Healthcare Quarterly Vol.16 No.1 2013 79

Comparative Models of Cervical Cancer Screening in ManitobaLinda DeRiviere, Shelley Stopera, Paul Van Caeseele and Robert Lotocki

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Abstractthe laboratory system in manitoba for routine cervical screening is outdated and costly. We developed a costing framework for the implementation of new cervical cancer screening technology models. the direct healthcare costs in the baseline model, the conventional Papanicolaou smear test, were compared with estimates of two newer technology platforms, liquid-based cytology and human papillomavirus (hPv) testing. the findings revealed that hPv testing as a primary screening model for women aged 30 years and older represented the least-cost strategy. liquid-based cytology would be used for routine screening of women under 30 years of age and to triage women 30 years and older whose results were hPv positive.

Human papillomavirus (HPV) is a sexually trans-mitted infection that is linked to cervical cancer, an entirely preventable disease (Fleurence et al. 2007; Huh 2009; Spitzer 1998). The traditional

Papanicolaou (Pap) smear test has been the method of cervical screening for over 50 years in Canada (Chuck 2010). However, cellular testing of the Pap smear lacks capacity for detecting the HPV virus. In the past decade, more advanced technology platforms for cervical screening have been approved for use in Canada. These include viral detection technology for high-risk genotypes of HPV infection, which are most likely to trigger the development of cervical cancer (Fleurence et al. 2007; Jeronimo and Schiffman 2006).

Healthcare Policy Context Manitoba Health, in collaboration with the Manitoba Cervical Cancer Screening Program, has been considering the adoption of emerging diagnostic strategies in cervical cancer screening. This initiative followed the report of the 2003 Pan-Canadian Forum on Cervical Cancer Prevention and Control (Stuart et al. 2004), which recommended that newer screening technologies, such as liquid-based cytology (LBC) and possibly HPV deoxyribonu-cleic acid (DNA) testing, be implemented within an organized program. New provincial policy should be developed as more evidence is gathered on HPV testing in primary screening.

The main policy challenge in Manitoba is that the current laboratory system for routine cervical cancer screening is outdated, deteriorating and unsustainable over the longer term. Generally,