Technical Information

Percentage of Ontario screen-eligible women with a high-grade cervical dysplasia on a Pap test, 21-69 years old, who underwent colposcopy or definitive treatment within 6 months of the high-grade abnormal screen date

Figures 1-3

Time to colposcopy or definitive treatment is a measure of system capacity and timely follow-up. (1,2) Even if follow-up is ultimately negative, an abnormal screen can cause anxiety, and excessive delays to diagnosis may worsen prognosis. (1)

Ontario’s colposcopy standards recommend colposcopic follow-up within eight to 12 weeks for women with less severe dysplasias. (3) The Society of Obstetricians and Gynaecologists of Canada recommends that women with ACS-H or AGC should receive colposcopic follow-up within 6 weeks of referral, while women with HSIL should receive colposcopic follow-up within 4 weeks of referral. (4)

1. Public Health Agency of Canada (2009). Report from the Screening Performance Indicators Working Group, Cervical Cancer Prevention and Control Network (CCPCN): Performance Monitoring for Cervical Cancer Screening Programs in Canada. Ottawa, Public Health Agency of Canada; 2009 Jan.
2. Canadian Partnership Against Cancer. Cervical cancer screening in Canada: Monitoring program performance 2009–2011. Toronto: Canadian Partnership Against Cancer; 2013.
3. Fung-Kee-Fung M, Howlett R, Oliver T, Murphy J, Elit L, Strychowsky J, et al. The optimum organization for the delivery of colposcopy service in Ontario. Toronto (ON): Cancer Care Ontario; 2008 Feb 14. Program in Evidence-based Care Evidence-based Series on Colposcopy.
4. Society of Obstetricians and Gyneacologists of Canada. Colposcopic management of abnormal cervical cytology and histology. J Obstet Gynaecol Can. 2012;34(12):1188–1202.

​(Total number of Ontario screen-eligible women with a high-grade cervical abnormality on a Pap test in a given calendar year, 21-69 years old, who underwent colposcopy or definitive treatment within 6 months of the high-grade abnormal screen date/ Total number of Ontario screen-eligible women, 21-69 years old, with a high-grade cervical abnormality on a Pap test in a given year) x 100= High grade follow-up

N/A

​Percentage (%)

• CytoBase - Pap tests
• OHIP's CHDB (Claims History Database) – previous Pap tests, colposcopies, definitive procedure claims, hysterectomy claims
• OCR (Ontario Cancer Registry) - Resolved invasive cervical cancers
• RPDB (Registered Persons Database) - Demographics
• PCCF+, version 6C - Residence and socio-demographic information

2012 – 2015

• Provincial (Ontario)
• LHIN of residence​

Total number of Ontario Screen–eligible women, 21–69 years old at the index date, who had a high–grade cervical abnormality on a Pap test

• Index date was defined as the date of the most recent high–grade cervical abnormality per person by date of specimen collection in CytoBase in each calendar year
• High–grade cervical dysplasia was defined as:



• Pap test category	Version 2
  ASC–H	4.4.5
  AGC	4.5.1, 4.5.2, 4.5.3, 4.5.4, 4.5.5, 4.5.7, 4.5.9
  Adeno in–situ	4.5.8, 4.6
  HSIL	4.8
  Carcinoma	4.9
  Squamous cell carcinoma	4.9.1
  Adenocarcinoma	4.9.2, 4.9.3
  Other malignancy	4.10

• Each woman was counted once per given year regardless of the number of tests performed
• The RPDB address closest to the index date was used to assign postal code
• LHIN assignment was determined using PCCF+, version 6C; residential postal code was used to identify LHIN and individuals with unknown/missing LHINs were excluded from the analysis

Exclusions:

• Women with a missing or invalid HIN, date of birth, LHIN or postal code
• Women who died during the follow–up period
• Women diagnosed with an invasive cervical cancer before the index Pap date; defined as : ICD–O–3 codes C53, a morphology indicative of cervical cancer, microscopically confirmed with a path report
• Women with a hysterectomy before the index Pap date
• Women with a hysterectomy were identified through OHIP, using the following fee codes:
• E862A – When hysterectomy is performed laparoscopically, or with laparoscopic assistance
• P042A – Obstetrics – labour – delivery – caesarean section including hysterectomy
• Q140A – Exclusion code for enrolled female patients aged 35–70 with hysterectomy
• S710A – Hysterectomy – with or without adnexa (unless otherwise specified) – with omentectomy for malignancy
• S727A – Ovarian debulking for stage 2C, 3B or 4 ovarian cancer and may include hysterectomy
• S757A – Hysterectomy – with or without adnexa (unless otherwise specified) – abdominal – total or subtotal
• S758A – Hysterectomy – with or without adnexa (unless otherwise specified) – with anterior and posterior vaginal repair and including enterocoele and/or vault prolapse repair when rendered
• S759A – Hysterectomy – with or without adnexa (unless otherwise specified) – with anterior or posterior vaginal repair and including enterocoele and/or vault prolapse repair when rendered
• S762A – Hysterectomy – with or without adnexa (unless otherwise specified) – radical trachelectomy – excluding node dissection
• S763A – Hysterectomy – with or without adnexa (unless otherwise specified) – radical (Wertheim or Schauta) – includes node dissection
• S765A – Amputation of cervix
• S766A – Cervix uteri – Exc – cervical stump – abdominal
• S767A – Cervix uteri – exc – Cervical stump – vaginal
• S816A – Hysterectomy – with or without adnexa (unless otherwise specified) – vaginal

Total number of women with a high–grade cervical abnormality on Pap test who underwent colposcopy or definitive treatment within six months of the high–grade abnormal Pap test

• Colposcopy was defined using the following fee codes in OHIP:
• Z731 – Initial investigation of abnormal cytology of vulva and/or vagina or cervix under colposcopic technique with or without biopsy(ies) and/or endocervical curetting
• Z787 – Follow–up colposcopy with biopsy(ies) with or without endocervical curetting
• Z730 – Follow–up colposcopy without biopsy with or without endocervical curetting

• If no record was found for a subsequent colposcopy after the high–grade cervical abnormality Pap test, other definitive procedures were included; these procedures were identified through OHIP claims as:
• Z732   Cryotherapy
• Z724   Electro
• Z766   Electrosurgical Excision Procedure (LEEP)
• S744   Cervix – cone biopsy – any technique, with or without D&C
• Z720   Cervix Biopsy – with or without fulguration
• Z729   Cryoconization, electroconization or CO2 laser therapy with or without curettage for premalignant lesion (dysplasia or carcinoma in–situ), out–patient procedure

• If no record was found for a colposcopy or one of the procedures listed above, the woman was still assumed to be followed up provided that a hysterectomy was performed within six months following the high–grade abnormal Pap test
• If a woman had multiple colposcopies or multiple procedures, the earliest colposcopy or procedure was selected
• If a woman had colposcopy within +/– 7 days of her Pap test, preceding tests in Cytobase and OHIP up to six months before were used to verify if this colposcopy might have been associated with a previous Pap test. If there was a previous Pap test in the specified time period, that Pap test would be used as the index Pap.
• The following codes were used to identify Pap tests through OHIP:
• E430A: add–on to A003, A004, A005, A006, A205, A203, A206 when pap performed outside hospital
• G365A: Periodic–pap smear – once per 33 months
• E431A: When Papanicolaou smear is performed outside of hospital, to G394.
• G394A: Additional for follow–up of abnormal or inadequate smears
• L713A: Lab.med.–anat path,hist,cyt–cytol–gynaecological specimen
• L733A: Cervicovaginal specimen (monolayer cell methodology)
• L812A: Cervical vaginal specimens including all types of cellular abnormality, assessment of flora, and/or cytohormonal evaluation
• Q678A: Gynaecology – pap smear – periodic – nurse practitioners
• L643A: Lab Med - Microbiol - Microscopy - Smear Only, Gram/Pap Stain

None

• Pap test results are available in Cytobase only