Cancer Screening Resumption during COVID-19 Pandemic

Ontario Health (Cancer Care Ontario) is now suggesting a gradual resumption of cancer screening. A key principle in their approach is balancing the benefits of organized cancer screening with the demands on the healthcare system during the COVID-19 pandemic.  A detailed tip sheet can be found here.  Below is a brief summary of the suggestions for priority patient categories to begin our screening restart.

For rostered patients, primary care can use the Screening Activity Report (SAR) to find the suggested priority patients.  Here is our SAR guide that explains how to access and use the SAR.  We also have prepared an additional guide here with more specific details for how to use the SAR to identify the priority patients to begin our cancer screening restart.

Ontario Breast Screening Program (OBSP) Priority Groups:

1. High Risk OBSP clients
2. Patients who have never had a mammogram
3. Patients where last scan suggested annual or one year follow-up mammogram
4. Patients who are significantly overdue (for example at least one year overdue)

Ontario Cervical Screening Program (OCSP) Priority Groups:

1. Last pap was a first time ASCUS or LSIL – try to rescreen within 12 months
2. Patients requiring annual screens (e.g. discharged from colposcopy with persistent low grade changes; discharged from colposcopy with +HPV)
3. Immunocompromised patients (e.g. organ transplant, HIV, immunosuppression drugs)

*Additional notes based on recent evidence:

• If patient had an initial ASCUS or LSIL on last pap and is HPV status is known and positive àrefer to colposcopy
• No need to delay if a patient is already in the office for other issue, go ahead and offer pap
• Start screening at age 25
• Consider waiting 5 years instead of 3 to re-screen if HPV status is known and negative

ColonCancerCheck (CCC) Program:

• Do not fax in FIT requisitions to LifeLabs yet
• There are a significant number of requisitions that have already been faxed to LifeLabs that will gradually be processed and kits mailed out
• Ontario Health (Cancer Care Ontario) will inform primary care when to start faxing new requisitions. When FIT testing is restarted, priority groups will targeted.
• Refer any patients who have a positive FIT to colonoscopy. Your SAR can help you identify rostered patients with a positive test who have not had follow-up