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Toronto Notes 2019 Periodic Health Examination Cervical Cancer Screening Guidelines
• eitherconventionalPapanicolaou(Pap)smearorliquidbasedcytologytesting
• endocervicalandexocervicalcellsampling(aimistosamplethetransitionalzone)
• bestidentifiessquamouscellabnormalities,lessreliableforglandularabnormalities
■ false positives 5-10%, false negatives 10-40% (for single test)
■ false negative rate 50% for existing cervical cancer
• cervicalcancerscreeningguidelinesdifferbyprovincialjurisdiction(seeTheSocietyofObstetricians
and Gynaecologists of Canada guidelines)
2013 Canadian Task Force for Preventative Care Guidelines
• screenallwomenage≥25q3yrwhoareorhaveeverbeensexuallyactive(includesintercourseor digital/oral activity with partner of either sex); age 25-29: weak recommendation; moderate quality evidence, age 30-69: strong recommendation; high quality evidence
• womenage≥70:if3normaltestsinarowandnoabnormaltestsinlast10yr,candiscontinuescreening (weak recommendation; low quality evidence)
• Ontarioguidelines
■ screen all women age ≥21 who are or have ever been sexually active
■ if cytology is normal, can screen every 3 yr
■ women age ≥70: if 3 successive negative Pap tests in last 10 yr, can discontinue screening
■ women who are not sexually active by age 21 should delay cervical cancer screening until sexually
active
• pregnantwomenandwomenwhohavesexwithwomenshouldfollowtheroutinecervicalscreening
Family Medicine FM5
Prostate Cancer Mortality at 11 Years of Follow-Up
NEJM2012;366:981-990
Purpose: To evaluate the effect of prostate-specific antigen (PSA) testing on prostate cancer mortality.
Methods: Update of European Randomized Study of Screening for Prostate Cancer with two additional years of follow-up. Men between the ages of 50 and 74 years were eligible, and eight European countries were involved. Men were randomly assigned to screening or control. Primary outcome was prostate cancer-related mortality.
Results: 162,388 men were involved, and a median follow- up of 11 years was completed. Relative reduction in the risk of prostate cancer-related deaths was 21% in favour of the screening group (rate ratio (RR) 0.79, 95% CI 0.68-0.91, p=0.001), and absolute reduction was 0.10 deaths/1,000 person-years (1.07 deaths/1,000 randomized men). 1,055 men would need to be invited for screening to prevent one death from prostate cancer with 11-year follow-up. No significant between-group difference in all-cause mortality was noted.
Conclusion: PSA-based screening significantly reduced prostate cancer-related mortality but did not affect all-cause mortality.
regimen
• womenwhohavehadahysterectomy
■ total: discontinue screening if hysterectomy was for benign disease and no history of cervical dysplasia or HPV infection, continue to swab vaginal vault if history of uterine malignancy/ dysplasia
■ subtotal: continue screening according to guidelines • exceptionstoguidelines
■ immunocompromised (transplant, steroids, diethylstilbestrol exposure, HIV)
■ previously unscreened patients
• for more information on cervical cancer (see Gynecology, GY43)
Normal
Routine screening in 3 yrs
Inadequate sample
Repeat cytology in 3 mo
Adequate sample – no TZ
ASCUS
Women ≥30
HPV-DNA testing
ASC-H AGUS/ atypical
endocervical Colposcopy cells/atypical endometrial
cells
Colposcopy ± endometrial sampling
LSIL OR
HSIL Colposcopy
Squamous carcinoma/ other malignant changes
Colposcopy
Routine screening in 3 yr
Women <30 or HPV testing not available
Repeat cytology in 6 mo
Colposcopy
Repeat cytology in 6 mo
Negative
Repeat cytology in 6 mo
≥ASCUS Colposcopy
Negative
Repeat cytology in 6 mo
≥ASCUS Colposcopy
Negative
Repeat cytology in 12 mo
Positive Colposcopy
Negative
Routine screening
≥ASCUS Colposcopy
Negative
Routine screening
≥ASCUS Colposcopy
Figure 2. Decision making chart for cervical cancer screening (not applicable to adolescents)
AGUS = atypical glandular cells of unknown significance; ASCUS = abnormal squamous cells of unknown significance; ASC-H = abnormal squamous cells cannot rule out HSIL; HSIL = high grade squamous intraepithelial lesion; LSIL = low grade squamous intraepithelial lesion; TZ = transitional zone
Adapted from: Ontario Cervical Screening Cytology Guidelines, May 2012
Prostate Cancer Screening Guidelines
2014 Canadian Task Force for Preventative Care Guidelines
• screeningforprostatecancerwiththeprostatespecificantigentestisnotrecommendedforanyage group (age <55: strong recommendation; low quality evidence, age 55-69: weak recommendation; moderate quality evidence, age >70: strong recommendation; low quality evidence)