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Cervix

British Columbia has updated its Cervical Cancer Screening Policy.

This policy reflects the latest evidence and the province’s commitment to reducing cervical cancer incidence and mortality. For more information, please see the "Eligibility" tab below or download updated policy resources found in the "Resources" tab.

Eligibility

Average risk screening start age

Cervical cancer screening should begin at age 25. Evidence suggests four well founded reasons for initiating screening at age 25:

  • Invasive cervical cancers in women younger than age 25 are rare;
  • Screening is relatively ineffective in younger women;
  • Women under 25 have a higher prevalence of lesions that often clear without treatment;
  • There are risks associated with unnecessary follow-up and treatments, many of which may have long-term consequences for pregnancy or cause undue anxiety and distress.

Average risk screening interval

Average risk women between the ages of 25-69 should be screened every three years.

Average risk screening stop age

Screening can stop at age 69 if results have always been normal.

Higher than average risk screening recommendations

Immunocompromised individuals and those previously treated for dysplasia are considered at high risk of developing cervical cancer and should be screened annually. Individuals currently being assessed by a colposcopy clinic or being followed by a cancer clinic should not undergo additional cervical cancer screening unless directed by the treating physician.

For more information on higher than average risk screening recommendations, please refer to the Screening Recommendations for Individuals at High Risk of developing cervical cancer.

Frequently asked questions

Individuals who have received the HPV vaccine still require cervical cancer screening because the vaccine does not protect against all types of HPV that can cause cervical cancer.


For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.

 
Evidence suggests four well founded reasons for initiating screening at age 25:

  • Invasive cervical cancers in women younger than age 25 are rare;
  • Screening is relatively ineffective in younger women;
  • Women under 25 have a higher prevalence of lesions that often clear without treatment;
  • There are risks associated with unnecessary follow-up and treatments, many of which may have long-term consequences for pregnancy or cause undue anxiety and distress.

For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.

 

Evidence, including BC data, demonstrates that cytology testing every three years is just as effective and safe as annually or biannually.


For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.

 

While cervical cancer screening has proven very effective in decreasing the incidence of pre-cancer and cervical cancer, like any screening test, it isn’t perfect. Women should be aware of the benefits and harms of cervical cancer screening and make an informed decision to screen.

Benefits of Screening

  • Screening where practiced effectively, has resulted in decreased cervical cancer incidence and mortality in women (1,2). 

  • Cervical cancer is one of the most preventable cancers. Cervical cancer begins as an infection of the uterine cervix with high risk human papillomavirus (hr-HPV) that needs to persist for many years. The transition from initial HPV infection to invasive cancer seems to take decades in most cases, with a minimal latency period of approximately 7 years (3,4).
  • Cervical cancer screening saves lives. Most cervical cancer cases occur among women who have not undergone screening or who have had a long interval between Pap tests. In BC, about 58% of the 178 patients diagnosed with invasive cervical cancer in 2014 were five years or more overdue for screening (5). The majority of cases are diagnosed in the 30-39 and 40-49 age groups (5).
  • Women between the ages of 25-69 stand to benefit the most from screening.

Harms of Screening

  • Most HPV infections and pre-cancerous lesions resolve spontaneously, particularly among younger women who are of childbearing age (6,7).
  • Over-diagnosis and treatment of these transient cervical intraepithelial neoplasia (CIN) is associated with substantial harms, including heightened psychosocial consequences in the women treated (8), increased risk of pre-term and low-birth weight babies (especially for women treated with excisional approaches) (9,10) and unneccesary utilization of health care resources.
  • A 2008 study concluded that in the treatment of CIN, all excisional procedures seem to be associated with adverse obstetric morbidity, but among these, only cold knife conisation is associated with a significantly increased rate of severe outcomes (11).
  • Initiating screening in women under 25 can produce more harm than benefit, as cervical cancer is not common in women under age 25. 

For clinical evidence, please see the Cervical Cancer Screening Policy Reference Guide.


(1) Arbyn M, Raifu AO, Bray F, Weiderpass E, Anttila A.Trends of cervical cancer mortality in the member states of the European Union. European Journal of Cancer 2009;45:2640–8.

(2) Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999;318(7188):904–8.

(3) Hildesheim A, Hadjmichael O, Schwartz P, et al.: Risk factors for rapid onset cervical cancer. Am J Obstet Gynecol 1999;180:571-577.

(4) Liebrich C, Brummer O, Von WR, et al.: Primary cervical cancer truly negative for high-risk human papillomavirus is a rare but distinct entity that can affect virgins and young adolescents. Eur J Gynaecol Oncol 2009;30:45-48.

(5) 2016 Cervical Cancer Screening Program Annual Report, BC Cancer Agency, www.screeningbc.ca

(6) Woodman CB, Collins SI and Young LS. The natural history of cervical HPV infection: unresolved issues. Nature Reviews: Cancer. 2007; 7(1): 11-22.

(7) Kulasingam S, Havrilesky L, Ghebre R et al. Screening for Cervical Cancer: A Decision Analysis for the U.S. Preventive Services Task Force. 2011. Available at http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcanceres.pdf. Accessed January 2012.

(8) Fylan F. Screening for cervical cancer: a review of women's attitudes, knowledge, and behaviour. The British Journal of General Practice. 1998; 48(433): 1509-14.

(9) Martin-Hirsch PP, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2010(6):CD001318.

(10) Kristensen J, Langhoff-Roos J and Kristensen FB. Increased risk of preterm birth in women with cervical conization. Obstetrics and Gynecology. 1993; 81(6): 1005-8.

(11) Arbyn M, Kyrgiou M, Simoens C, Raifu AO, Koliopoulos G, Martin-Hirsch P, Prendiville W, Paraskevaidis E. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ. 2008 Sep 18;337:a1284

 
For average risk patients under age 25 we now recommend a repeat Pap test in 36 months or upon reaching the age of 25 – whichever occurs later.

However, for patients under 25 with a previous abnormal Pap, where the lab report indicates repeat screening in six months, we recommend continuing to follow guidelines for abnormal results.  If they are being followed for a low grade abnormality (ASC-US/LSIL) they will need a total of two repeat cervical cancer screening tests at 6 monthly intervals.  They can return to routine follow up if results from both tests are normal.  Routine follow up will be a repeat test in 36 months or upon reaching the age of 25 – whichever occurs later.  

Regardless of age, if the previous recommendation was for colposcopy follow-up, please continue to arrange for colposcopic follow-up.
 
If the recall reminder recommends re-screening in 12 or 24 months for an average risk patient between the ages of 25-69, please follow the new cervical cancer screening guidelines and repeat screening at 36 months.
 

Guidance

Talking to patients

The single most powerful motivator for women to be screened is an invitation or suggestion by her primary care provider. 

Health care professionals can help address barriers or discouraging experiences that may have prevented their patients from having regular cervical cancer screening (Pap tests).

Women often describe the cervical cancer screening experience as awkward, invasive, uncomfortable, embarrassing and traumatic. Some women never return for subsequent tests. In many cases the failure to return has been attributed to a negative first experience. Therefore, it is imperative that health care professionals do all they can to provide a positive, sensitive and caring experience for the woman; including comfortable, pleasant surroundings and an organized and informative environment.

If possible, women should be provided the following information before their cervical cancer screening visit:

  • Do not douche the vagina for 48 hours before the examination
  • Avoid using contraceptive creams or jellies for 48 hours before the examination
  • Cervical cancer screening is not recommended during menstruation; a mid-cycle test is optimal
  • They will be asked for the date of their last menstrual period (LMP)

Submitting Pap tests

All Pap tests submitted for cervical cancer screening must be accompanied by a gynecological cytology requisition that identifies the name of a licensed health professional in British Columbia to whom the Pap test report and follow-up reminder letters can be sent.

A “licensed health professional” is a member in good standing of the BC College of Physicians and Surgeons, the College of Registered Nurses of BC or the Association of Naturopathic Physicians of BC. Registered midwives and certain nursing stations in rural areas are also acceptable.

Gynecological cytology requisitions have to be completed appropriately with the requester and patient information. Pap sample slides have to be labeled with the patient’s last name and date of birth, fixed with a cytology spray fixative and submitted in slide mailers.

Frequently asked questions

A patient’s date of birth (DOB dd/mm/yyyy) and their last name are required to be written in lead pencil on all Pap sample slides. Please note Pap samples will be rejected if both identifiers are not present on the slide.

 

New BC practitioners and clinics submitting gynecological cytology samples should contact the lab and provide contact details before sending in samples to ensure all requirements are satisfied prior to submission. The lab can be reached by telephone at 1-877-747-2522 or by fax at 604-707-2809.

 

Pap test supplies are available through the BC Cancer Agency. To place an order, complete the Gynecological Cytology Supply Order Form and fax it to 604-707-2606. Please allow 3-4 weeks for delivery. For a complete listing of resources available, visit the "Resources" tab.

 

Updated practitioner and clinic contact information is vital for the timely delivery of Pap test reports and follow-up reminder letters. Call 1-877-747-2522 to ensure contact information is correct, or fax the changes to 604-707-2809.

 

Registered nurses who meet the criteria may apply for an individual provider number to submit cytology samples for cervical cancer screening in BC with the Individual Provider Number Application Form.

 

Pap tests are free for BC residents who fall within the eligible population with appropriate medical insurance. Pap tests are billable to non-BC residents and those without appropriate medical insurance. Payments can be made by having the patient submit a cheque payable to PHSA Laboratories or use the credit card payment form (please submit the cheque or form with the Pap sample).

 

Resources

Education materials for health care providers and women are available at no charge from the Cervical Cancer Screening Program (CCSP). To obtain resources, download the materials below, email the order form to screening@bccancer.bc.ca, or fax it to 604-660-3645.

Brochures

Forms

Promotional materials

Reports

Scientific publications

Videos

  • A Women-Centred Approach to Cervical Cancer Screening
    • College of Family Physicians of Canada members and non-members may claim 0.5 Mainpro-M2 credits for this program
    • Email screening@bccancer.bc.ca for access
  • Screening for Cervical Cancer: Pap Test

Useful links






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