HEALTH SURVEILLANCE INDICATORS: CERVICAL CANCER SCREENING Public Health Relevance Cervical cancer is 90% preventable by having regular Papaniclau (Pap) tests. The Pap test, als knwn as a cervical smear, is a screening test used t detect precancerus lesins in the cervix. Changes in the cervix usually develp slwly ver numerus years, s there is a lng perid f time when abnrmal cell changes can be detected befre cervical cancer develps. Cervical cancer is mst ften diagnsed in wmen wh have never been screened r have nt been screened regularly. Cancer Care Ontari's (CCO) cervical cancer screening guidelines recmmend cervical cancer screening every 3 years fr wmen aged 21 t 69 wh are (r wh have ever been) sexually active. Screening can stp at age 70 in wmen wh have had 3 r mre nrmal tests in the previus 10 years. Highlights. 1. The percent f wmen having a Pap test in Trnt remained relatively stable frm 2002 t 2013. 2. The Pap test participatin rate f wmen in Trnt was significantly lwer than in the rest f Ontari and the rest f the GTA. 3. The Trnt Central Lcal Health Integratin Netwrk (LHIN) had the lwest Pap test participatin rate f the five LHINs with prtins in Trnt.
Trends Over Time The percent f wmen having a Pap test in Trnt remained relatively stable frm 2002 t 2013. Figure 1 shws the percent f Trnt wmen aged 21 t 69 years wh received a Pap test within three-year perids frm 2002 t 2013. The percent f wmen wh had at least ne Pap test within three-year perids frm 2002 t 2013 remained relatively stable at abut 60%. In the 2011 t 2013 perid, the pap test participatin rate was 57.3%, which is belw the prvincial target f 85% r higher. Figure 1: Cervical Cancer Screening (Pap Test) Participatin Rate within Three-Year Perids, Wmen Aged 21 t 69 Years, Trnt, 2002 t 2013 70 60 50 Percent 40 30 20 10 0 2002-2004 2005-2007 2008-2010 2011-2013 Year Data Surce: see Data ntes. Health Surveillance Indicatrs: Cervical Cancer Screening Trnt Public Health Page 2 f 6
Reginal Cmparisns The Pap test partipatin rate f wmen in Trnt was significantly lwer than in the rest f Ontari and the rest f the GTA. Figure 2 shws the percent f wmen aged 21 t 69 wh received a Pap test in Trnt between 2011 and 2013 cmpared t the rest f Ontari, the rest f the GTA, and the Ontari health units with the highest and lwest rates. The Pap test participatin rate in Trnt was significantly lwer than in the rest f Ontari and the rest f the GTA. Trnt had the 3 rd lwest Pap test participatin rate f the 36 health units in Ontari. Figure 2: Cervical Cancer Screening (Pap Test) Participatin Rate, Wmen Aged 21 t 69 Years, Trnt Cmpared t Other Regins in Ontari, 2011 t 2013 75% Highest Ontari Health Unit, 68.2% Rest f GTA, 64.2% Rest f Ontari, 63.3% Trnt, 57.3% Lwest Ontari Health Unit, 54.1% 45% Data Surce: see Data Ntes. Health Surveillance Indicatrs: Cervical Cancer Screening Trnt Public Health Page 3 f 6
Trnt Neighburhd Cmparisns The Trnt Central Lcal Health Integratin Netwrk (LHIN) had the lwest Pap test participatin rate f the five LHINs with prtins in Trnt. Table 1 shws the percent f wmen aged 21 t 69 wh received a Pap test between 2011 and 2013 in the Lcal Health Integratin Netwrk (LHIN) areas with prtins in Trnt. The Trnt Central LHIN had the lwest Pap test participatin rate ut f the five LHINs, whereas the Central LHIN had the highest. Table 1: Cervical Cancer Screening (Pap Test) Participatin Rate, Wmen Aged 21 t 69 Years, LHIN Areas with Prtins in Trnt, 2011 t 2013 LHIN Area Percentage f eligible wmen wh cmpleted a Pap Test Central West 59.2% Mississauga-Haltn 61.3% Trnt Central 57.8% Central 62.3% Central East 62.2% Trnt 57.3% Data Surce: see Data Ntes. Health Surveillance Indicatrs: Cervical Cancer Screening Trnt Public Health Page 4 f 6
Data Ntes Ntes Data includes all screen-eligible wmen aged 21-69 at the index date in Trnt. Index date was defined as the midpint in a three-year perid, e.g. July 1 st 2012 fr 2011-2013. The Registered Persns Database (RPDB) address clsest t the index date was used t assign pstal cde. Estimates are age-standardized t the 2011 Canadian ppulatin. This allws fr cmparisn f estimates ver time and gegraphy. LHIN assignment was determined using PCCF+, versin 6A; residential pstal cde was used t identify LHIN and individuals with unknwn/missing LHINs were excluded frm the analysis. Significant differences were estimated using verlapping cnfidence intervals. Althugh this methd is cnservative (α ~< 0.01) and mst apprpriate when cmparing mutually exclusive grups, it was chsen as an bjective means f making cnclusins n ppulatin-based data. Errr bars are nt shwn n the charts as variability f data is very lw. Pap tests Identificatin includes: Pap tests were identified in CytBase (an electrnic medical recrd database fr cervical cytlgy). All Pap tests in CytBase were cunted, including thse with inadequate specimens. Pap tests were als identified using fee cdes in OHIP: E430A: add-n t A003, A004, A005, A006 when pap perfrmed utside hspital G365A: Peridic-pap smear E431A: When Pap smear is perfrmed utside f hspital, t G394 G394A: Additinal fr fllw-up f abnrmal r inadequate smears L713A: Lab.med.-anat path,hist,cyt-cytl-gynaeclgical specimen L733A: Cervicvaginal specimen (mnlayer cell methdlgy) L812A: Cervical vaginal specimens including all types f cellular abnrmality, assessment f flra, and/r cythrmnal evaluatin Q678A: Gynaeclgy pap smear peridic nurse practitiners. Each wman was cunted nce regardless f the number f Pap tests perfrmed in a three-year perid. Health Surveillance Indicatrs: Cervical Cancer Screening Trnt Public Health Page 5 f 6
The fllwing were excluded: Wmen with a missing r invalid Health Insurance Number (HIN), date f birth, LHIN pstal cde Wmen diagnsed with an invasive cervical cancer prir t the January 1 st that begins three-year perid, e.g. January 1 st 2011 fr 2011-2013; prir diagnsis f cervical cancer was defined as: ICD-O-3 cdes C53, a mrphlgy indicative f cervical cancer, micrscpically cnfirmed with a pathlgy reprt. Wmen with a hysterectmy prir t the January 1 st that begins a three-year perid, e.g. January 1 st 2011 fr 2011-2013 time perid. Wmen with a hysterectmy were identified thrugh Claims Histry Database (CHDB). Definitins 95% Cnfidence Interval is the range within which the true value lies, 19 times ut f 20. Age Standardizatin is a technique based n weighted averaging that remves the effects f the distributin f age when cmparing tw r mre ppulatins. Cervical Cancer Screening (Pap Test) Participatin Rate is the percentage f screeneligible wmen, 21-69 years ld, wh cmpleted at least ne Pap test in a three-year perid. GTA excluding Trnt means the Greater Trnt Area (GTA) with Trnt remved frm the GTA data. Ontari excluding Trnt means Ontari with Trnt remved frm the Ontari data. Surces Cervical Cancer Screening: Cancer Screening Evaluatin and Reprting, Cance Care Ontari. Used in: Figures 1 and 2 Table 1 Health Surveillance Indicatr: Cervical Cancer Screening Categry: Chrnic Disease Prepared: Octber, 2017 This indicatr reprt is part f a series that infrms the nging assessment f Trnt s Health Status. Fr a full list f the indicatrs, please g t: www.trnt.ca/health Health Surveillance Indicatrs: Cervical Cancer Screening Trnt Public Health Page 6 f 6