• Identifying Pap tests:

Pap tests were identified through CytoBase

Pap tests were also identified using fee codes in OHIP:

           -E430A: add-on to a003, a004, a005, a006 when pap performed outside hospita

           -G365A: Periodic-pap smear

           -E431A:  When Papanicolaou smear is performed outside of hospital, to G394. 

           -G394A: Additional for follow-up of abnormal or inadequate smears

           -L713A: Lab.med.-anat path,hist,cyt-cytol-gynaecological specimen

           -L733A: Cervicovaginal specimen (monolayer cell methodology)

           -L812A: Cervical vaginal specimens including all types of cellular abnormality, assessment of flora, and/or                   cytohormonal evaluation

           -Q678A: Gynaecology – pap smear – periodic – nurse practitioners

           -L643A:Lab Med - Microbiol - Microscopy - Smear Only, Gram/Pap Stain

• All Pap tests in CytoBase were counted, including those with inadequate specimens

           -Each woman was counted once regardless of the number of Pap tests performed in a 42 month time frame

Total number of Ontario screen-eligible women, 21-69 years old, in the reporting period

• Ontario screen-eligible women aged 21-69 at the index date
• Index date was defined as the midpoint in a reporting period, e.g. July 1st 2014 for 2013-2015
• The 2011 Canadian population was used as the standard population for calculating age-standardized rates
• The RPDB address closest to the index date was used to assign postal code
• LHIN assignment was determined using PCCF+, version 6C; residential postal code was used to identify LHIN and individuals with unknown/missing LHINs were excluded from the analysis
• Public health unit data was determined using PCCF+, version 6C

Exclusions:

• Women with a missing or invalid HIN, date of birth, LHIN or postal code
• Women diagnosed with an invasive cervical cancer prior to January 1st of  the reporting period, e.g. January 1st 2013 for 2013-2015; prior diagnosis of cervical cancer was defined as: ICD-O-3 codes C53, a morphology indicative of cervical cancer, microscopically confirmed with a path report
• Women who had a colposcopy and/or treatment within 2 years prior to January 1st of the reporting period Colposcopy and/or treatment were identified through OHIP, using the following fee codes:
  • Colposcopy
    • Z731 - Initial investigation of abnormal cytology of vulva and/or vagina or cervix under colposcopic technique with or without biopsy(ies) and/or endocervical curetting
    • Z787 - Follow-up colposcopy with biopsy(ies) with or without endocervical curetting
    • Z730 - Follow-up colposcopy without biopsy with or without endocervical curetting
  • Treatment
    • Z732 - Cryotherapy
    • Z724 - Electro
    • Z766 - Electrosurgical Excision Procedure (LEEP)
    • S744 - Cervix - cone biopsy - any technique, with or without D&C
    • Z720 - Cervix Biopsy - with or without fulguration
    • Z729 - Cryoconization, electroconization or CO2 laser therapy with or without curettage for premalignant lesion (dysplasia or carcinoma in-situ), out-patient procedure
• Women with a hysterectomy prior to January 1st of the reporting period, e.g. January 1st 2013 for 2013-2015
• Women with a hysterectomy were identified through CHDB, using the following fee codes:
  • E862A – When hysterectomy is performed laparoscopically, or with laparoscopic assistance
  • P042A – Obstetrics – labour – delivery – caesarean section including hysterectomy
  • Q140A – Exclusion code for enrolled female patients aged 35-70 with hysterectomy
  • S710A – Hysterectomy - with or without adnexa (unless otherwise specified)  – with omentectomy for malignancy
  • S727A – Ovarian debulking for stage 2C, 3B or 4 ovarian cancer and may include hysterectomy
  • S757A – Hysterectomy – with or without adnexa (unless otherwise specified) – abdominal – total or subtotal
  • S758A – Hysterectomy - with or without adnexa (unless otherwise specified) – with anterior and posterior vaginal repair and including enterocoele and/or vault prolapse repair when rendered
  • S759A - Hysterectomy - with or without adnexa (unless otherwise specified) – with anterior or posterior vaginal repair and including enterocoele and/or vault prolapse repair when rendered
  • S762A - Hysterectomy - with or without adnexa (unless otherwise specified) – radical trachelectomy - excluding node dissection
  • S763A - Hysterectomy - with or without adnexa (unless otherwise specified) – radical (Wertheim or Schauta) - includes node dissection
  • S765A – Amputation of cervix
  • S766A- Cervix uteri - Exc - cervical stump – abdominal
  • S767A- Cervix uteri - exc - Cervical stump – vaginal
  • S816A - Hysterectomy - with or without adnexa (unless otherwise specified) - vaginal