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Cervix Screening

Woman in dr office with cervix self-screening swab

About the program

BC Cancer Cervix Screening has oversight responsibility for cervix screening in BC. The program reminds healthcare providers when their patients are due for screening, tracks adherence to screening recommendations, and monitors system performance and outcomes of cervix screening activities. 

BC is transitioning from cytology (Pap test) to HPV testing as the primary screening method for cervical cancer. Cervix self-screening is recommended every five years for women and people with a cervix ages 25-69 (or every three years for those who are recommended to have a Pap test).

Screening tests are analyzed and results are provided by the Cervical Cancer Screening Laboratory (CCSL), which is operated by PHSA’s Provincial Laboratory Medicine Services. 

You might be looking for....

 
  • BULLETIN: Cervix Screening in BC: Transitioning from Cytology (Pap Test) to HPV Primary Screening April 2024 (PDF)

 
Who can order self-screening swabs

Health care providers (such as physicians, nurse practitioners, midwives, registered nurses) who possess the competencies required to appropriately assess patient eligibility for cervix screening and to support patients with recommended follow-up care, can order the self-screening devices.

How to order self-screening swabs

Starting on January 29th, cervix self-screening swabs will be available on the Cervix Screening Supplies online system  for health care providers or community health clinics to order. This is the same system currently used to order LBC/Pap test supplies. If your clinic has not used the Cervix Screening Supplies online system before, enrol your clinic by completing the Cervix Screening Supplies registration form.

As a reminder, before offering self-screening to a patient, ensure the patient is due and eligible for self-screening to avoid risks associated with over-screening. Please refer to the  Resource Guide for Health Care Providers to become familiar with the eligibility criteria.


 

Program Overview
An overview of the BC Cancer Cervix Screening Program detailing eligibility and screening recommendations.

Cervix Self-Screening at the Clinic Instructions 

Cervix Self-Screen or LBC Sample Collection Algorithm


Cervix screening guidelines

Anyone with a cervix, including women and TTGD individuals, age 25 to 69 should get screened regularly for cervical cancer.

Average risk 

 

Routine screening is not recommended. 

 

‎With a cervix:

  • Screen with a vaginal swab or a provider-collected liquid-based cytology (LBC) sample.
Have or have not received the HPV vaccine:
  • Screen with a vaginal swab or a provider-collected liquid-based cytology (LBC) sample.
Have had any sexual contact with another person of any gender:
  • Screen with a vaginal swab or a provider-collected liquid-based cytology (LBC) sample.

Pregnant:

  • Screen with a provider-collected liquid-based cytology (LBC) sample if screening is due or overdue. Screening is not necessary as a routine part of pre-natal screening for those who are up to date with screening
  • Self-screening is not recommended for patients who are pregnant
Subtotal hysterectomy (cervix not removed), with no prior history of CIN 2, CIN 3, AIS or cervical carcinoma:
  • Screen with a vaginal swab or a provider-collected liquid-based cytology (LBC) sample
Cervix removed and has history of CIN 2, CIN 3 or AIS:
  • Screen with a provider-collected liquid-based cytology (LBC) sample from the vaginal vault at 12 months post-hysterectomy. The sample will be tested for both HPV and cytology (co-test). Any positive HPV test or a high-grade or glandular cytology result should be referred directly to colposcopy. After a negative co-test, screening can be discontinued
Has a neovagina:
  • Screening is not recommended.
Never had sexual contact:
  • Routine screening is not recommended. Delay screening until initiation of sexual contact
Uses a pessary:
  • Screen with a provider-collected liquid-based cytology (LBC) sample
  • Self-screening is not recommended for patients who are using a pessary

 
Had a negative HPV screen between age 65 and 69 and under no active surveillance of pre-cursor abnormalities
  • Screening is not recommended.
Inadequate screening history or has not screened in past 5 years and generally well.
  • Screen with a vaginal swab or provider-collected liquid-based cytology (LBC) sample. Stop routine screening if result is HPV negative. 

High risk

 
Screen with a vaginal swab or provider-collected liquid-based cytology (LBC) sample every 3 years.

Stop screening at age 74 if:
  • There has been a negative HPV screening test between age 65 and 69 and under no active surveillance of pre-cursor abnormalities; or
  • Discharged from colposcopy and have had a negative co-test (HPV and cytology testing) at 12-month follow-up

 
Screen with annual colposcopic evaluation of both the cervix and vagina with a co-test (HPV and cytology testing) until age 69.

 

Discharged from colposcopy:

  • At 12-months post-discharge, screen with a co-test (HPV and cytology testing) using a single provider-collected liquid-based cytology (LBC) sample through primary care provider:
    • If HPV negative and cytology is NILM, ASCUS or LSIL: Routine HPV based screening at 3-year intervals (average risk) or 1-year interval (immunocompromised)
    • If HPV positive or cytology is ASC-H, HSIL or AGC: Re-refer to colposcopy
  • Stop screening at age 69 (average risk) or age 74 (immunocompromised) if patient has had a negative co-test (HPV and cytology testing) and under no active surveillance of pre-cursor abnormalities. 

 
Discharged from colposcopy:
  • At 12-months post-discharge, screen with a co-test (HPV and cytology testing) using a single provider-collected liquid-based cytology (LBC) sample through primary care provider:
    • If HPV negative and cytology is NILM, ASCUS or LSIL: Routine HPV-based screening at 3-year intervals (average risk) or 1-year interval (immunocompromised)
    • If HPV positive or cytology is ASC-H, HSIL or AGC: Re-refer to colposcopy
  • Stop screening at age 69 (average risk) or age 74 (immunocompromised) if patient has had a negative co-test (HPV and cytology testing) and under no active surveillance of pre-cursor abnormalities
History of invasive carcinoma and discharged from cancer treatment (surgery or radiation) by oncologist or colposcopy clinic:
  • The patient’s colposcopist or oncologist is responsible for outlining the post treatment follow-up of a patient diagnosed with cervical cancer for the first 5 years
  • Once discharged, routine screening is not recommended. Ongoing surveillance for recurrence by someone experienced in cervical disease is recommended

Symptomatic

 
Symptomatic, includes:
  • Post coital bleeding
  • Abnormal uterine bleeding
  • Persistent vaginal discharge that cannot be explained by benign causes such as infection string)
Do not screen. The patient should have a speculum examination by someone with experience in gynecologic exams. Referral to a colposcopist is appropriate and may be expedited if the clinical suspicion is high.

Providers can perform a cotest (HPV and cytology testing) with a single provider
collected LBC sample. A cotest is not required for referral and referral should not be delayed pending results of the cotest.


Management of cervix screening results

 
Repeat HPV testing. Unless a cotest (HPV and cytology testing) was recommended, a self-screening test will be sent to the patient at the time of the invalid result notification.

If repeat test is invalid, refer to colposcopy.

Patients who continue to have an invalid result with 3 separate tests, regardless of collection method, will be referred to colposcopy.

 
If specimen identification cannot be confirmed or the sample cannot be tested (e.g., broken container), the Cervical Cancer Screening Laboratory will reject the sample.

Unless a co-test (HPV and cytology testing) was recommended, a self-screening kit will be sent to the patient at the time of the invalid result notification.

 
Samples that are inadequate for cytology interpretation due to poor preservation or obscuring elements.

Unless a co-test (HPV and cytology testing) was recommended, a self-screening kit will be sent to the patient at the time of the invalid result notification.

 
Re-screen in 5 years.

Shorter screening interval recommendation for immunocompromised patients and after treatment for CIN 2, CIN 3 or AIS.

 
Colposcopy is recommended.
  • If screening is performed with a provider-collected liquid-based cytology (LBC) sample, the Cervical Cancer Screening Laboratory will perform a cytological evaluation to aid in the colposcopist’s decision.
  • If screening is performed with self-screening, colposcopist will collect a cytology sample to aid with management decisions.
 

 
Cytology is recommended.

For immunocompromised patients, colposcopy is recommended.

 

Colposcopy is recommended.

 

 
Follow-up cervix screening with primary care provider.

If cytology samples are reported as Unsatisfactory on 2 different occasions, colposcopy is recommended.

 
High-risk HPV: repeat HPV test in 12 months:
  • If HPV negative: return to routine screening
  • If HPV positive: refer to colposcopy
    • If screening is performed with a provider-collected liquid-based cytology (LBC) sample, the Cervical Cancer Screening Laboratory will perform a cytological evaluation to aid in the colposcopist's decision
    • If screening is performed with self-screening, colposcopist will collect a cytology sample to aid with management decisions
 

 

Re-screen in 3 years.

 

 
  • Atypical squamous cells of undetermined significance(ASCUS)
  • Low grade squamous intraepithelial lesion (LSIL)
The Cervical Cancer Screening Laboratory will triage the sample to reflex HPV testing.
  • If HPV Negative: Return to routine screening.
  • If HPV 16/18 Positive: Colposcopy is recommended.
  • If HPV Other Positive: Repeat HPV test in 12 months

 
  • Atypical Squamous Cells of Undetermined Significance (Cannot Rule Out High Grade Lesion) (ASC-H)
  •  High-Grade Squamous Intraepithelial Lesion (HSIL), moderate dysplasia
  • High-Grade Squamous Intraepithelial Lesion (HSIL), severe dysplasia
  • Atypical Endocervical Glandular Cells—Not Otherwise Specified (AGCNOS)
  • Atypical Endocervical Glandular Cells—Favour Neoplasia (AGC-FN)
  • Endocervical Adenocarcinoma In Situ (AIS)
Colposcopy is recommended.

 
Cervical cytology examination has poor sensitivity for endometrial carcinoma and should not be used as a screening test to either rule in or rule out an endometrial abnormality.

 
Colposcopy is recommended or refer to gynecologist for further evaluation which should include an endometrial biopsy.
 

 
Features of possible extrauterine carcinoma or rare malignancies may be identified in  cytology samples collected from participants who are HPV positive.

Managed on a case-by-case basis and may need a multidisciplinary team approach for management. Contact the Cervical Cancer Screening Laboratory for clarification of the results if needed.

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Resources
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Cervix screening resources
SOURCE: Cervix Screening ( )
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