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Follow-up recommendations after low-grade results

Recommendation

  • The Ontario Cervical Screening Program (OCSP) now recommends that people with the following cervical screening results repeat their cytology test in 12 months instead of in 6 months:
    • A first time low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASCUS) result
    • An LSIL or ASCUS result followed by a normal result

Evidence and rationale

  • ASCUS and LSIL changes can be the result of HPV infections in the cells of the cervix.
  • Approximately 48% of HPV infections will resolve 12 months and 70% of HPV infections will resolve in 24 months. Therefore, repeating the cytology test at 12 months allows more time for clearance of the infection and normalization of the cytology and avoids unnecessary interventions (e.g., colposcopy).
  • There is also published data from Ontario shows that 68.2% of ASCUS results and 48.3% of LSIL results resolve on their own within 24 months further supporting extending the interval.
  • Ontario data shows that the risk of developing cervical cancer is very low for people with low-grade cytology results (i.e., LSIL, ASCUS) which supports lengthening the interval to repeat a cytology test to 12 months.

HPV testing

  • Currently HPV testing is not an insured test in Ontario. However, HPV testing is available in Ontario though patient-pay or in some hospitals. HPV testing for someone with a first time ASCUS or LSIL is not required (repeat cytology in 12 months is safe and acceptable). However, those who make an informed decision to have an HPV test at their own cost after a low-grade cytology result can follow these management recommendations:
    • People who are HPV 16/18 positive can be referred directly to colposcopy
    • People who are HPV non-16/18 positive should repeat their cytology in 12 months
    • People who are HPV negative should return to routine screening with cytology in 3 years

Ontario Health (Cancer Care Ontario) worked with Ontario labs that provide cervical screening testing to update cytology result reports so they reflect this recommendation change.

Cervical screening should not be used for investigating symptoms, such as abnormal vaginal bleeding or discharge, bleeding after intercourse or pelvic pain. Cervical cytology is often negative in the presence of a visible cervical tumour and therefore unreliable. People with symptoms or a visible cervical tumour should be evaluated by their family doctor or nurse practitioner or a specialist.