Ontario Cervical Screening Cytology Guidelines Summary

Updated May 2012

Screening Initiation

Cervical cytology screening should be initiated at 21 years of age for women who are or have ever been sexually active. This includes intercourse, as well as digital or oral sexual activity involving the genital area with a partner of either gender.

Screening Interval

If cytology is normal, screening should be done every 3 years. The absence of T zone is not a reason to repeat a Pap test earlier than the recommended interval.

Screening Cessation

Screening may be discontinued at the age of 70 if there is an adequate negative cytology screening history in the previous 10 years (i.e., 3 or more negative cytology tests).

Qualifying Statements

Women who are not sexually active by age 21 should delay cervical cancer screening until sexually active. For more details on the guidelines, please refer to: www.cancercare.on.ca/screenforlife

Breast Cancer Screening

The Ontario Breast Screening Program

The OBSP is a province-wide organized screening program that ensures asymptomatic Ontario women aged 50 and over receive the benefits of regular mammography screening. This program is a significant contributor to earlier detection of cancer and better health outcomes. Women aged 50 to 69 with an average risk of breast cancer are screened biennially. Women aged 50 to 69 who have a breast density of 75 per cent or greater, documented pathology of a high-risk lesion, personal history of ovarian cancer, or significant family history of breast cancer are considered to be at higher risk and may be screened annually. To book an appointment, please find the nearest location and contact them directly. A physician referral is not required.

Colorectal cancer screening

ColonCancerCheck program

ColonCancerCheck recommends that all Ontarians aged 50 and over be screened for colorectal cancer.

A Fecal Occult Blood Test (FOBT) is recommended for people aged 50-74 at average risk for colorectal cancer. If positive, a colonoscopy is strongly recommended within 8 weeks of referral. The ColonCancerCheck program recommends that participants not be screened using FOBT for a ten year period after a normal colonoscopy; patients may start or resume FOBT screening ten years after a normal colonoscopy (Source: ColonCancerCheck Clinical Advisory Committee). If the FOBT is negative, this test should be repeated once every two years.

For those at increased risk because of crohn's, ulcerative colitis or a family history of one or more first-degree relatives (parent, sibling or child) with a diagnosis of colorectal cancer, a colonoscopy is advised. For family history cases, colonoscopy screening should start 10 years prior to the diagnosis of the family member or at age 50, whichever comes first.

Frequency of Complete Physicals/Annual Checkups

As the EWFHT is a team that adopts and follows clinical best practice, research has clearly indicated that most people do not need a complete physical every year.

Any patient can be assessed if they have a new medical problem. Those patients with an ongoing or chronic problem such as diabetes, hypertension, breathing problems, depression or anxiety, arthritis etc. are asked to be seen at regular intervals. In addition, recommended screening tests (for cancer or abnormal blood values) are not left until a “complete physical” appointment. These are now being discussed when a patient has an appointment for another problem. There are also immunization reminders which are dealt with at any appointment. The “complete physical” is used to review healthy lifestyle choices including a proper diet, exercise, not smoking, not drinking alcohol to excess, etc. Also, during a complete physical, patients are asked about new symptoms and a physical examination is done which checks for any abnormality that may not be apparent to the patient. Since the chance of detecting a significant condition in a patient who has no symptoms is very unlikely it has not been shown that doing a complete physical every year is beneficial to the patient but rather at the intervals listed below.

The new guidelines for the frequency of a complete physical for a patient who has no symptoms are:

Age Physical should be done every:
18-40 3-5 years
40-50 2-3 years
50 and over 2 years

Please note: the idea of not needing a complete physical every year is not new and has been proposed for over 30 years. Also, this is not due to government cutbacks.

These recommendations come from studying scientifically what is the best interval to benefit patients to optimize their health without asking for unnecessary appointments and testing.

Dr. Duncan Bull
Lead Physician



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