Ontario Cervical Screening Guidelines (2025 Update)
UPDATED: May 2025
As of March 2025, Ontario has transitioned to HPV testing for cervical screening and colposcopy, this replaces cytology (Pap tests). This change has occurred because HPV testing had been found to be better at screening for pre-cancer and early cancer.
How is HPV involved?
There over 100 different HPV strains, and while not all have the ability to lead to cervical cancer, cervical cancer can begin as an infection from a high risk strain of HPV at the cervix.
HPV is transmitted from sexual contact of any kind with another person. In this instance, sexual contact includes contact with another person’s genitals (ex. mouth, hands, genitals, toys).
Are you eligible?
If you meet the below criteria, you are eligible for cervical screening:
Have a cervix
Ages 25-69
History of sexual activity (any contact with another person’s genitalia - hands, mouth, genitals, sharing toys)
No symptoms suggestive of cervical cancer
OHIP covered
When should screening begin?
If you have a cervix and have ever been sexually active, then screening would begin at 25 years old. This is also consistent in people who are immunocompetent, immunocompromised, or vaccinated for HPV.
Screening is not recommended in:
People who are younger than 25 and have been sexually active
People who have never been sexually active
How often should screening take place?
Screening recommendations have drastically changed:
For people at average risk: 5 years
For people who are immunocompromised: 3 years
For people at moderate risk: 2 years
For people at elevated risk: Should be getting a colposcopy
This schedule has been updated where a follow-up was done in 3 years time, instead of 5. Research has shown that a negative HPV test result every 5 years provides at least as much protection as a normal cytology test result every 3 years.
What is a colposcopy?
A colposcopy is a procedure where the cervix more closely examined using a bright light and examining lens to determine if anything abnormal exists. A biopsy may be done of the abnormal cervical tissue for further testing.
Understanding Risk Factors
Elevated Risk
People with HPV-positive (types 16, 18/45) test results
People with HPV-positive (other high-risk types) and high-grade reflex cytology (atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion; low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion; high-grade squamous intraepithelial lesion, atypical glandular cells, adenocarcinoma in situ, squamous cell carcinoma, adenocarcinoma, endocervical adenocarcinoma, poorly differentiated carcinoma) test result
People at elevated risk are referred to colposcopy, regardless of their reflex cytology test result.
Moderate Risk
People with HPV-positive (other high-risk types) and normal reflex cytology (negative for intraepithelial lesion or malignancy) or low-grade reflex cytology (atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion)
When does screening stop?
Screening stops based on a few factors, but generally if you had a negative test between 65-69 years old, you can stop screening.
This table from Cancer Care Ontario has more detailed information.
While screening is not recommended for people aged 75+, visible cervical abnormalities or abnormal symptoms, investigations should occur regardless of their age.
Where can you get screened?
You can make an appointment with your medical doctor or your naturopathic doctor (I perform these in clinic). If you can't find a healthcare provider, you can find someone here. Some pelvic health units and community health centres may also perform screenings.
What's next?
While Naturopathic Doctors are able to provide cytology (ex. Pap tests), in Ontario it is outside of our scope to provide HPV testing - although Midwives do provide this service (which you can consider having done during your care with them if applicable).