Screening Activity Report: Frequently Asked Questions

Ontario Health’s ability to link cancer screening data with primary care providers is limited to patients who are rostered to a physician (i.e., patient enrollment model physicians).

In the Sioux Lookout municipality and zone (27 First Nations), the communities have identified postal codes that link with their communities and primary care providers servicing those communities. This has allowed Ontario Health to extract screening data for non-patient enrollment model physicians and nurses servicing the Sioux Lookout municipality and zone (27 First Nations) and develop SARs specifically for those communities.

Outside of the Sioux Lookout municipality and zone, it can be difficult to determine which primary care provider a non-enrolled patient belongs to. As a result, the SAR is only available to physicians who practice in a patient enrollment model outside this region.

Ontario Health is exploring opportunities to expand the SAR to more primary care providers across the province who do not practice in a patient enrolment model.

Physicians servicing the Sioux Lookout Municipality and Sioux Lookout Zone (27 First Nations communities) can continue to access the Sioux Lookout and Zone Screening Activity Report (SAR) report on eReport.

The report draws upon several data sources. Ontario Health receives feeds from the following Ministry of Health databases:

• Claims History Database (CHDB)
• Registered Persons Database (RPDB)
• Corporate Provider Database (CPDB)
• Client Agency Program Enrolment (CAPE)

Ontario Health has also created custom-built tools used by participating laboratories to upload fecal test results (for guaiac-based fecal occult blood and fecal immunochemical tests) and cervical screening test results (for human papillomavirus and reflex cytology tests). In addition, the tools allow hospitals to upload data on colonoscopy procedures and Ontario Breast Screening Program sites to upload data on breast cancer screening.

Yes. The SAR can aid your EMR-based cancer screening activities by providing you with:

• a double check of patients who may need screening or follow-up
• historical screening data that may not have been migrated to your EMR or for patients who are new to your practice
• clear, actionable groupings of patients to support population-based prevention and cancer screening

No, the report does not exclude patients from cancer screening based on the use of exclusion Q codes.

However, according to the data we have, patients in your target population who have had a previous program-specific cancer or related-surgery will be excluded from screening on your report. For a list of Ontario Health Insurance Plan codes that are used to exclude patients, please see the following sections:

Who is excluded from breast screening on my report?

Who is excluded from cervical screening on my report?

Who is excluded from colorectal screening on my report?

Any visualizations can have their sort order changed. For tables and matrices, simply click a column header to change the sort order. Once clicked, a bi-directional arrow will appear to indicate if the data is ordered descending or ascending.

For other visualizations, you can change the sort order by hovering over the visual and selecting the three dots at the top. From there, you will have the option to change the sort order of the axis or legend.

The easiest way to view patients who are overdue for screening or require follow-up is to navigate to the Cancer Screening – Patient Summary tab of the report. From there, select the slicer ‘Screening Result’ and choose the relevant screening result (e.g., Abnormal screen, follow-up needed).

Alternatively, from the ‘SAR Home’ tab, you can use the ‘drill through’ function in Power BI to filter results on other tabs. Simply right-click on the row 'Abnormal screen, follow-up needed’ and select “drill through to...” to view patients with an abnormal screen requiring follow-up.

Ontario Health must select a cut-off date when producing the report, submitting it for quality assurance and releasing it for distribution. This date is displayed at the top of all reports. Any data received after the cut-off date is not included in the SAR.

For certain screening tests and follow-up procedures, there is a reporting lag between the time of the test or procedure and when Ontario Health receives this information.

Your screening rate is calculated in alignment with Ontario Health's clinical guidelines and recommendations.

Breast screening – A participant is considered up-to-date if they are 50 to 74 years old and have had a mammogram within 24 months of the report's cut-off date.

Cervical screening – A participant is considered up-to-date with cervical screening if they are 25 to 69 years old and have completed a human papillomavirus test within 60 months or a cervical cytology (Pap) test within 36 months of the report’s cut-off date.

Colorectal screening – A participant is considered up-to-date with colorectal testing if they are 50 to 74 years old and have had a fecal immunochemical test within 24 months, a flexible sigmoidoscopy within 10 years or a colonoscopy within 10 years before the report’s cut-off date. A participant will not be considered up-to-date with colorectal cancer screening if they have completed a guaiac fecal occult blood test after December 24, 2019.

The regional and provincial screening rates differ from those reported in the Cancer System Quality Index (CSQI) ­– a set of publicly reported indicators from the Cancer Quality Council of Ontario – because the CSQI reports on all primary care providers, while the Screening Activity Report comparison data only reports on providers who practice in a patient enrolment model.

For each screening program, an algorithm was developed to determine which screening status an enrolled and eligible patient would be assigned based on the date and result of their most recent screening tests at the time of the report's cut-off date. This screening status is intended to assist you in managing your practice by providing a quick view of a patient’s screening needs. The screening status, however, is limited by the data that Ontario Health receives. For more information please see: Are there any data limitations to the report?

A screening status has been assigned to each rostered and eligible patient to represent their cancer screening needs based on Ontario Health's clinical guidelines. A patient will be assigned to one category for each screening program that they are eligible for. These screening statuses can assist you in managing your practice by allowing you to sort your list according to which patients are overdue for screening, who requires follow-up or re-screening, and who is up to date with screening.

Red: Action Required

Abnormal screen, follow-up needed: Patients who may require follow-up of an abnormal screen.

Invalid result, re-test required: Patients who need to be re-tested due to an invalid result on a screening test (not applicable to breast screening).

Overdue for screening: Patients who are overdue for screening.

Yellow: Due for Screening < 6 Months

Patients who are due for screening in the next 6 months. This category applies to:

• People whose last screening test result was normal
• People whose last cervical screening test result was HPV-positive (other high-risk types) with normal or low-grade reflex cytology who are advised to repeat cervical screening in 2 years and are due in the next 6 months

Yellow: Physician Review Required

Colonoscopy or flexible sigmoidoscopy in the last 10 years: Patients who have had a colonoscopy or a flexible sigmoidoscopy in the last 10 years, but are not due for colorectal cancer screening within the next 6 months.

Review patient history:

• Patients whose screening test result is unknown because they were screened outside of the Ontario Breast Screening Program, the Ontario Cervical Screening Program or ColonCancerCheck. Due to these data limitations, patients with unknown test results require review by a provider to determine next steps.
• This category also includes people whose last cervical screening test result was HPV-positive (other high-risk types) with normal or low-grade reflex cytology who are advised to repeat cervical screening in 2 years. These people will remain in this category for the first 18 months after this test result and until they are due for screening in the next 6 months.

Abnormal screen, follow-up underway or completed: People who have had at least 1 follow-up procedure after an abnormal screening test. A review by the physician may be required to determine if the patient has completed all the necessary follow-up. Ontario Health does not collect the results of follow-up activities, with the exception of some breast assessment procedures.

Green: No Screening Action Required: Normal Screen

Enrolled and eligible people who are up-to-date with recommended screening and are not due for screening within the next 6 months.

We recognize there are limitations to this report (please see: Are there any data limitations to the report?) and that clinical judgment and patient choice may result in different decisions from those recommended by the clinical guidelines. Please consider this report a supplement to the other clinical tools that are part of your regular practice.

These letters describe someone's eligibility for screening in each screening program based on Ontario Health's clinical guidelines. Each letter represents the following:

Y: A person is eligible for screening based on their age, sex and lack of exclusionary criteria (e.g., previous cancer or surgery).

N: A person is ineligible for screening based on their age and/or sex.

X: A person is ineligible for screening based on their previous program-specific cancer or cancer surgery, or is enrolled in the High Risk Ontario Breast Screening Program.

HR: A person is ineligible for breast screening based on enrollment in the High Risk Ontario Breast Screening Program.

For a list of Ontario Health Insurance Plan codes that are used to exclude patients, please see the following sections:

Who is excluded from breast screening on my report?

Who is excluded from cervical screening on my report?

Who is excluded from colorectal screening on my report?

A patient may be assigned a dark grey screening status if they are excluded from screening due to a previous program-specific cancer, cancer surgery or if they are enrolled in the High Risk Ontario Breast Screening Program.

People who are within the target age range of 50 to 74 years with a history of breast cancer or who have had a mastectomy are not eligible for breast screening in the OBSP and so are not assigned a screening status on this report. People who are enrolled in the High Risk OBSP are also excluded from this report.

The following Ontario Health Insurance Plan mastectomy codes are used as exclusion criteria:

E546A: mastectomy with axillary node dissection up to level of axillary vein

R108A: mastectomy (female) with or without biopsy; simple

R109A: mastectomy with or without biopsy; radical or modified radical

E506A: mastectomy with axillary sentinel node biopsy

R117A: mastectomy (female) with or without biopsy; subcutaneous with nipple preserved

E505A: mastectomy with limited axillary node sampling

If an eligible patient was screened outside of the Ontario Breast Screening Program (OBSP), Ontario Health does not receive information on the mammography result. While the report will provide the date of a mammogram performed outside of the OBSP, you will have to refer to your patient charts for result information as well as the appropriate recall interval.

Participants identified to return to the OBSP in 1 year (“return 1 Y”) require re-screening in one year as a one-time event. The results of the next screening test will determine the person’s next recall interval. Participants who have been identified to “return annually” require yearly screening as long as they remain eligible for screening through the OBSP.

Participants are recalled annually if they have a history of high-risk breast lesions, or if they have a family history of breast and/or ovarian cancer. Participants are recalled in 1 year if they have high breast density (BIRADS Category D) or if the radiologist recommends that the participant be screened again in one year instead of two years.

A final result for the follow-up of an abnormal OBSP mammogram may appear as "in progress" due to a data lag. It will be updated when the final result information is available.

The SAR has been updated to reflect the new HPV-based cervical screening recommendations. Key updates include:

• Age eligibility, which now starts at age 25 (for more information on how data for people ages 21 to 24 are handled, see the “Who is excluded from the Ontario Cervical Screening Program (OCSP) data on the Screening Activity Report (SAR)?” question below).
• Screening interval, which will be reflected in the SAR as long as the correct test indication is selected on the requisition. The new intervals are:
  • 5 years for most people after an HPV-negative result
  • 3 years for immunocompromised people
  • 2 years for some people who have been discharged from colposcopy, as well as for people whose last cervical screening test result was HPV-positive (other high-risk types) with normal or low-grade reflex cytology
• HPV and cytology test results reflected in the detailed patient list view (for more information, see the “How has the detailed patient list view changed to reflect human papillomavirus (HPV) testing?” question below)

The recommended screening interval after a negative human papillomavirus (HPV) test result is three years for immunocompromised people, instead of five years for immunocompetent people. Once someone is screened with an HPV test, as long as the correct test indication is selected on the requisition (i.e., immunocompromised screening), they will be correctly identified in the SAR as needing to be recalled at three years.

If an immunocompromised person’s most recent cervical screening test was cytology (i.e., occurred before HPV testing launch), their recommended screening interval is 1 year, instead of 3 years for immunocompetent people. This earlier recall is not represented in the SAR and people screened with cytology will need to be managed by their provider until they are screened with an HPV test.

The lab will reject screening requisitions submitted for participants who have had a screening test within the previous 21 months, unless the test result was human papillomavirus (HPV) invalid or HPV-positive with unsatisfactory reflex cytology.

The detailed patient list view for cervical screening now includes two new sections: “Most recent cervical screening test” and “Most recent pre-HPV cytology test.”

The “Most recent cervical screening test” section will be populated for anyone who has had a cervical screening test since the launch of HPV testing. This section includes information about the test indication selected by the provider on the requisition, the date of the cervical screening test and the date of the HPV result. People with a positive HPV test result will get a reflex cytology test and the “Reflex cytology category” and “Detailed cytology result” columns will be populated. There is also a field for a “Non-cervical abnormality (if applicable),” which will contain any non-cervical abnormalities found on the cytology test.

The “Most recent pre-HPV cytology test” section will be populated for anyone who has not yet had a cervical screening test since the launch of HPV testing. It includes the date and result of the most recent cytology (Pap) test.

With the implementation of human papillomavirus (HPV) testing, people are not eligible for cervical screening until they turn 25, so most people ages 21 to 24 are now excluded from the SAR. The only people ages 21 to 24 who will be captured in the SAR are those who had a high-grade abnormal cytology result in the 36 months before HPV testing launch.

Anyone under age 25 who has had an abnormal HPV or low-grade or normal cytology test result will not be represented in the SAR until they turn 25. In many cases, no action will be required for these people until they turn 25, but it will be up to providers to manage them outside of the SAR. For more information, please refer to Interim guidance to support the transition years following the launch of human papillomavirus testing in Ontario: Cervical screening and colposcopy recommendations for people ages 21 to 24.

People who are ages 25 to 69 with a history of cervical cancer or who have had a hysterectomy are not assigned a screening status in the SAR because they are not eligible for cervical screening through the OCSP.

Some people age 70 and older will continue to require screening based on previous test results. These people will not be represented in the SAR and providers will need to manage them outside of the SAR.

The following Ontario Health Insurance Plan hysterectomy codes are used as exclusion criteria:

E862A: hysterectomy performed laparoscopically or with laparoscopic assistance

P042A: caesarean section, including hysterectomy

S710A: hysterectomy with or without adnexa; 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; abdominal (total or subtotal)

S758A: hysterectomy with or without adnexa, with anterior and posterior vaginal repair

S759A: hysterectomy with or without adnexa, with anterior or posterior vaginal repair

S762A: hysterectomy with or without adnexa; radical trachelectomy, excluding node dissection

S763A: hysterectomy with or without adnexa; radical, includes node dissection

S765A: amputation of cervix

S816A: hysterectomy with or without adnexa; vaginal

S766A: cervical stump; abdominal

S767A: cervical stump; vaginal

According to Ontario Health's previous cytology-based recommendations, the recommended follow-up for a cervical cytology (Pap) test with a low-grade cytology test result (atypical squamous cells of undetermined significance or low-grade squamous epithelial lesion) is to repeat the cytology test in 12 months. If this repeat cytology test is normal, the next step is to repeat the cytology test in another 12 months. After 2 consecutive normal follow-up cytology tests, it is considered safe for participants to return to routine screening (in 3 years for people who are immunocompetent and in 1 year for people who are immunocompromised). If someone had an abnormal cytology test in the 9 months before the report cut-off date, their history should be reviewed to determine next steps for follow-up. While the Ontario Cervical Screening Program has now transitioned to new human papillomavirus (HPV)-based cervical screening recommendations, the above will apply to people who were screened with a cytology test within 3 years of HPV testing launch until they have their first HPV-based cervical screening test.

For more details on the recommended follow-up of abnormal screening test results, please see the Ontario Cervical Screening Program Cervical Screening Recommendations Summary.

People who are within the target age range of 50 to 74 years who have a history of colorectal cancer or who have had a total colectomy are not eligible for colorectal cancer screening through the CCC and so are not assigned a screening status in this report.

The following Ontario Health Insurance Plan colectomy codes are used as exclusion criteria:

S170A: ileostomy plus total colectomy plus abdominal-perineal resection

S169A: total colectomy with ileo-rectal anastomosis

S172A: total colectomy with mucosal proctectomy with ilieal pouch, ileoanal anastomoses

The ColonCancerCheck (CCC) program conducted a systematic review on the available clinical evidence for colorectal cancer screening tests, including CT colonography. The Colorectal Cancer Screening in Average Risk Populations: Evidence Summary did not find evidence to support use of CT colonography as a first-line test in average risk screening. Therefore, CT colonography is not included as a recommended screening test in the CCC program and is not included in the SAR.

Ontario Health receives data regularly from the Ministry of Health regarding deceased patients. However, these data sources might not always be up to date or might submit their data after the report's cut-off date.

The Screening Activity Report (SAR) reflects the data available as of the report cut-off date and in accordance with Ontario Health's clinical guidelines; therefore, there may be information that the SAR is missing. For example, Ontario Health does not receive patient-pay human papillomavirus (HPV) test data. Furthermore, Ontario Health does not receive fecal immunochemical test (FIT) data for people screened with patient-pay FIT. It is important to note that a provider may have followed up with a patient about doing a FIT, but because it is an at-home test, their patient may or may not have completed the test after their follow-up with the provider.

We acknowledge that there may be limitations to the SAR and that physicians may have additional information that Ontario Health is unaware of or cannot collect. Please consider this report a supplement to other clinical tools that are part of your regular practice.

We are unable to remove patients from your report. We acknowledge that this report has limitations and that it may not capture follow-up actions you have taken with every patient. Consider this report a supplement to other clinical tools being used in your practice.

All visualizations and tables in the SAR can be downloaded in an Excel format (xlsx, csv). Simply hover over any visualization, select the three dots from the top right, and navigate to export data. Once your report is downloaded, you are free to make any changes to the data and content of the report to be consistent with your own patient records. Please note, these changes, which contain personal health information, are for your practice’s use only, and should not be sent to Ontario Health.

You are responsible for managing any reports or documents printed or otherwise extracted from the eReport portal in accordance with Personal Health Information Protection Act (PHIPA) and your organization’s policies and procedures

If you receive an error message after you have logged in to eReport platform, a time out is the most likely reason. Please try to log in again as a first step.

Physicians will get an error message in the following situations:

• The physician is not in a patient enrolment model. The SAR is only available to physicians in a patient enrolment model. If you are not in a patient enrolment model, you may still view the MyPractice Primary Care Physician Report.
• The physician did not have any eligible patients as of the report cut-off date.
• The site has timed out for security reasons.
• The site is under maintenance.
• The physician services the Sioux Lookout municipality and zone.

Delegates will get an error message in the following situations:

• A physician has not assigned that person as a delegate.
• The physician did not have any eligible patients as of the report cut-off date.
• The physician chosen does not have patient enrolment model status. The SAR is only available to physicians in a patient enrolment model. If you are not in a patient enrolment model, you may still view the MyPractice Primary Care Physician Report.
• The physician chosen services the Sioux Lookout municipality and zone.
• The site has timed out for security reasons.
• The site is under maintenance.

Users of the Sioux Lookout and Zone SAR will continue to access the report through eReport. Physicians and delegates will be locked out of the system and will get an error message after 5 failed login attempts with an incorrect password. If this occurs, call Ontario Health at 1-866-250-1554 or email oh-servicedesk@ontariohealth.ca for assistance.

For any questions related to the Screening Activity Report, please contact the Ontario Health Contact Centre at 1-866-662-9233 (Monday to Friday 8:30 a.m. to 5:00 p.m.) or cancerinfo@ontariohealth.ca. Please do not send personal health information or personal information to this email address.

Additional support information is available on the MyPractice Primary Care Plus (with Screening Activity Report data) page.

For your billing-related inquiries, please contact the Ministry of Health Service Support Contact Centre at 1-800-262-6524.