Download Issue 1 Insert 2013 - Canadian Task Force on Preventive Health

CANADIAN TASK FORCE ON PREVENTIVE HEALTH CARE – CERVICAL CANCER
SCREENING GUIDELINES RELEASE
Briefing Note
PURPOSE:
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The Canadian Task Force on Preventive Health Care (CTFPHC) has developed new
cervical cancer screening guidelines that have been published in the Canadian Medical
Association Journal (CMAJ).
The CTFPHC’s recommendations largely align with Ontario’s guidelines – with two major
exceptions – age of initiation and use of the HPV test.
CCO is not planning any changes to the current guidelines as a result of the CTFPHC
recommendations.
BACKGROUND:
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Ontario’s guidelines were developed based on a systematic review and meta-analysis of
high quality evidence conducted by Cancer Care Ontario’s (CCO’s) Program in EvidenceBased Care (PEBC). The working group was chaired by Dr. Joan Murphy, who is Clinical
Lead for the Ontario Cervical Screening Program.
CCO’s PEBC and the Canadian Task Force found that there was little high-quality
evidence available to determine the optimal age of initiating cervical cancer screening,
particularly for women in their 20s.
The new CTFPHC Guidelines:
o Recommendation is to initiate cervical cancer screening at age 25 with cytology only
o Screening is to be done every three years.
o Screening should continue until age 70. Screening may stop in women aged 70 and over
after three successive negative Pap tests.
NOTE: The CTFPHC did not review the evidence for HPV testing in cervical cancer screening.
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The CTFPHC chose age 25 as the age to start screening based on data that showed:
o A higher incidence of cervical cancer in women aged 25 to 29 compared to women
aged 20 to 24.
o Screening with Pap tests may have a small effect in reducing mortality and
morbidity associated with cervical cancer among women aged 25 to 29 but not in
women younger than age 25.
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CCO’s PEBC found that the evidence for screening women in their 20s is not strong.
Women aged 21 to 24 could benefit by detection and treatment of pre-malignant lesions
via cervical cancer screening.
Ontario’s cervical screening guidelines:
o
o
o
o
Continued cervical cancer screening with cytology.
Initiate screening in sexually active women at age 21.
Screening is to be done every three years.
Screening may be discontinued at age 70 if there is an adequate negative cytology
screening history in the previous 10 years.
o Recommended transitioning to primary screening with the human papillomavirus (HPV)
test for women aged 30 to 65 every five years, within an organized screening program.
NOTE: The PEBC conducted a systematic review of the evidence evaluating HPV testing
compared to cytology for cervical cancer screening. It found that HPV testing with cytology
triage for HPV positive results will lead to screening for cervical cancer that achieves high
sensitivity and specificity, with increased detection of adenocarcinoma cancers and ultimately
additional reductions in cervical cancer incidence and mortality.
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CCO will continue to monitor the evidence as to when women should initiate screening for
cervical cancer. CCO ensures that its programs balance the potential benefits and harms
of cancer screening. CCO plans to re-evaluate the evidence regarding the optimal age in
which to initiate cervical cancer screening when its guidelines are updated in 2014/15.
NEXT STEPS
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Primary Care providers in Ontario should continue to follow CCO’s cervical cancer
screening guidelines that were published in May 2012 for cytology.
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The guidelines can be found on CCO’s website http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13104
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CCO will be updating the cervical cancer screening guidelines in 2014/15.
Prepared by:
Tori Gass, Senior Communications Advisor, Communications
Program contact: Name, Title
Originated: December 21
Updated: (if applicable)
Approved by:
Name, Title, Division