Cervical Screening

This section contains information for Registered Nurses (RNs) performing Cervical Cancer Screening.

This section contains information and resources for when your patient has an abnormal Pap result, and resources for colposcopy.

This section contains clinical information and resources for Colposcopy.

This section contains information and resources for unsatisfactory results.

What does an unsatisfactory Pap result mean?

This means the test was rejected/not processed by the laboratory or that the specimen was processed and examined but was unsatisfactory for evaluation of epithelial abnormality or the cells could not be seen well enough to give a result.

Why is it important?

The ACCSP monitors quality and performance indicators in the cervical cancer screening pathway. One of these is the unsatisfactory rate. The provincial target is <1%.

Causes

Unsatisfactory Pap test results are mostly due to cervical sampling and specimen collection issues. This may be due to a number of factors which includes:

1. Scant cellularity.
2. Faulty technique.
3. Post-menopausal status.
4. Excess lubricant use.
5. Interfering substances like mucus, blood and bacteria.
6. Human error such as:

• Unlabeled specimens: Name and unique identifier missing.
• Incorrect or mislabeled specimens: For example, patient details (name or different patient ID) on requisition form and sample container don’t match.
• Identifier incomplete: Missing fields like first or last name missing, initials only, missed numbers on patient’s PHN.
• Significant misspelling where more than 2 letters are transposed or missing/added, letters that changes the interpretation of the name.
• The use of incorrect containers or preservatives.
• Test request received without a corresponding sample or vice versa.
• Sample container not properly sealed leading to loss of sample.

What happens after an unsatisfactory result?

Every unsatisfactory Pap leads to a repeat Pap test in 3 months.

What can I do to reduce my unsatisfactory rates?

Patient related:

• Book their appointments for a day they won’t be on their periods (but should book an appointment if they have an abnormal bleeding). Wait at least 7 – 10 days after first day of menstrual period.
• Prepare your patients for their Pap test by informing them about the following:

1. Avoid douching or using contraceptive creams, vaginal medicines, sprays, powders or jellies in the 48 hours before the test.
2. Avoid sexual intercourse in the 24 hours before the test.
3. Avoid the use of personal lubricants in the 48 hours before the test.
4. Avoid having a Pap test when you are being treated for cervical or vaginal infections. Wait at least 2 weeks after treatment ends before having a Pap test.

Physician related

• Collect samples far enough into endocervical canal to obtain cells.
• Follow manufacturer’s instructions for transferring the sample from the instrument to the liquid medium.
• Use lukewarm water for speculum lubrication.
• If clinically indicated or for patient’s comfort, use dime sized carbomer free lubricants.
• Provide all relevant clinical information on laboratory requisition forms.

Manufacturers’ guides

• APL: ThinPrep Gynecological Pap Specimen Collection Quick Reference Guide (albertahealthservices.ca)
• DynaLife: BD SurePath collection instructions.pdf (dynalife.ca)

Resources

APL

• Sample Acceptance Policy: Acceptance of Laboratory Samples and Test Requests Policy (albertahealthservices.ca)
• Gyneacological Cytopathology Requisition Completion Aid: PCYSCR00003 Gynecological Cytopathology Requisition Completion Aid (albertahealthservices.ca)
• Label Placements: PA17-02.010 Laboratory Specimens – Label Placement (albertahealthservices.ca)

DynaLife

• Requisition Completion Aid: Requisition completion minimum requirements.pdf (dynalife.ca)
• Gyneacological Cytopathology Requisition Completion Aid: Gyne Requisition Completion Guide (dynalife.ca)
• Label Placements: Specimen Submission Criteria (dynalife.ca)

This section contains information on the HPV Test of Cure for primary healthcare providers.

What is the HPV Test of Cure?

The HPV Test of Cure is a risk stratification tool for colposcopists. The purpose of this test is to determine which patients in colposcopy care will need ongoing follow-up in colposcopy and which can be safely discharged back to primary care for cervical cancer screening per Clinical Practice Guidelines (CPGs).

What is the role of primary healthcare providers in the HPV Test of Cure initiative?

As per the HPV Test of Cure algorithm, eligible patients in colposcopy with a negative colposcopy evaluation and HPV Test of Cure result will be discharged to primary care. Primary healthcare providers will then be responsible for their subsequent follow-up and cervical screening needs. Patients with more questions may seek primary healthcare provider assistance.

What are the benefits of HPV Test of Cure?

• To improve patient experience.
• Fewer appointments required for patients to complete the assessment and treatment cycle in colposcopy.
• An objective risk stratification tool to help determine the right care by the right provider.

How is the HPV Test of Cure different from HPV Reflex?

The test is the same; it is called different names to identify where in the care pathway the test is conducted. Currently in Alberta, the HPV test is used as a triage tool. HPV Reflex is used after an abnormal low-grade Pap test to determine referral to colposcopy while HPV Test of Cure is used after colposcopy treatment to determine if further colposcopy treatment is required.

How will primary healthcare providers be notified of patient discharge due to HPV Test of Cure status?

A communication from colposcopists will be sent to referring providers notifying them that their patient has been discharged from colposcopy services.

Who is eligible for the HPV Test of Cure?

Patients in colposcopy care who have received treatment for high-grade lesions.

Who can order the HPV Test of Cure?

Only colposcopists can order the HPV Test of Cure.

When can colposcopists start ordering the HPV Test of Cure?

Starting on September 15, 2022, colposcopists can order the HPV Test of Cure.

What happens if a primary care provider orders the HPV Test of Cure?

Any requisition for the HPV Test of Cure submitted by other providers will not be processed by the labs. Please do not order this test unless you are a colposcopist.

What happens after the HPV Test of Cure?

• Colposcopy evaluation negative + HPV Test of Cure negative = Discharge to primary care for continued cervical screening.
• Colposcopy evaluation negative + HPV Test of Cure positive = Colposcopy care + HPV Test of Cure in 6 months.
• Colposcopy evaluation positive = Treat as per colposcopy care guidelines.

Will patients receive an HPV Test of Cure result communication from the Alberta Cervical Cancer Screening Program (ACCSP)?

No, as this test is part of specialist follow-up care, communication will be from specialists to primary care providers.

Patient is asking about the HPV vaccine. What information is available?

Information on the HPV vaccine can be found here.

Need more information about the HPV Test of Cure?

Contact Alberta Health Services Screening Programs at 1-866-727-3926 or email accsp@ahs.ca.

Resources

• Evidence to Support Change of Clinical Pathway Following Colposcopy Treatment for Cervical Intraepithelial Neoplasia in Canada (jogc.com).
• HPV Test of Cure Patient Resource.