Screening for cervical cancer
A 42-year-old patient was diagnosed with cervical cancer and the care provided by her primary care physician was reviewed by the Inquiry Committee following a complaint. The patient had been seeing the same primary care physician for over 20 years and had never undergone Pap screening for cervical cancer. In this instance, the physician believed that since the patient was engaged exclusively in a same-sex relationship, screening was not required.
The published guidelines for Pap tests on the BC Cancer Agency website are clear.
Anyone with a cervix, including women and transgender people, between the ages of 25 and 69 should be screened for cervical cancer every three years. These recommendations apply if:
- The patient is post-menopausal.
- The patient has ever been sexually active, even if they are not currently sexually active.
- The patient has received the human papillomavirus (HPV) vaccine.
- The patient is sexually active in a same-sex relationship.
Cervical cancer screening is not required in patients who have had their cervix removed (such as with a hysterectomy or gender-affirming surgery).
Cervical cancer screening can stop at age 69 if results have always been normal.
Primary care physicians should have their own system in place to ensure eligible patients are recalled for regular screenings in a timely manner. If a patient declines cervical cancer screening, this must be documented in the patient’s medical record.
The top reason for not receiving timely cervical cancer screening is the patient’s lack of knowledge about screening and the necessity of it. Registrants play an important part in educating patients about this screening tool.
Note: This article presents guidelines and indications for performing Pap smear testing. The article does not discuss the role of Human Papilloma Virus testing in cervical cancer screening. Although used in many jurisdictions, it is not widely used in BC. The test is not covered by MSP and currently, the BC Cervix Screening Program recommends against private testing. For registrants who do choose this method of screening, patients only need to be tested every five years if results are negative.