You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search

Methodology 4.12.a

Cervical Screening Participation Methodology
Short description of Indicator Age-adjusted percentage of Ontario screen-eligible women, 21-69 years old, who completed at least one Pap test in a 42-month period
Rationale for measurement Cervical cancer screening using cervical cytology (Pap smear) can lead to early detection of pre-cancerous lesions before they develop into invasive cervical cancer, thereby reducing both cervical cancer incidence and mortality.1–3 Adequate participation in cervical cancer screening is essential for reductions in mortality to occur in the Ontario population.4

Participation rate is one of the most important factors in determining the success of an organized screening program.5
Evidence/references for rationale
  1. Andrae B, Kemetli L, Sparen P, Silfverdal L, Strander B, Ryd W, et al. Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden. J Natl Cancer Inst. 2008;100(9):622-9.
  2. Laara E, Day NE, Hakama M. Trends in mortality from cervical cancer in the Nordic countries: Association with organized screening. Lancet. 1987 May 30;1(8544):1247–9.
  3. Walsh JM. Cervical cancer: Developments in screening and evaluation of the abnormal Pap smear. West J Med. 1998 Nov;169(5):304–10.
  4. International Agency for Research on Cancer Prevention; World Health Organization. Handbook of cancer screening volume seven: cervix cancer screening. Lyon: IARCPress; 2005.
  5. Hakama M. Screening for cervical cancer: Experience of the Nordic countries. In: Franco E., Monsonego J., editors. New developments in cervical cancer screening and prevention. Oxford [England]; Malden, MA, USA: Blackwell Science; 1997. p. 190–99.
Calculations for the indicator (Total number of Ontario screen-eligible women, 21-69 years old, who have completed at least one Pap test in a 42 month period / Total number of Ontario screen-eligible women, 21-69 years old in the reporting period) x 100 = Cervical screening participation
Standardized Rate Calculation Standardized to the 2011 Canadian population
Unit Percentage (%)
Data sources
  • ​​CytoBase - Pap tests
  • OHIP's CHDB (Claims History Database) – Pap tests, hysterectomy claims
  • OCR (Ontario Cancer Registry) - Resolved invasive cervical cancers
  • RPDB (Registered Persons Database) - Demographics
  • PCCF+, version 6D - Residence and socio-demographic information
Time Frame 2005-2016
Geographic Scale
  • ​Provincial (Ontario)
  • LHIN of residence
  • Public Health Unit (PHU)
Denominator description Total number of Ontario screen-eligible women, 21-69 years old, in the reporting period
  • Ontario screen-eligible women age 21-69 at the index date
  • Index date was defined as the midpoint of a reporting period, e.g. July 1st 2015 for 2014-2016
  • The 2011 Canadian population was used as the standard population for calculating age-standardized rates
  • The RPDB address closest to the index date was used to assign postal code
  • LHIN assignment was determined using PCCF+, version 6D; residential postal code was used to identify LHIN
  • Public health unit data was determined using PCCF+, version 6D; residential postal code was used to identify public health unit

Exclusions:

  • Women with a missing or invalid HIN, date of birth, LHIN or postal code
  • Women diagnosed with an invasive cervical cancer prior to January 1st of the reporting period, e.g. January 1st 2014 for 2014-2016; prior diagnosis of cervical cancer was defined as: ICD-O-3 codes C53, a morphology indicative of cervical cancer, microscopically confirmed with a path report
  • Women who had a colposcopy and/or treatment within 2 years prior to January 1st of the reporting period
  • Colposcopy and/or treatment were identified through OHIP, using the following Fee Codes:

    Colposcopy
    • 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

    Treatment

    • 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
  • Women with a hysterectomy prior to January 1st of the reporting period
  • 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
Numerator description Total number of Ontario screen-eligible women, 21-69 years old, who have completed at least one Pap test in a 42 month period
  • Identifying Pap tests:

    Pap tests were identified through CytoBase

    Pap tests were also identified using fee codes through OHIP:
    • E430A: add-on to a003, a004, a005, a006 when pap performed outside hospital
    • G365A: Periodic-pap smear
    • 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
  • All Pap tests in CytoBase were counted, including those with inadequate specimens

Each woman was counted once regardless of the number of Pap tests performed in a 42 month time frame

Considerations  N/A
Data availability & limitations
  • ​Pap test results are available in CytoBase only
  • CytoBase includes only Pap tests analyzed in community-based laboratories in Ontario; Pap tests analyzed in Ontario hospitals and Community Health Centres are not captured in CytoBase
  • It is difficult to determine whether a Pap test in CytoBase and/or OHIP was done for screening or diagnostic purposes, and therefore, some Pap tests included in these analyses may have been performed for diagnostic purposes
CSQI Year 2018