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Cervical Screening Participation and Retention

Key findings

Measure:  Participation: percentage of Ontario screen-eligible women, age 21 to 69, who completed at least 1 Pap test in a 42-month period

 

Desired Direction:

 

An image of an arrow pointing upwards. This indicates that desired direction for this action is upwards.

 

As of this Report:

 

An image of an arrow pointing downwards in a red box. This indicates that there has been a decrease in performance over the previous periods identified and this action is well below target.

Approximately 2.75 million Ontario women age 21 to 69 (62% of eligible women) were screened for cervical cancer with a Pap test in the 42 month period of 2014 to 2016 (2014–2016). This represents a decrease of 4% from the 2005–2007 period, when 66% of eligible women were screened.

The number of women eligible for screening through the Ontario Cervical Screening Program (OCSP) (Ontario’s organized cervical screening program) has continued to increase, from 4 million women in 2005–2007 to 4.4 million women in 2014–2016.

In 2010, 80% of the women who had a normal Pap test result that year returned for a subsequent Pap test within 42 months. Sixty-two percent of Ontario women who had a normal Pap test result in 2013 returned for another Pap test within 42 months, which represents a decrease of 18%.

Cancer Care Ontario revised its cervical screening guidance in 2012. This included increasing the recommended screening interval from annually to once every 3 years. Changes to the Ontario Health Insurance Plan fee schedule were made as a result of the new recommendations. Women screened in 2011 and 2012 would be expected to be re-screened in 2014 and 2015, respectively, achieving a total of 1 screening test in the 42-month period following their 2011 or 2012 Pap test. This change in the OCSP-recommended screening interval may have contributed to the decrease in screening participation observed in recent years.

What is cervical screening?

  • Cancer screening is testing for people who may be at risk of getting cancer, but who have no symptoms and generally feel fine. It is not meant to diagnose cancer. Instead, it helps determine which people are more likely to develop cancer in the future. Ontario operates organized screening programs for 3 types of cancer: breast, cervical and colorectal.

Measure:  Retention: percentage of Ontario screen-eligible women, age 21 to 66, who had a subsequent Pap test within 42 months of a normal Pap test result

 

Desired Direction:

 

An image of an arrow pointing upwards. This indicates that desired direction for this action is upwards.

 

As of this Report:

 

An image of an arrow pointing downwards in a red box. This indicates that there has been a decrease in performance over the previous periods identified and this action is well below target.

  • The purpose of cervical screening is to prevent cervical cancer by identifying pre-cancerous changes in the cells of the cervix. In Ontario, the cervical screening test currently in use is the Pap test. Changes to cervical screening tests are under consideration.
  • Cancer Care Ontario updated its cervical screening guidance in 2012. It now recommends cervical screening every 3 years for women age 21 to 69 who are, or who have ever been, sexually active. Women can stop screening at age 70 if they have had 3 or more normal tests within the previous 10 years [1].
  • Changes in the cervix that lead to cancer are called precursor or pre-cancerous lesions, and they usually develop slowly over many years. Screening is the best way to find the early cell changes that might lead to cervical cancer because those early cell changes do not have any symptoms.
  • Colposcopy is an exam done by a specially trained doctor (i.e., a colposcopist) after a woman has an abnormal screening test result. It is the next step in the investigation of most abnormal screening test results. The colposcopist may remove or take a biopsy of abnormal-looking tissues, make a diagnosis and (if necessary) develop a treatment plan. After the diagnostic process is complete, a woman with a precursor lesion requiring treatment may undergo a loop electrical excision procedure, laser therapy or cold knife cone biopsy [2]. Treating precursor lesions can prevent cervical cancer from developing.

Figure 1. Age-adjusted percentage of Ontario screen-eligible women, age 21 to 69, who completed at least 1 Pap test in a 42-month period, by Local Health Integration Network (LHIN), for the 42 -month period from 2005 – 2007 to 2014 - 2016

More information regarding the methodology is available.

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. ⱡRate is adjusted for age
  2. Please refer to technical documentation.

 

Figure 2. Percentage of Ontario screen-eligible women, age 21 to 69, who completed at least 1 Pap test in a 42-month period, by age group, for the 42 -month period from 2005 - 2007 to 2014 - 2016

More information regarding the methodology is available.

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. ⱡRate is adjusted for age
  2. Please refer to technical documentation.

 

Figure 3. Percentage of Ontario screen-eligible women, age 21 to 66, who had a subsequent Pap test within 42 months of a normal Pap test result, by Local Health Integration Network (LHIN), 2010 to 2013

More information regarding the methodology is available.

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

 

Figure 4. Percentage of Ontario screen-eligible women, age 21 to 66, who had a subsequent Pap test within 42 months of a normal Pap test result, by age group, 2010 to 2013

More information regarding the methodology is available.

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

 

Data Table 1. Age-adjusted percentage of Ontario screen-eligible women, age 21 to 69, who completed at least 1 Pap test in a 42-month period, by Local Health Integration Network (LHIN), for the 42 -month period from 2005 – 2007 to 2014 - 2016

LHIN Rate (%) from 2005-2007 Numerator from 2005-2007 Denominator from 2005-2007 Lower confidence interval from 2005-2007 Upper confidence interval from 2005-2007 Rate (%) from 2008-2010 Numerator from 2008-2010 Denominator from 2008-2010 Lower confidence interval from 2008-2010 Upper confidence interval from 2008-2010 Rate (%) from 2011-2013 Numerator from 2011-2013 Denominator from 2011-2013 Lower confidence interval from 2011-2013 Upper confidence interval from 2011-2013 Rate (%) from 2014-2016 Numerator from 2014-2016 Denominator from 2014-2016 Lower confidence interval from 2014-2016 Upper confidence interval from 2014-2016
Ontario 66.2 2,679,911 4,004,724 66.1 66.2 67.1 2,771,778 4,101,519 67.1 67.2 65.0 2,773,939 4,259,797 64.9 65.0 62.0 2,750,161 4,442,970 61.9 62.0
Erie St. Clair 63.1 119,852 188,882 62.9 63.3 63.7 118,951 186,730 63.5 63.9 62.0 117,380 189,764 61.8 62.2 59.7 115,277 193,968 59.5 60.0
South West 66.9 184,709 275,368 66.7 67.0 68.2 187,772 275,219 68.1 68.4 66.0 183,093 277,843 65.9 66.2 63.6 181,310 286,587 63.4 63.8
Waterloo Wellington 68.5 151,836 217,991 68.3 68.7 69.5 156,677 223,120 69.3 69.6 66.9 153,897 228,756 66.7 67.1 64.5 154,079 238,692 64.3 64.7
Hmltn-Ngr-Hldmnd-Brnt 67.6 279,124 410,968 67.4 67.7 68.6 282,579 411,283 68.5 68.8 66.2 275,844 417,700 66.1 66.4 63.4 273,646 433,940 63.2 63.5
Central West 63.2 163,326 251,531 63.0 63.4 64.2 176,195 269,381 64.0 64.4 63.3 184,423 288,344 63.1 63.4 60.3 186,757 309,121 60.1 60.4
Mississauga Halton 67.4 239,780 349,516 67.2 67.6 67.6 251,079 366,916 67.5 67.8 64.6 252,446 388,157 64.4 64.7 60.8 248,699 407,563 60.7 61.0
Toronto Central 63.1 250,281 390,866 63.0 63.3 63.5 264,394 411,723 63.3 63.6 60.5 268,069 438,735 60.4 60.7 57.9 269,655 463,718 57.8 58.1
Central 66.8 367,616 542,601 66.7 66.9 67.5 390,123 572,282 67.4 67.7 65.4 401,818 610,986 65.3 65.5 61.8 398,070 642,333 61.7 62.0
Central East 66.3 316,564 472,641 66.2 66.5 67.5 326,011 480,131 67.4 67.7 65.4 325,238 496,894 65.2 65.5 62.2 317,695 512,274 62.0 62.3
South East 68.7 102,099 149,500 68.4 68.9 70.7 103,534 147,407 70.5 70.9 68.0 99,332 147,310 67.8 68.2 64.9 96,304 149,531 64.7 65.1
Champlain 69.5 266,440 380,245 69.3 69.6 70.7 277,884 391,330 70.5 70.8 68.7 279,676 406,684 68.5 68.8 65.4 277,316 425,170 65.2 65.5
North Simcoe Muskoka 67.0 88,101 131,006 66.7 67.2 68.2 88,404 129,469 68.0 68.5 67.4 88,706 132,160 67.1 67.6 65.7 91,136 139,478 65.4 65.9
North East 62.7 106,637 171,317 62.5 62.9 62.8 102,712 165,218 62.6 63.0 61.3 98,950 163,117 61.1 61.6 58.7 95,762 165,206 58.4 58.9
North West 59.8 43,546 72,292 59.4 60.1 63.5 45,463 71,310 63.2 63.9 61.5 45,067 73,347 61.1 61.8 59.2 44,455 75,389 58.9 59.6

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. ⱡRate is adjusted for age
  2. Please refer to technical documentation.

 

Data Table 2. Percentage of Ontario screen-eligible women, age 21 to 69, who completed at least 1 Pap test in a 42-month period, by age group, for the 42 -month period from 2005 - 2007 to 2014 - 2016

Age group Rate (%) from 2005-2007 Numerator from 2005-2007 Denominator from 2005-2007 Lower confidence interval from 2005-2007 Upper confidence interval from 2005-2007 Rate (%) from 2008-2010 Numerator from 2008-2010 Denominator from 2008-2010 Lower confidence interval from 2008-2010 Upper confidence interval from 2008-2010 Rate (%) from 2011-2013 Numerator from 2011-2013 Denominator from 2011-2013 Lower confidence interval from 2011-2013 Upper confidence interval from 2011-2013 Rate (%) from 2014-2016 Numerator from 2014-2016 Denominator from 2014-2016 Lower confidence interval from 2014-2016 Upper confidence interval from 2014-2016 p-value
21 to 69 (adj.) 66.2 2,679,911 4,004,724 66.1 66.2 67.1 2,771,778 4,101,519 67.1 67.2 65.0 2,773,939 4,259,797 64.9 65.0 62.0 2,750,161 4,442,970 61.9 62.0 -
21 to 29 70.4 517,908 735,899 70.3 70.5 68.9 534,787 776,656 68.8 69.0 63.9 525,011 821,946 63.8 64.0 57.4 493,344 859,940 57.3 57.5 Ref
30 to 39 72.6 669,642 922,052 72.5 72.7 72.4 664,212 917,240 72.3 72.5 69.5 648,335 933,432 69.4 69.6 64.9 634,647 978,581 64.8 64.9 0.001
40 to 49 70.4 716,695 1,018,206 70.3 70.5 71.6 714,003 997,120 71.5 71.7 69.2 681,362 984,997 69.1 69.3 65.8 629,700 957,661 65.7 65.8 0.001
50 to 59 63.4 508,824 803,119 63.3 63.5 65.9 545,043 827,529 65.8 66.0 65.3 577,463 883,893 65.2 65.4 64.3 605,353 941,651 64.2 64.4 0.001
60 to 69 50.8 266,842 525,448 50.6 50.9 53.8 313,733 582,974 53.7 53.9 53.8 341,768 635,529 53.7 53.9 54.9 387,117 705,137 54.8 55.0 0.001

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. ⱡRate is adjusted for age
  2. Please refer to technical documentation.

 

Data Table 3. Percentage of Ontario screen-eligible women, age 21 to 66, who had a subsequent Pap test within 42 months of a normal Pap test result, by Local Health Integration Network (LHIN), 2010 to 2013

LHIN Rate (%) in 2010 Numerator in 2010 Denominator in 2010 Lower confidence interval in 2010 Upper confidence interval in 2010 Rate (%) in 2011 Numerator in 2011 Denominator in 2011 Lower confidence interval in 2011 Upper confidence interval in 2011 Rate (%) in 2012 Numerator in 2012 Denominator in 2012 Lower confidence interval in 2012 Upper confidence interval in 2012 Rate (%) in 2013 Numerator in 2013 Denominator in 2013 Lower confidence interval in 2013 Upper confidence interval in 2013
Ontario 80.4 1,025,901 1,275,379 80.4 80.5 71.5 914,721 1,280,196 71.4 71.5 65.6 741,901 1,130,762 65.5 65.7 62.4 438,443 703,138 62.2 62.5
Erie St. Clair 80.4 45,910 57,132 80.0 80.7 71.6 41,179 57,479 71.3 72.0 66.6 34,287 51,475 66.2 67.0 64.7 20,529 31,732 64.2 65.2
South West 79.1 65,409 82,667 78.8 79.4 70.0 57,784 82,559 69.7 70.3 66.2 47,210 71,331 65.8 66.5 63.1 28,796 45,632 62.7 63.5
Waterloo Wellington 80.2 58,323 72,754 79.9 80.5 70.6 50,939 72,134 70.3 71.0 66.2 42,221 63,752 65.9 66.6 64.1 26,168 40,833 63.6 64.6
Hmltn-Ngr-Hldmnd-Brnt 79.2 102,107 128,995 78.9 79.4 70.3 89,664 127,559 70.0 70.5 64.5 74,359 115,202 64.3 64.8 61.4 42,901 69,822 61.1 61.8
Central West 78.6 62,089 78,978 78.3 78.9 69.4 55,213 79,535 69.1 69.7 61.1 43,644 71,404 60.8 61.5 56.7 24,612 43,431 56.2 57.1
Mississauga Halton 81.0 93,354 115,220 80.8 81.2 72.8 86,651 119,105 72.5 73.0 66.7 71,069 106,503 66.4 67.0 62.8 39,835 63,423 62.4 63.2
Toronto Central 80.3 96,803 120,600 80.0 80.5 71.3 87,340 122,443 71.1 71.6 64.8 69,460 107,131 64.6 65.1 62.8 42,664 67,945 62.4 63.2
Central 83.6 159,699 191,102 83.4 83.7 74.9 145,366 193,984 74.7 75.1 68.3 117,716 172,280 68.1 68.5 64.1 68,611 107,039 63.8 64.4
Central East 81.1 123,283 152,067 80.9 81.3 71.9 109,477 152,277 71.7 72.1 65.8 87,980 133,805 65.5 66.0 61.8 50,414 81,558 61.5 62.1
South East 78.8 36,805 46,683 78.5 79.2 69.3 31,861 45,945 68.9 69.8 65.9 26,395 40,059 65.4 66.4 62.7 16,209 25,849 62.1 63.3
Champlain 81.9 103,998 126,954 81.7 82.1 72.2 91,024 126,085 71.9 72.4 65.1 71,345 109,572 64.8 65.4 62.6 41,798 66,785 62.2 63.0
North Simcoe Muskoka 79.3 32,390 40,841 78.9 79.7 69.7 28,071 40,272 69.3 70.2 64.9 23,361 35,971 64.4 65.4 62.5 14,356 22,985 61.8 63.1
North East 73.9 30,449 41,221 73.4 74.3 65.8 26,768 40,650 65.4 66.3 62.5 22,189 35,494 62.0 63.0 60.1 14,853 24,718 59.5 60.7
North West 75.8 15,282 20,165 75.2 76.4 66.4 13,384 20,169 65.7 67.0 63.5 10,665 16,783 62.8 64.3 58.8 6,697 11,386 57.9 59.7

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

 

Data Table 4. Percentage of Ontario screen-eligible women, age 21 to 66, who had a subsequent Pap test within 42 months of a normal Pap test result, by age group, 2010 to 2013

Age group Rate (%) in 2010 Numerator in 2010 Denominator in 2010 Lower confidence interval in 2010 Upper confidence interval in 2010 Rate (%) in 2011 Numerator in 2011 Denominator in 2011 Lower confidence interval in 2011 Upper confidence interval in 2011 Rate (%) in 2012 Numerator in 2012 Denominator in 2012 Lower confidence interval in 2012 Upper confidence interval in 2012 Rate (%) in 2013 Numerator in 2013 Denominator in 2013 Lower confidence interval in 2013 Upper confidence interval in 2013 p-value
21 to 66 80.4 1,025,901 1,275,379 80.4 80.5 71.5 914,721 1,280,196 71.4 71.5 65.6 741,901 1,130,762 65.5 65.7 62.4 438,443 703,138 62.2 62.5
21 to 29 81.6 213,065 261,121 81.4 81.7 72.7 189,130 260,138 72.5 72.9 63.4 145,199 229,041 63.2 63.6 60.2 87,066 144,590 60.0 60.5 Ref.
30 to 39 80.6 253,457 314,596 80.4 80.7 71.5 223,377 312,476 71.3 71.6 64.9 181,510 279,884 64.7 65.0 61.7 109,578 177,710 61.4 61.9 0.001
40 to 49 81.2 265,975 327,634 81.0 81.3 71.8 232,734 324,206 71.6 71.9 66.5 187,546 281,972 66.3 66.7 63.0 107,643 170,929 62.7 63.2 0.001
50 to 59 79.9 206,484 258,532 79.7 80.0 71.2 189,120 265,654 71.0 71.4 67.3 159,127 236,361 67.1 67.5 64.3 93,699 145,790 64.0 64.5 0.001
60 to 66 76.6 86,920 113,496 76.3 76.8 68.3 80,360 117,722 68.0 68.5 66.2 68,519 103,504 65.9 66.5 63.1 40,457 64,119 62.7 63.5 0.001

Report date: December 2017

Data source: OHIP CHDB, CytoBase, OCR, RPDB, PCCF+ version 6D

Prepared by: Analytics, Cancer Screening,  P&CC

Note:

  1. Please refer to technical documentation.

 

What do the results show?

Cervical screening participation decreased for the period of 2014–2016 (Figure 1).

  • Provincial cervical screening participation for the period of 2014–2016 was 62%. This is lower than it was for 2005–2007 (66%), and it falls short of the 85% Ontario Cancer Plan target.
  • Approximately 2.75 million Ontario women age 21 to 69 were screened for cervical cancer in 2014–2016. During the 2014-2016 period, the Local Health Integration Network (LHIN) with the highest cervical screening participation was North Simcoe Muskoka (66%), while the Toronto Central LHIN had the lowest participation (58%).

Cervical screening participation varies by age group (Figure 2).

  • For the period of 2014–2016, participation in cervical screening was highest in women age 40 to 49 (66%) and lowest in women age 60 to 69 (55%). Compared to 2011–2013, participation in cervical screening decreased in all age groups in 2014–2016.

Cervical screening retention needs improvement (Figure 3 and 4).

  • Approximately 440,000 women who had a normal Pap test in 2013 returned for a Pap test within 42 months (62% of eligible women).
  • Eighty percent of women who had a normal Pap test result in 2010 returned for a subsequent Pap test within 42 months. Sixty-two percent of Ontario women who had a normal Pap test result in 2013 returned for another Pap test within 42 months, a decrease of 18 percentage points.
  • The Erie St. Clair LHIN had the highest retention of women with a normal Pap test in 2013 (65%). The Central West LHIN had the lowest retention of women with a normal Pap test in 2013 (57%).
  • Retention has decreased for each cohort of women since 2010 and across all LHINs.
  • Among women who had a normal Pap test in 2013 and returned for a Pap test within 42 months, retention was highest in those age 50 to 59 (64%). It was lowest in those age 21 to 29 (60%). A similar pattern can be seen in previous years.

Why is this important to Ontarians?

Cervical screening has reduced cervical cancer incidence and mortality.

  • Cervical cancer almost always can be prevented with regular screening and the right kind of follow-up tests and treatment after abnormal screening test results. Finding cervical cancer or cell changes that could become cervical cancer is important. When cell changes or cancer of the cervix are found early, treatment is almost always successful.
  • Most cervical cancers are found in women who have never been screened or those who have been screened less often than recommended by current cervical screening guidance [3]. Organized cervical screening significantly reduces cervical cancer incidence (i.e., new cancer cases) and mortality (i.e., deaths) [3–5]. Long-term reductions in cervical cancer incidence and mortality in Ontario are linked to regular screening with appropriate and timely follow-up.
  • It is estimated that 748 Ontario women will be diagnosed with cervical cancer in 2018 [6]. In 2017, roughly 150 women died of the disease [7]. This low incidence and low mortality are a measure of the success of Ontario’s screening system, but they also reflect the need for improvement in prevention and early detection of this essentially preventable disease.
  • Human papillomavirus (HPV) infections can cause abnormal cell changes in the cervix and abnormal screening test results. Only abnormal cell changes caused by cancer-causing types of HPV put a woman at risk of getting cervical cancer. While there are over 100 different types of HPV, cervical cancer is mainly caused by the 12 to 15 high risk types of HPV infections. When a high risk infection persists (does not go away) for a number of years, it can lead to cervical cancer.
  • HPV is passed from one person to another through intimate (i.e.., skin-to-skin) sexual contact. HPV infections are common, and up to 80% of sexually active men and women will have an HPV infection in their lifetime [8, 9]. Most HPV infections commonly go away on their own without causing any harm, especially in women under age 30. Factors that determine the clearance of a high risk HPV infection (as opposed to its persistence) are not well understood.
  • Because pre-cancerous cervical changes rarely cause symptoms, screening is the only way to find early cell changes that could lead to cervical cancer.

Cervical screening needs to continue despite HPV vaccination.

  • Vaccines are now available to prevent the most common cancer-causing HPV infections [10]. The HPV vaccine is most effective at preventing cervical cancer when administered before someone becomes sexually active. However, even women who receive the HPV vaccine still need to get cervical screening.
  • The HPV vaccine does not protect against all cancer-causing HPV types, and it does not eliminate HPV infections acquired before a woman gets vaccinated. Only screening can protect against cervical cancer that is caused by an earlier infection.

How does Ontario compare with other jurisdictions?

  • Ensuring that the data and measures from other jurisdictions are comparable to those in Ontario is a challenge. Caution should be used when comparing Ontario’s indicator results to those from other jurisdictions due to potential differences in data definitions, methodologies and time periods. Cross-jurisdictional comparison, however, is still useful for providing a rough indication of how well Ontario is doing compared to other jurisdictions.
  • For the period of 2014–2016, Ontario’s cervical screening participation (Pap test completion) among eligible women was 62%, compared to 70% in Australia. However, Australia uses a different reporting period (24-month vs. 42-month in Ontario) [11].
  • For more information on comparisons of cervical screening participation among jurisdictions, see the Cancer Screening Quality Index’s (CSQI’s) screening comparison section.

Next steps

  • Cancer Care Ontario’s current guidance recommends HPV testing as the screening test for cervical cancer. Cancer Care Ontario is working with the Ministry of Health and Long-Term Care to implement HPV testing in the OCSP.
  • In the interim, the OCSP supports continuing to use the Pap test as the cervical screening test.
  • Cancer Care Ontario is moving towards fully organized cervical screening to improve the effectiveness of the OCSP. Screening participation rates remain a priority for the OCSP.
  • Cancer Care Ontario is working to improve cervical screening participation and retention in eligible women, and it is pursuing multiple strategies to engage populations where screening participation is low.
  • The OCSP correspondence program, which supports cervical screening participation and retention, began in the fall of 2013. Eligible women are mailed letters inviting them to get screened for cervical cancer, advising them of their test results (I.e. abnormal versus normal) and reminding them when it is time to return for screening. In 2018, the OCSP will be implementing a new invitation letter format intended to increase cervical screening participation.
  • Cancer Care Ontario has developed an online Primary Care Screening Activity Report (PCSAR) for all 3 screening programs (breast, cervical and colorectal cancer). This tool, which is accessed online, allows physicians in a patient enrolment model practice to see the complete screening status of each of their enrolled age-eligible patients, including those due for screening and follow-up.
  • Cancer Care Ontario is developing evidence-informed strategies to increase access, align processes, improve practices and enhance the quality of colposcopy services in the province. The OCSP recently released evidence-informed clinical guidance for the delivery of colposcopy services in Ontario [12]. Next steps include working with regional partners to encourage implementation of this guidance.

Notes

  1. Guidelines & Advice Cervical Screening [Internet]. Toronto: Cancer Care Ontario2016 Oct [cited 2015 Dec 18]. Available from here.
  2. Cone Biopsy [Internet]. Canadian Cancer Society; c2018 [cited 2018 Jan 5]. Available from here.
  3. Pettersson F, Björkholm E, Näslund I. Evaluation of screening for cervical cancer in Sweden: trends in incidence and mortality 1958–1980. Int J Epidemiol. 1985 Dec;14(4):521–7.
  4. Lynge E, Madsen M, Engholm G. Effect of organized screening on incidence and mortality of cervical cancer in Denmark. Cancer Res. 1989 Apr 15;49(8):2157–60.
  5. Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of the cervix in England: evaluation based on routinely collected statics. BMJ. 1999 Apr 3;318(7188):904–8.
  6. Cancer Care Ontario. Ontario cancer statistics 2018 [Internet]. Toronto: Cancer Care Ontario; 2018 Jan [cited 2018 Feb 7]. Available from here.
  7. Canadian Cancer Society. Canadian cancer statistics, 2017. Toronto: Canadian Cancer Society; Steering Committee on Cancer Statistics; 2017.
  8. Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. 1997 May;102(5A):3–8.
  9. Chesson HW, Dunne EF, Hariri S, Markowitz LE. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2015 Nov;41(11):660–4.
  10. Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, et al. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. Int J Cancer. 2007 Aug 1;121(3):621–32.
  11. Supplementary Data Tables: Participation in the National Cervical Screening Program 2015–2016 [Internet]. Australia Institute of Health and Welfare; c2018 [updated 2017 August 25, cited 2018 February 9]. Available from here.
  12. Cancer Care Ontario. Clinical guidance: recommended best practices for delivery of colposcopy services in Ontario [Internet]. Toronto: Cancer Care Ontario; 2016 June [cited 27 Jan 2017]. Available from here.