Cervical Screening: A Guideline for Clinical Practice in Ontario

Murphy, Joan; Kennedy, Erin B.; Dunn, Sheila; McLachlin, C. Meg; Fung, Michael Fung Kee; Gzik, Danusia; Shier, Michael; Paszat, Lawrence

doi:10.1016/s1701-2163(16)35242-2

Cited by 55 publications

(45 citation statements)

References 24 publications

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“…16,17,19 The lower rates of cervical screening and imaging for low back pain compared with repeat DEXA scans may reflect increased penetrance of guideline recommendations and policy changes. The Ontario government amended the fee schedule to align with the guideline changes made in 2012: 20 effective January 2013, cervical cancer screening was not insured for women less than 21 or more than 70 years of age. 21 Imaging for low back pain has been the subject of sig- nificant quality improvement efforts funded in part by the provincial government.…”

Section: Discussionmentioning

confidence: 99%

Frequency of and variation in low-value care in primary care: a retrospective cohort study

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Frequency of and variation in low-value care in primary care: a retrospective cohort study

et al. 2017

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“…The Netherlands has recently transitioned from cytology to hpv testing for primary cervical cancer screening in their National program. Many organized screening programs intend to implement primary hpv screening [6][7][8][9] , including Australia, which will begin implementation in December 2017.…”

Section: Paradigm Shift Towards Hpv Screening Globallymentioning

confidence: 99%

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

et al. 2018

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The success of cytology (Pap screening) programs is undeniable and has drastically reduced cervical cancer rates in high-income settings where it has been implemented 1 . However, cytology for primary cervical cancer screening has a number of limitations including poor sensitivity, a taxing demand on human and operational infrastructure, high health system costs, and limited uptake rates, leading researchers and policy-makers to question whether further gains in public health are possible using this approach 2 . Persistent infection with high-risk genotypes of human papillomavirus (hpv) is well established as the necessary cause for development of cervical cancer 3 . Research has shown a 30% improvement in sensitivity in detecting high-grade lesions, cervical squamous intraepithelial neoplasia (cin) grade 2 or greater (cin2+), can be achieved with high-risk hpv dna testing compared with cytology 4 . A negative hpv test confers two-fold greater reassurance against the development of cervical cancer over three years compared with a negative cytology test 2,5 . The Netherlands has recently transitioned from cytology to hpv testing for primary cervical cancer screening in their National program. Many organized screening programs intend to implement primary hpv screening 6-9 , including Australia, which will begin implementation in December 2017.A consistent barrier to cytology-based cervical cancer screening is non-attendance, which can be addressed through hpv testing using self-collected samples. Primary cervical cancer screening with hpv dna testing allows for the opportunity of self-collected samples, which is not possible with cytology. In hpv self-collection the sample is obtained vaginally by the woman herself, using a device such as a swab or brush. The swab is subsequently tested for high-risk strains of hpv in a laboratory. With this approach to screening, programs can mail self-collection kits directly to women who are overdue for screening as an alternative to a clinic-based visit. Self-collected cervical samples receiving hpv testing show comparable cin2+ sensitivity compared with clinician-collected samples tested with cytology and with hpv 10-12 . Self-collection has proven to be highly acceptable among women 13 .Huma n papillomav ir us self-collection has t he potential to overcome many of the personal and systemlevel barriers to screening that exist for cytology or other clinic-based screening methods. Some women, particularly those who have experienced abuse 14 or are otherwise marginalized, may find self-sampling preferable because of such things as cultural/religious embarrassment or discomfort associated with a pelvic exam 13,[15][16][17] . Time, transportation, inconvenient clinic hours, or not having a regular practitioner are also relevant factors associated with under-screening that can be mitigated through hpv self-collection using mailed samples 13,16,17 . However, there are psychosocial barriers to hpv screening, including women's lack of awareness and fears around hpv and cervical cancer...

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“…For example, the Ontario cervical cancer screening guidelines advise that women 21 to 69 years of age be screened using the Pap test every 3 years. 5 An age group of those 18-66 years on January 1, 2007 corresponds to an age group of those 21-69 years at the end of the 3-year period on December 31, 2009. We recognize that some of the individuals in our study cohort may have been outside the age range for a particular screening test (e.g., age 20 when a woman had her Pap test).…”

Section: Screen-eligible Cohorts By Disease (Denominators)mentioning

confidence: 99%

“…Canadian cancer screening guidelines for average-risk individuals recommend that all adults 50 to 74 years of age be screened for cancer of the colon and rectum (with the fecal occult blood test (FOBT) every 2 years and/or endoscopic visual examination of the large bowel via a flexible sigmoidoscopy every 5 years or colonoscopy every 10 years), 3 and that women who are 50 to 74 years of age be screened for breast cancer (with mammography) every 2 to 3 years 4 and those 21 to 69 years of age be screened for cervical cancer (using the Pap test) every 3 years. 5 Despite universal health care, and cancer screening guidelines, socio-demographic disparities both in cancer incidence and uptake of screening persist in Ontario. 6 In Canada and in other jurisdictions, many new cases of cancer are found in screen-eligible people who have never been screened or are underscreened.…”

mentioning

confidence: 99%

Disparities in Receipt of Screening Tests for Cancer, Diabetes and High Cholesterol in Ontario, Canada: A Population-based Study Using Area-based Methods

Borkhoff

Saskin

Rabeneck

et al. 2013

Can J Public Health

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OBJECTIVES:Few have compared socio-economic disparities in screening tests for cancer with recommended tests for other chronic diseases. We examined whether receipt of testing for colorectal, cervical and breast cancer, as well as diabetes and high cholesterol, differs by neighbourhood-level socio-economic and recent immigrant status. METHODS:We conducted a population-based retrospective cohort study of patients identified as screen-eligible in 2009 living in Ontario, Canada. Postal codes were used to assign residents to a dissemination area (DA). Using Canadian census data, DAs were stratified by income quintile and proportion of recent immigrants. Prevalence of screening for cancer (colorectal, cervical, breast), diabetes, and high cholesterol, using administrative data, and prevalence ratios (least/most advantaged) were calculated. RESULTS:The cohort comprised 7,652,592 people. Receipt of screening for colorectal cancer (women 61.6%; men 55.1%) and breast cancer (59.9%) were the lowest and diabetes (women 72.9%; men 61.4%) and high cholesterol (women 82.4%; men 70.3%) were the highest. We found disparities in the receipt of all tests, with the lowest uptake and largest disparities for cancer screening among those living in both low-income and high-immigration DAs: colorectal -women 48.6%; RR 0. CONCLUSION:People living in low-income and high-immigration DAs had the lowest screening participation for all tests, although disparities were highest for cancer. An organized integrated chronic disease screening strategy leveraging the higher diabetes and high cholesterol screening participation may increase screening for cancer and other chronic diseases in never-and underscreened populations.

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Cervical Screening: A Guideline for Clinical Practice in Ontario

Cited by 55 publications

References 24 publications

Frequency of and variation in low-value care in primary care: a retrospective cohort study

Frequency of and variation in low-value care in primary care: a retrospective cohort study

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

Disparities in Receipt of Screening Tests for Cancer, Diabetes and High Cholesterol in Ontario, Canada: A Population-based Study Using Area-based Methods

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