The PEI Cervical Cancer Screening Clinical Practice Guidelines have recently been updated, and you should be aware of some significant changes starting May 23, 2023. One of the most significant changes is the move from conventional Pap smear testing to HPV (Human papillomavirus) testing using PCR to screen for cervical cancer.
This means that the collection device and platform that will be used are now different, and there are new collection requirements. Please find the lab memo below for details and contacts.
NOTE: Glass slides and slide holders can be returned to the QEH lab. Other items such as scrapers or brushes can be send to the QEH lab, too.
Policy
Cervical Cancer Screening – Clinical Practice Guidelines 2023 (available on the PDMS website, log-in and search)
Resources
Guideline Package Request [PDF]
Cervical Cancer Screening Clinical Reference Tool 2023 [PDF]
End May 23, 2023: Cervical Cancer Screening Clinical Reference Tool 2019 [PDF]
HPV Testing Cervical Screening FAQ Patient Handout [PDF]
BD SurePath LBC Collection Video
Lab Memo: Changes in collection requirements LBC, HPV [PDF] On May 23, 2023, Provincial Laboratory Services will replace the conventional Pap smear with primary HPV (human papilloma virus) testing using PCR to screen patients for cervical cancer.
Lab Memo: Screening Tool for pregnant women [PDF]
Lab Presentation: Primary HPV Screening for Cervical Cancer in PEI, 2023-06
Q&A Clinicians Live session recording 2023-06 Q&A Sheet 2023-06
Canadian Colposcopy Guideline 2023-06
Primary Care Providers
As a primary care provider, you are the first point of access for offering cervical cancer screening. Primary care physicians, nurse practitioners and nurses play a key role in taking pap tests.
Your role in Cervical Cancer Screening includes:
- Primary HPV testing: Taking an HPV test using liquid based cytology to allow for reflex cytology to take place in the lab when required.
- Talk about it: Discussing cervical cancer screening with your patients who have a cervix at their next appointment.
- Follow up on abnormal/positive results.
PAP Screening Guidelines 2023
These guidelines are for screening asymptomatic individuals with a cervix.
- Screening initiation:
Primary HPV screening should be initiated at 25 years of age for individuals with a cervix who are or have ever been sexually active. Individuals who are not sexually active by age 25 should delay cervical cancer screening until sexually active.
- Screening intervals:
If HPV is negative, routine screening should be done every 5 years.
- Screening cessation:
Screening may be discontinued for individuals with a cervix aged 66 years or older if there is an adequate negative pap screening history in the previous 10 years. Adequate negative screening is defined as two consecutive, negative primary HPV tests, three negative cytology tests or a combination of both (one HPV test and two cytology tests) within the past 10 years.
Note: If previous PAP cytology was normal for cervical cancer screening, routine screening with primary HPV testing can start in 3 years.
Note: If you follow-up on patients with a previous recommendation to repeat a pap in 3, 6 or 12 months, complete a pap test only (no HPV test) using liquid based cytology.
FAQs for Healthcare Providers
What do I tell my patients who want to be screened every 3 years or more often? HPV testing is more sensitive and effective at identifying individuals at greater risk of developing pre-cancerous cervical lesions than the Pap smear test.
Under what circumstances should I screen women more frequently? Certain populations of individuals benefit from more frequent screening than the average risk population. HPV testing is advised every three years for:
• People living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
• People with congenital (primary) immunodeficiency
• Transplant recipients
• People requiring treatment with medications that cause immune suppression for three years or more
• People living with systematic lupus erythematosus (SLE)
• People living with renal failure and require dialysis
Follow up on positive HPV tests / abnormal Paps
Please follow the HPV Testing Cervical Screening Pathway (Provided in the 2023 clinical practice guidelines) for recommendation on patient follow-up.
Laboratories send results of cervical cytology and reminders for overdue follow-ups to primary care providers.
Screening Women with Special Circumstances
- 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 HPV 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. Transgender Men, LGBTQ+, all individuals with a cervix, age 25 to 65, are eligible for regular cervical screening. Transgender men who have retained their cervix should be screened.
- Women who have received the HPV vaccine should be screened according to the guidelines.
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/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