Cervical Cancer Screening Program of British Columbia

1
Cervical Cancer Screening Program of British
Columbia
2007 Annual Reporting
2
Number of Smears Received (2006)
3
Participation Rate
Over a 30-month period (July 2004 December 2006)

20-69, adjusted for hysterectomy
50-59
30-39
20-69
BC Ministry of Finance and Corporate Relations
4
Smear Results (2006)
Last cervical / endocervical smears
5
Smear Results (2006)
Significant atypia rates by age group
6
Smear Results (2006)
Significant atypia rates by age group
7
Smear Results (2006)
Significant atypia rates by age group
8
(No Transcript)
9
Doctor Report Card
Pap Smear Quality Feedback Report
10
(No Transcript)
11
Screening Recommendations

• Who
• All women who are or have ever been sexually
  active
• When
• Onset of sexual activity or soon after

12
Screening Recommendations

• How often
• Negative or benign changes
• Repeat smear in 12 months until there are 3
  consecutive normal smears
• Then continue at 24-month intervals
• Mild atypia (dyskaryosis) squamous or glandular
• Repeat in 6 months
• Colposcopy examination is recommended if mild
  atypia persists for 2 years
• Moderate or higher atypia
• Colposcopic examination is recommended
• All women who are or have ever been sexually
  active

13
Screening Recommendations

• When to stop
• After age 69, with 3 or more normal smears in
  the last 10 years and no prior abnormality
  (moderate atypia or higher)

14
Post-hysterectomy Recommendations

• After Total Hysterectomy (uterus and cervix
  completely excised)
• Women with no history of moderate or higher
  abnormality and benign hysterectomy pathology can
  discontinue screening.
• If no previous Pap smear record is available and
  hysterectomy pathology is benign, the patient
  should have 2 consecutive negative smears 1 year
  apart before discontinuing screening.
• Women with a history of moderate or higher
  abnormality (CIN II, CIN III, or carcinoma in
  situ on history), but no history of invasive
  cervical carcinoma should have 3 documented
  consecutive, technically satisfactory
  normal/negative vaginal smears 1 year apart over
  a 3-year period before discontinuing screening.
• More

15
Post-hysterectomy Recommendations

• After Total Hysterectomy (uterus and cervix
  completely excised)
• Women with a history of in utero DES exposure
  should continue screening as long as this is
  clinically feasbile.
• Women with a history of invasive cervical
  carcinoma should follow the recommendation
  provided by the BC Cancer Agency Gynecological
  Tumor Group.
• Note For women who had total hysterectomy
  (uterus and cervix completely excised) subsequent
  to a history of CIN II or III and no evidence of
  invasive carcinoma, routine vaginal screening can
  be discontinued after 3 consecutive, technically
  satisfactory smears over a 3 year period.

16
Post-hysterectomy Recommendations

• After sub-total hysterectomy (uterus corpus
  removed, cervix in place)
• Women who have had a subtotal hysterectomy
  should continue cervical cancer screening as per
  program guidelines.

17
CCSP Screening Recommendations
18
Follow-up Reminder System
19
Follow-up Reminder System
20
Cumulative Numbers and Proportions Rescreened
Patients with unsatisfactory or moderate atypia
smears were excluded.
21
Invasive Cervical Cancers (2005)
22
Age Standardized Incidence and Mortality Rate of
Invasive Cervical Cancer
Rate per 100,000
Rates are standardized to the 1991 Canadian
population
23
Screening History for Invasive Squamous Cell
Cervical Cancer (Patients by age group, 2005)
24
Screening History of Invasive Adenocarcinoma
Cervical Cancer (Patients by age group, 2005)
25
Result Terminology
Unsatisfactory and negative
26
Result Terminology
Benign changes
More
27
Result Terminology
Benign changes
28
Result Terminology
Mild squamous
29
Result Terminology
Moderate squamous
30
Result Terminology
Malignant
31
Result Terminology
Mild glandular and other
32
Educational Materials

• For Women
• Cervical cancer protect yourself with regular
  Pap tests (English)
• HPV cervical cancer what you should know and
  do (English)
• Preventing cervical cancer (English booklet)
• Abnormal pap smear causes and proper follow-up
  (English booklet)
• For Smear-takers
• Technique for Obtaining Cervical Smears
  (laminated card)
• Screening for Cancer of the Cervix An Office
  Manual for Health Professionals
• Speculum Exam Pap Smear DVD

33
Website

• www.bccancer.bc.ca/cervicalscreening