of information about vaccination. HealthLink BC and there's, there's others as well. Maybe, you know, I can share some links with you that you can share with your listeners. Yeah.

Sabrina 46:58

Yeah. We'll put all of the links in the ver- the bio. Okay, two final questions- Okay. -to wrap up- Mm-hmm. Okay to wrap up that we -that we ask all of our guests. If you could bust one myth about women's health forever, what would it about women's health forever, what would it

Laurie 47:10

be? So this may not be specifically for women's health, but I think I would like people to really realize that the HPV vaccine isn't just a cervical cancer vaccine. It's not just for women or people with a cervix. The HPV vaccine is for everybody, and it can really help prevent HPV-related cancers.

Mathilde 47:32

And then final question: What's one change you hope to see in women's health? the next 10 10 years?

Laurie 47:38

Well, I would love it if we actually achieve that goal of cervical cancer elimination. That would be, especially for the work that we do, if we could eliminate cervical cancer, that would be a huge achievement in women's health. For women not to have to die unnecessarily from a preventable disease. We have about 1,600 cases of cervical cancer a year in Canada. About 400 women die it, and that may not sound like a lot, but these are mothers, sisters, friends, aunts, people that shouldn't die from cervical cancer. Mm-hmm. So, I think that would be what I would love to see- Absolutely achieved. Yeah. For a preventable disease- Mm-hmm 400 deaths is a lot. Yeah.

Sabrina 48:20

Yeah. All right.

Laurie 48:20

Well, that was a great episode

Sabrina 48:22

I feel like we for sure learned so much, and I'm hoping that our listeners also learned a lot of it. Yes. Hopefully, people will be less scared of

Laurie 48:30

Pap smears and also know that they

Sabrina 48:31

options when it

Laurie 48:33

have options when it comes to

Sabrina 48:33

HPV screening, and get vaccinated.

Mathilde 48:36

Yes.

Laurie 48:37

me such great questions. Yeah, really, really good questions. Well, thank you for making the time for us today. Yeah. Thank you. Thank you.

Sabrina 48:43

you.