Cervical cancer screening in Canada: 2021/2022
About this section
After an abnormal Pap tests, participants may be referred for a colposcopy. Colposcopy is the primary follow-up test after an abnormal screening to confirm the presence of pre-cancerous and cancerous cells and determine appropriate care. This section describes colposcopy services in Canada.
Colposcopy services
Referral to colposcopy services
Individuals with abnormal Pap test results requiring follow-up may be referred for colposcopy. Criteria for referring participants to colposcopy services vary across jurisdictions.
Criteria for referral to colposcopy services
| P/T | ASC-US (1st result) | LSIL (1st result) | ASC-US and HPV+ result | Repeated ASC-US/LSIL after previous ASC-US/LSIL | Age ≥ 50 with LSIL and HPV+ result | AGC | HSIL+ | Other |
|---|---|---|---|---|---|---|---|---|
| YT* | ✓ | ✓ | ✓ | · Yukon follows BC criteria | ||||
| NT | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
| NU | Individuals <30 ASCUS repeat cytology in 6 months | Repeat test twice at 6 month intervals | ✓ (age ≥ 30) |
No specific guidelines for >50 | ✓ | ✓ | · ASC-H · Squamous Carcinoma · Adenocarcinoma · Other malignant neoplasms · Suspicious cervix |
|
| BC | ✓ | ✓ | ✓ | |||||
| AB | ✓ (age ≥ 30) |
✓ | ✓ | ✓ | ✓ | · ASC-H | ||
| SK | ✓ | ✓ | ✓ | |||||
| MB | ✓ (age ≥30) Post triage implementation |
✓ | ✓ Post triage implementation |
✓ | ✓ | · Atypical endocervical cells, visual abnormality of the cervix, or all cytological abnormalities (including low grade lesions) of individuals who are immunosuppressed (HIV+ with CD4 count < 400 or transplantation with immunosuppressive therapy > 3 years) · Exposure to diethylstilboestrol (DES) in utero |
||
| ON | ✓^ | ✓~ | ✓ | ✓ | ✓ | ✓ | · ASC-H, atypical endocervical cells, atypical endometrial cells | |
| QC | ✓ | ✓ (age > 30) |
✓ | ✓ | ✓ | · Postcoital bleeding or cervicitis | ||
| NB | ✓ (age ≥ 30) |
✓ | ✓ | ✓ | ✓ | · ASC-H | ||
| NS | ✓ | ✓ | ✓ | · ASC-H | ||||
| PE | ✓ | ✓ | ✓ | ✓ | · ASC-H | |||
| NL | ✓ (age < 30 repeat ASC-US x3 at 6month interval; if the third Pap is abnormal, refer to colposcopy) |
✓ | ✓ | ✓ |
YT: *YT will be following BC’s criteria
ON: ^Repeat cytology or colposcopy are acceptable management options after the first LSIL result. Low-grade abnormalities often regress on their own and may be best managed in surveillance, however colposcopy may be considered.
ON: ~HPV testing is not currently funded; however, the program has best practice recommendations when its use is available (e.g., on a patient-pay basis or in some hospital-based colposcopy units).
Abbreviations: ASC-US: atypical squamous cells of undetermined significance; LSIL: low-grade squamous intraepithelial lesion; AGC: atypical glandular cells; HSIL: high-grade squamous intraepithelial lesion.
Definitions: HSIL+: high grade squamous intraepithelial lesions or worse (HSIL+ includes HSIL, AIS and invasive carcinoma); ASC-H: atypical squamous cells, cannot exclude HSIL
Colposcopy services in Canada
Colposcopy services are most often provided in hospitals, colposcopy clinics and by individual practitioners. Six provinces and two territories currently use HPV testing in colposcopy care, and HPV testing is used by many jurisdictions to determine whether participants can return to routine cervical cancer screening.
Location of colposcopy
| P/T | Provided by hospitals | Provided by individual practitioners | Provided by colposcopy clinics | How colposcopy services are provided |
|---|---|---|---|---|
| YT | ✓ | YT colposcopies are done in colposcopy clinic at Whitehorse General Hospital. | ||
| NT | ✓ | All colposcopies are performed by the OB-GYN service. The service is based out of Stanton Territorial Hospital in Yellowknife, but travels to other NT hospitals to provide the service. | ||
| NU | ✓ | ✓ | Qikiqtani General Hospital in Iqaluit has a colposcope and provides colposcopies for people in the Qikiqtani Region. Services in the Kivalliq Region may be provided at the Rankin Inlet Health Centre during specialist visits or out of Territory in Winnipeg. Services in the Kitikmeot Region are provided by a travelling Colposcopy clinic or out of Territory in Yellowknife or Edmonton. | |
| BC | ✓ | ✓ | ✓ | Most colposcopy is done in a colposcopy clinic out of a hospital. A few colposcopists who have completed the BC Colposcopy Training Program provide colposcopy out of their office. |
| AB | ✓ | ✓ | Majority of colposcopies are done in ambulatory clinics in hospitals. Program has standardized colposcopy referral form, and procedure report form. | |
| SK | ✓ | ✓ | ✓ | Colposcopy services are provided by colposcopy clinics in the large cities and by individual colposcopists for the rest of the province. |
| MB | ✓ | ✓ | ✓ | One formal colposcopy clinic in Winnipeg. Other medical clinics and hospitals also offer colposcopy services by gynecologists. Referral to colposcopy are made by the referring clinician to colposcopy clinic. The program will follow up with the referring clinician if there is no colposcopy information in Cervix registry within pre-set time frames as per guidelines. |
| ON | ✓ | ✓ | ✓ | The majority of colposcopies occur in hospital-based clinics (66%) instead of non-hospital clinics (34%). Clear referral criteria and evidence-based clinical pathways are recommended by the program. |
| QC | ✓ | ✓ | Colposcopy services are conducted in hospital settings or colposcopy clinics. Referrals are done by the hospital and there are no formal programs. | |
| NB | ✓ | ✓ | Colposcopies are provided by each of the 8 regional hospitals across NB. Colposcopies are operationalized by the Regional Health Authorities. | |
| NS | ✓ | ✓ | Colposcopy is delivered primarily in hospital-based clinics. There are a few private office-based clinics that provide initial assessment with treatment performed in a hospital setting. | |
| PE | ✓ | Colposcopy services are provided by individual gynecologists primarily in an office setting. | ||
| NL | ✓ | ✓ | ✓ | Colposcopy services are provided in 11 hospital-based sites within 4 Regional Health Authorities. There are also individual practitioner, private-based colposcopy services available. If treatment is required, it is performed in a hospital-based setting. |
Use of HPV testing in colposcopy care
| P/T | Current use or plans to implement HPV testing in colposcopy care | Type of HPV test for colposcopy care | Use of HPV test to determine return to routine screening |
|---|---|---|---|
| YT | Yes – available annually post treatment | Roche Cobas 4800 | Yes – if HPV negative post treatment, will be discharged after appropriate follow-up |
| NT | Yes – limited use, only for participants needing to travel long distances for colposcopy service | Not known | Yes – occasional use in restricted circumstances |
| NU | No organized screening program available | ||
| BC | Yes – available annually post treatment | Roche Cobas 4800 | Yes – if HPV negative post treatment, will be discharged after appropriate follow-up |
| AB | Yes – full provincial implementation underway | No decision yet | Yes – HPV test of cure using Hologic Aptima and Cobas 4800 |
| SK | Available for colposcopists on special request | Health Canada approved PCR method | Yes – based on colposcopist request |
| MB | No current plans | N/A | No |
| ON | Yes – in planning stages. HPV testing is not currently funded; however, the program has best practice recommendations when its use is available (e.g. on a patient pay basis or in some hospital-based colposcopy units) | The future state of HPV testing in colposcopy care is currently in development (i.e., type of test, interval, and use) as a part of planning for the implementation of HPV testing in Ontario | The future state of HPV testing in colposcopy care is currently in development (i.e., type of test, interval, and use) as a part of planning for the implementation of HPV testing in Ontario |
| QC | Yes – used as a diagnosis tool | Roche Cobas 4800 | Not frequently |
| NB | Available for colposcopists in colposcopy clinics, upon request | Roche Cobas 4800 | Use is determined and operationalized by some providers and Regional Health Authorities |
| NS | Yes – used as test of cure and to help with triage of cases | Roche test | Yes – used at 6 months with Pap, not used by all colposcopists |
| PE | No current plans | Roche Cobas 1800* | No |
| NL | No current plans | N/A | Available upon request |
PE: *HPV test is used for follow-up care in PEI, as opposed for colposcopy care or discharge purposes