Cervical Cancer Screening

Policy

Cervical Cancer Screening – Clinical Practice Guidelines 2019 (available on the PDMS website, log-in and search)

Resources

Guideline Package Request [PDF]

Cervical Cancer Screening Clinical Reference Tool 2019 [PDF] 

Primary Care Providers

As a primary care provider, you are the first point of access for offering cervical cancer screening. Primary care physicians play a key role in taking pap smears.

Your role in Cervical Cancer Screening Program (CCSP) includes:

  • Pap testing:  Taking cervical cytology samples/pap smears.
  • Talk about it:  Discussing cervical cancer screening with your female patients at their next appointment.
  • Follow up on abnormal/positive results

PAP Screening Guidelines 2019

These guidelines are for screening average risk, asymptomatic women.

  • Screening initiation:     
    Cervical cytology screening should be initiated at 25 years of age for women who are or have ever been sexually active.  Women who are not sexually active by age 25 should delay cervical cancer screening until sexually active.
  • Screening intervals:    
    If cytology is normal, screening should be done every 3 years.
  • Screening cessation:  
    Screening may be discontinued for women older than 65 years if there is an adequate negative pap screening history in the previous 10 years (i.e., 3 or more negative pap tests).

FAQs for Healthcare Providers

What do I tell my patients who want to be screened annually?
The recommendation for screening average-risk women every 3 years was based on evidence showing that a 3-year screening interval is safe and effective. 

What does the evidence say about triennial (every 3 years) screening vs. annual screening?
There is no evidence that annual screening for average-risk women is better than screening every 3 years. There is evidence that it is harmful to screen women more often than every 3 years.

You will find more information for clinicians that support triennial screening on the Canadian Task Force on Preventive Health Care website  

Under what circumstances should I screen women more frequently than what is recommended in the guidelines?
Certain populations of women benefit from more frequent screening than the average risk population. Annual cervical cytology screening is advised for:

  • women who are immunocompromised, including, women with HIV/AIDS and 
  • women who are taking long-term immunosuppressants (e.g., organ transplants, long-term immune suppressant drug therapy)
  • women who have previously been treated for high-grade cervical or vaginal neoplasia (high-grade squamous intraepithelial lesion or HSIL; cervical intraepithelial neoplasia [CIN] II/CIN III) and/or cervical cancer.

Follow up on abnormal Paps

See Recommendations for follow-up of abnormal cytology:  SOGC Joint Clinical Guidelines “Colposcopic Management of abnormal cervical cytology and histology guidelines: 
https://www.jogc.com/article/S1701-2163(16)35468-8/fulltext

Laboratories send results of cervical cytology and reminders for overdue follow-ups to primary care providers.

Screening Women with Special Circumstances

  • Women who are immunosuppressed (e.g HIV-positive or on long-term immunosuppressants) should receive annual screening.
  • Women who have undergone subtotal hysterectomy and retained their cervix should continue screening according to the guidelines.
  • Pregnant women should be screened according to the guidelines.  Only conduct Pap tests during pre- and post-natal care if a woman is due for regular screening.
  • Women who have sex with women should be screened according to the guidelines
  • Women who have received the HPV vaccine should be screened according to the guidelines.  The vaccine may be considered by men and women who have not received the HPV vaccine or who have certain risk factors. 

Consider HPV Immunization for adults through Public Health Nursing PEI

Detailed information on adult immunization in PEI for use by Healthcare Providers:
https://www.princeedwardisland.ca/sites/default/files/publications/ai_detailed_schedule_201906.pdf  
https://www.princeedwardisland.ca/en/publication/adults-immunization-schedule-use-health-care-providers 
https://www.princeedwardisland.ca/en/information/adult-immunizations

Contact Public Health Nursing:
https://www.princeedwardisland.ca/en/information/health-pei/public-health-nursing

Last Updated
Thu, 02/13/2020 - 12:52