As Colposcopy clinics work to address the backlog of abnormal paps, Ontario Health – CancerCare Ontario has provided updated guidance on how to manage an abnormal pap.
Here are some quick “how to” tips from our regional Colposcopy Lead, Dr. Dustin Costescu.
- Do NOT screen patients under 25, do NOT screen patients who have never been sexually active, and do NOT screen patients who have had a hysterectomy (removal of cervix) and have not had a history of high-grade dysplasia.
- Start Screening age 25. If first pap cytology was normal in a patient under 25, but patient will not yet be 25 in three years, wait until age 25 for next pap. If first pap under age 25 was abnormal, treat as for any patient.
| PAP RESULT | NEXT STEP | RISK OF CIN3+ (high grade dysplasia) |
| Pap Negative | Pap in 3 years | <1% |
| HPV Test Negative (Normal, LSIL or ASCUS Pap) | Pap in 5 years | <1% |
| ASCUS | Rescreen in 1 year and refer if positive | 2-4% |
| LSIL | Rescreen in 1 year and refer if positive | 5% |
| ASCUS x 2 or LSIL x 2 | Colposcopy | 10% |
| ASCUS → Negative → ASCUS LSIL → Negative → LSIL | Rescreen in 1 year | 1% |
| ANY High Grade ASC-H, LSIL-H, HSIL, AGUS | Colposcopy | High |
| HPV 16/18+ regardless of cytology result | Colposcopy | 15% |
If you aren’t sure what to do, send an e-consult for the fastest response. We are always happy to help.
For further information click here for the Colposcopy Referral Form.