When can we expect HPV primary testing in Ontario?

Over the next few years, although there is no official date yet.

Why end screening at age 65?

Especially since women over 65 are still sexually active, and are having increased rate of sexually transmitted infections. It is difficult to acquire a new HPV infection in a post-menopausal cervix, and there is a long timeline between infection and the development of a cancer.

Initially, will HPV primary test run concurrently with Pap test for a period of time or only HPV testing? Also, how will this impact the workload of the laboratories?

We are not sure yet. Likely to do HPV test when pap is due then reflex pap if HPV positive.

In Canada, what different modalities are available for women to access self-sampling kits and where should they send their samples for analysis?

Self-sampling is not available in Canada at this time outside of research projects.

Is HPV testing recommended even after a total hysterectomy?

It is likely that the guidelines will be for cervical screening, therefore, testing will not apply if a person has no cervix.

If a woman requests testing for STIs, should you include HPV testing along with routine cultures?

No, primary HPV testing will be for screening in the future, however, suggest pap testing at the same time if due.

Dr. Gagnon, can you comment on how to potentially use HPV testing + moments to discuss HPV vaccination with older women who have not been vaccinated? Do you personally recommend it up to any age? And how can we educate future healthcare providers?

As per NACI recommendations, there is no upper age limit for vaccination. You can discuss HPV vaccination with any at risk patient.

Self-sampling is a great idea. But who would actually follows-up on the results as many Canadians / Canadian residents do not have a primary healthcare provider?

It is unlikely to start up with self-sampling, but a future idea. I agree, we would likely need a public health nurse or other practitioner to follow-up on the results.