||As of this Report
|Percentage of Ontario screen-eligible women with a high-grade cervical dysplasia (abnormal) on a Pap test, ages 21 to 69, who underwent colposcopy or definitive treatment within 6 months of the high-grade abnormal screen date.
| See Methodology and Approach to find out how the ratings are calculated.
In 2014, approximately 3,000 Ontario women aged 21 to 69 who had a high-grade abnormal result on a Pap test underwent a follow-up procedure (colposcopy or definitive treatment) within 6 months. The proportion of Ontario women receiving cervical screening follow-up within 6 months increased, from 80% in 2011 to 84% in 2014, although there was notable variation in abnormal follow-up by region. Follow-up was highest for women with a high-grade squamous intraepithelial lesion (HSIL) in 2014 (88%).
What is a cervical cancer screening
- A screening test identifies people in a healthy, asymptomatic population who may be at risk for disease. It is not a diagnostic test. The purpose of screening is to prevent cancer by identifying pre-cancerous changes or to find cancer at an early stage when it is easier to treat. Ontario operates screening programs for 3 types of cancer: breast, cervical and colorectal.
- The purpose of cervical screening is to prevent cancer by identifying pre-cancerous changes to the cells of the cervix.
- Changes in the cervix usually develop very slowly over many years, so there is a long period of time when abnormal cell changes can be detected before cervical cancer appears. These changes, called precursor lesions, can be found with a Pap test.
- Colposcopy is a diagnostic procedure performed following an abnormal Pap test result. This procedure allows a colposcopist to selectively take tissue samples of cervical abnormalities so a pathologist can make a definitive diagnosis and a doctor can develop a treatment plan1.
- After the diagnostic process is complete, a woman requiring treatment could undergo a loop electrical excision procedure, laser therapy, cryotherapy or cold knife cone biopsy1. Treating precursor lesions is intended to prevent cervical cancer from developing.
- Cancer Care Ontario provides guidelines for the management of abnormal Pap test results and referral to colposcopy services. Referral to colposcopy following 1 abnormal Pap test is recommended for women with findings of atypical squamous cells (ASC-H), HSIL and atypical glandular cells (AGC). Endocervical and endometrial sampling is also recommended for women with AGC, where appropriate2.
What do the results show?
More Ontario women with a high-grade abnormal Pap test are receiving timely cervical screening follow-up within 6 months (Figure 1).
- The proportion of Ontario women receiving follow-up within 6 months of a high-grade abnormal Pap test result increased, from 80% in 2011 to 84% in 2014.
- In 2014, the Local Health Integration Network (LHIN) with the highest follow-up was North Simcoe Muskoka (90%), while the North West LHIN had the lowest follow-up (68%).
- The LHINs that showed the greatest improvement in follow-up from 2011 to 2014 were Central and Champlain (an 8 percentage point increase). The greatest decreases in follow-up over this time period occurred in North West (a decrease of 7 percentage points).
- Follow-up was highest (88% in 2014) for women with an HSIL finding and lowest for women with an AGC finding (75% in 2014). A similar pattern can be seen in previous years (Figure 3).
Follow-up of high-grade abnormal Pap test results varies by socio-demographic factor‡.
- Cervical cancer screening follow-up varied by age group (Figure 2). In 2014, follow-up within 6 months of an abnormal Pap test result was highest among women ages 40 to 49 (87%). A similar pattern can be seen in previous years.
- In 2014, 85% of women living in urban areas received follow-up within 6 months of an abnormal Pap test, compared to 73% of women in rural-very remote areas.
‡ Percentages by socio-demographic factor are available in the data table (select the desired file type and click “Download”) and presented in the figure by age group.
Why is this important to Ontarians?
Screening and appropriate and timely follow-up of abnormal results is essential.
- Virtually all cervical cancers and their precursor lesions are caused by persistent infection with high-risk oncogenic (i.e. cancer-causing) human papillomavirus (HPV) types, especially types 16 and 183–5. HPV is transmitted through intimate sexual contact and is common among sexually active men and women6,7. Most sexually active men and women will acquire an HPV infection in their lifetime7–9. Most HPV infections will go away or clear without causing harm. Factors that determine clearance as opposed to persistence of a high-risk HPV infection are not well understood.
- Persistent high-risk HPV infections are a necessary factor in the development of cervical cancer and pre-cancerous changes in the cervix.
- The first cohort in Ontario’s school-based vaccination program will reach screen-eligible age this year. As the proportion of HPV-vaccinated women in the screening cohort increases, Cancer Care Ontario is exploring implications for the OCSP related to this shift and is planning to address them.
- Timely follow-up of abnormalities that are found through cervical screening is necessary for the reduction of cervical cancer incidence (i.e. new cancer cases) and mortality (i.e. deaths).
- Cervical cancer incidence has declined by as much as 80% where the screening quality, access and follow-up of women are high10. See the Special Focus Story: Cervical Cancer for information regarding the decline in cervical cancer incidence and mortality in Ontario.
How does Ontario compare with other jurisdictions?
- Ensuring there are comparable data and measures from multiple jurisdictions is a challenge. It is recommended to use caution when comparing indicators from different jurisdictions due to the different data definitions, methodologies and years that are used in indicators measured outside of and across Canada. Cross-jurisdictional comparison is still useful, however, for providing an indication of how Ontario is doing compared to other jurisdictions.
- The colposcopy percentages for Ontario women with high-grade abnormal Pap test results are comparable with other jurisdictions in Canada11.
- Cancer Care Ontario is developing strategies to increase access, align processes, improve practices and enhance the quality of colposcopy services in the province.
- An integrated Primary Care Screening Activity Report for all 3 screening programs (cervical, breast and colorectal) was recently developed. This tool allows physicians in a Patient Enrolment Model (PEM) practice to see the complete screening status for each patient, including those who are due for screening and follow-up. Next steps include encouraging increased use of the Primary Care Screening Activity Report.
- The OCSP correspondence program began in the fall of 2013. Women eligible to be screened are mailed letters inviting them to be screened, advising them of next steps based on their test results and reminding them when it is time to return for screening. Cancer Care Ontario is evaluating the impact of correspondence on participation.
- Public awareness campaigns are conducted annually.
- Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Insight on cancer: news and information on cervical cancer; 2005 Oct [cited 2015 Dec 18]. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=13802.
- Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. Ontario cervical screening cytology guidelines summary; 2012 May [cited 2015 Dec 18]. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=13104.
- Kwong J, Crowcoft N, Campitelli MA, Ratnasingham S, Daneman N, Deeks SL, et al. Ontario burden of infectious disease study (ONBOIDS). Toronto: Ontario Agency for Health Protection and Promotion, Institute for Clinical Evaluative Sciences; 2010.
- Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999 Sep; 189(1):12–9.
- Franco EL, Schlecht NF, Saslow D. The epidemiology of cervical cancer. The Cancer Journal. 2003 Oct; 9(5):348–59.
- Yabroff KR, Mandelblatt JS, Kerner JF. Effectiveness of interventions to improve follow-up after abnormal cervical cancer screening. Prev Med. 2000 Oct; 31(4):429–39.
- Brown DR, Shew ML, Qadadri B, Neptune N, Vargas M, Tu W, et al. A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women. J Infect Dis. 2005 Jan 15; 191(2):182–92.
- Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. 1997 May 5; 102(5A):3–8.
- Bosch FX, de Sanjosé S. Human papillomavirus and cervical cancer: burden and assessment of causality. J Natl Cancer Inst Monogr. 2003; 31:3–13.
- World Health Organization and the International Agency for Research on Cancer (IARC). IARC handbooks of cancer prevention: cervix cancer screening. Vol. 10. Lyon: IARC Press; 2005.
- Canadian Partnership Against Cancer. Cervical cancer screening in Canada—monitoring program performance: 2009–2011. Toronto: Canadian Partnership Against Cancer; 2013.