Guidelines on Cervical Cancer Screening in Québec

Population targeted by the screening

All women who are sexually active or were in the past.

Sexual activities include all types of genital contact, with or without vaginal penetration, with male or female partners.

At what age should screening begin?

The recommended age to begin screening is 21.

However, screening can be delayed for women who have not yet had sexual activity at this age. Exceptionally and based on the clinical context, screening may begin earlier, for example, among immunodepressed young women.

How often should one have a screening test?

The recommended interval between screening tests is two to three years.

At what age should screening be stopped?

Among women who have had screening tests regularly, screening may cease at the age of 65 if the results of the last two tests conducted in the previous 10 years were negative.

Any other situation should be addressed in an individualized manner based on the timing of the last test, the results of the last test, and the woman's specific situation. It is not necessary to continue cervical cancer screening in women who have had a complete hysterectomy for a benign condition.

What should be done in the case of abnormal screening test results?

If the result is equivocal (ASC-US result):

It is not recommended that all women with equivocal (ASC-US) results be referred to colposcopy, but that a triage strategy, varying according to age, be applied:

• Before the age of 30: Repeat the cytological test 6 and 12 months later. Refer to colposcopy if one or the other of these cytological tests show a result of ASC-US or worse.
• From the age of 30: Perform an oncogenic HPV detection test¹ and refer to colposcopy if the result is positive. When the HPV test result is negative, repeat the cytological test after 12 months.

In the case of any other abnormal results, the woman must be referred to colposcopy.

¹A generic test approved by Health Canada must be used. While waiting for the test to be available in the public system, the same approach used for women under the age of 30 can be applied.