Nieminen P, Kallio M, Anttila A, Hakama M. Organised vs. spontaneous Pap–smear screening for cervical cancer: a case–control study. Int J Cancer 1999;83:55–8.
Miller MG, Sung HY, Sawaya GF, Kearney KA, Kinney W, Hiatt RA. Screening interval and risk of invasive squamous cell cervical cancer. Obstet Gynecol 2003;101:29–37.
Sasieni P, Adams J, Cuzick J. Benefit of cervical screening at different ages: evidence from the UK audit of screening histories. Br J Cancer 2003;89:88–93.
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Cheung AN, Szeto EF, Leung BS, Khoo US, Ng AW. Liquid–based cytology and conventional cervical smears: a comparison study in an Asian screening population. Cancer 2003;99:331–5.
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Appendix 1. Recommendations of the Ontario Cervica
Target Population This practice guideline applies to all women who are, or have ever been, sexually active.
Recommendations Please note that evidence ratings are in brackets. Please see the scale in Appendix 2.
Optimal Cervical Screening Tool
Liquid-based cytology (LBC) is the preferred tool for cervical cytology screening. (B-II) Conventional smear cytology remains an acceptable alternative. (C-III)
Optimal Screening Circumstances
Given the lower incidence and mortality associated with organized screening programs (with recall systems) elsewhere, a province-wide cervical screening program with an adequate recall mechanism is recommended. (A-II)
Cervical cytology screening should be initiated within three years of first vaginal sexual activity (i.e., vaginal intercourse, vaginal/oral and (or) vaginal/digital sexual activity). (C-III)
Screening Interval These recommendations do not apply to women who have had previous abnormal Pap tests. Please see the Management of Women with Abnormal Cytology section for further information.
Ontario Cervical Cancer Screening Clinical Practice Guidelines
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Hammoud MM, Haefner HK, Michael CW, Ansbacher R. Atypical glandular cells of undetermined significance. Histologic findings and proposed management. J Reprod Med 2002;47:266–70.
Chan CW, Cheung KB. Clinical significance and management of cervical atypical glandular cells of undetermined significance. Hong Kong Med J 2003;9:346–51.
Stuart G, Taylor G, Bancej CM, Beaulac J, Colgan TJ, Franco EL, et al. Report of the 2003 Pan–Canadian forum on cervical cancer prevention and control. J Obstet Gynaecol Can 2004;26(11):1004–28.
The AGREE Collaboration. Appraisal of Guidelines Research and Evaluation. AGREE Collaboration. 2004 Mar [Cited 2004 Apr 13]. Available from: http://www.agreecollaboration.org/. Accessed September 14, 2007.
Cancer Care Ontario [website]. Program in Evidence-Based Care (PEBC). Available at: http://www.cancercare.on.ca. Accessed January 30, 2007.
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l Screening Guidelines Development Committee
Screening should be done annually until there are three consecutive negative Pap tests. (C-III)
Screening should continue every two to three years after three annual negative Pap tests. (B-II)
Screening at a three-year interval is recommended, supported by an adequate recall mechanism. (B-II)
Women who have not been screened in more than five years should be screened annually until there are three consecutive negative Pap tests. (C-III)
Screening may be discontinued after the age of 70 if there is an adequate negative screening history in the previous 10 years (i.e., 3–4 negative tests). (B-II)
Screening Women with Special Circumstances
Immunocompromised or HIV-positive women should receive annual screening. (C-III)
Examples of situations where women may be immunocompromised include women who have received transplants and women who have undergone chemotherapy.
Screening can be discontinued in women who have undergone total hysterectomy for benign causes with no history of cervical dysplasia or human papillomavirus. (C-III)
Women who have undergone subtotal hysterectomy (with an intact cervix) should continue screening according to the guidelines.
APRIL JOGC AVRIL 2007