Invitation to Provincial Cervical Screening and Colposcopy Education Day:
Our region is proud to host the annual (accredited) OSCP update both in person or via webinar. Topics especially helpful for primary care include: normal cervical anatomy anatomy of variants, new HPV vaccination recommendations and lessons learned after HPV launch.
Here is the invite!
OSCP Updates:
With HPV screening availability just passing the first year anniversary of its launch on March 3rd, 2025, it’s time for some reflections. Here are a few:
- While the number one reason for specimen rejections used to be the broom left in the container, it is now sample rejection due to a recent screening test being on file. If the last screening test was via a pap (ie prior to March 3rd 2025), patients are due for the new HPV screening test when they would have been due for a pap. So, for average risk patients with normal pap tests, this would be after 3 years. They are thus due for their first HPV screen 3 years after their normal Pap. Any testing done more often than the recommended intervals are being rejected. More info here.
- How about patients who are above average risk ie those whose last pap (prior to HPV launch) showed low grade changes (ascus or lsil)? For patients with most recent prior pap showing abnormal low grade dysplasia Pap, the next screen would be 12 months from previous Pap via the new HPV test. This recommendation is similar for patients who had been discharged from colposcopy with an annual screening recommendation. prior to HPV’s launch in March 23rd, 2025. When completing the requisition for their HPV testing, choose the “HPV-positive (other high-risk types) with normal or low-grade (NILM/ASCUS/LSIL) cytology: 2-year follow-up (moderate risk)” on the requisition. AND if that result comes back HPV +, regardless of HPV subtype or cytology, these patients require referral to colposcopy. Data analysis shows that more of these patients are not getting referred to colposcopy. More can be found on Q’s #32 and #33 in the HPV Testing Frequently Asked Questions
- When do we pick ‘vaginal’ specimen site on the requisition? Very Rarely! This is only used for a patient who meets the criteria for one-time vaginal vault testing which is: post total hysterectomy with LSIL, HSIL or Adenocarcinoma in situ found on their hysterectomy pathology OR people with a history of early cervical cancer (microinvasive cervical cancer, stage 1A1 only). Ideally the consulting gynecologist will advise if this is necessary post their discharge. More information is here. Currently we are over selecting this site box on the requisition ‘vaginal’ when we should be selecting ‘cervical/endocervical’ which is leading to specimen rejections.
- Laboratory service providers have noted that a number of screening requisitions have been submitted for people experiencing symptoms. Cervical screening is meant only for people who are due for screening, not as part of a clinical workup. If your patient is up to date with their screening and they are having symptoms, they need a physical exam with diagnostic testing (ie. Imaging, biopsies), or referral to general gynecology. A screening test has a very high false negative rates in this circumstance and does not add valuable information to the diagnostic work-up (ie. should not be reassuring)Some patients are not receiving their results in the mail, and it is most often because the PO BOX or apartment/unit is not on the requisition.
- Some patients are being invited to be screened via the central provincial correspondence program who are between ages 69-74 but have in fact completed their screening. This coding error should have been fixed. However, sometimes it might persist due to gaps in Ontario Health’s historical cervical screening data where particularly hospital-based cytology records are missing. If our patient receives a recall letter and they have met cessation criteria (average risk, over age 70 and they have had 3 negative cytology results in the previous 10 years) they do not need screening, and the letter can be ignored. If you think there has been a correspondence error, providers and/or participants can follow-up with the Ontario Health Contact Centre (1-866-662-9233) or Primarycareinquiries@ontariohealth.ca