Screening Activity Report Data Frequently Asked Questions

The report draws upon several data sources. Cancer Care Ontario 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)

We have also created custom-built tools used by participating laboratories to upload fecal occult blood test results, and by funded hospitals to upload data on colonoscopy procedures.

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 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?

Cancer Care Ontario recognizes the limitation of not incorporating the use of Q codes and is therefore considering them for future enhancements to ensure the Screening Activity Report continues to provide meaningful data to primary care physicians.

Cancer Care Ontario 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 Screening Activity Report.

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

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

• Breast screening – A participant is considered up-to-date if they are 50 to 74 years old and has had a mammogram within 24 months before the report's cut-off date.
• Cervical screening – A participant is considered up-to-date with cervical screening if they are 21 to 69 years old and has completed a Pap test within 36 months before 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 (FIT) 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 complete a fecal occult blood test after December 24, 2019.

The regional screening rates differ slightly from those reported in the Cancer System Quality Index ­– a set of publicly reported indicators from the Cancer Quality Council of Ontario – because the index reports on all physicians, while the Screening Activity Report comparison data only report 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 your population health management by providing a quick view of a patient’s screening needs. The screening status, however, is limited by the data that Cancer Care Ontario receives.

A screening status has been assigned to each rostered and eligible patient to represent their cancer screening needs based on Cancer Care Ontario'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 your population health management 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 only applies to people whose last screening test result was normal.

Yellow: Physician Review Required

• Colonoscopy in the last 10 years or flexible sigmoidoscopy in the last 5 years: Patients who had a colonoscopy in the last 10 years or a flexible sigmoidoscopy in the last 5 years, but are not due for colorectal cancer screening within the next 6 months.
• Review patient history: Patients whose screening result is unknown due to screening being performed outside of the Ontario Breast Screening Program, the Ontario Cervical Screening Program or ColonCancerCheck. Due to these data limitations, patients with unknown results require review by a provider to determine next steps.
• Abnormal screen, follow-up underway or completed: Patients who 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. Cancer Care Ontario does not collect the results of follow-up activities, with the exception of some breast assessment procedures.

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 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 Cancer Care Ontario's clinical guidelines. Each letter represents the following:

• Y: Yes, a person is eligible for screening based on their age, sex and lack of exclusionary criteria.
• N: No, a person is ineligible for screening based on their age and/or sex.
• X: A person has been excluded due to a previous program-specific cancer or cancer resection surgery, or is enrolled in the High Risk Ontario Breast Screening Program.

There are a number of reasons a patient may be assigned a dark grey screening status with "N/D" or "no data." Some patients are excluded from screening due to a previous program-specific cancer or surgery. Also, at times Cancer Care Ontario is limited in the data we can provide due to privacy reasons. Please consider the Screening Activity Report as a supplement to your patient charts and other clinical tools that are part of your practice.

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 assigned a screening status on this report. People who are enrolled in the High Risk Ontario Breast Screening Program are also excluded from this report.

The following Ontario Health Insurance Plan mastectomy codes were 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, Cancer Care Ontario does not receive information related to the result of that screening test. The report will provide the date of a mammogram performed outside of the program; however, you will have to refer to your patient charts for result information.

For people screened outside of the Ontario Breast Screening Program, the recommended screening recall interval is also unknown because Cancer Care Ontario does not receive this information.

Participants who have been asked to return in 1 year as a one-time event will have a screening recall displayed as "return 1 Y"; these participants will have their recall interval reassessed at their next screening appointment. For those who have been asked to return annually on a permanent basis, "return annually" will be displayed within the screening recall column.

A recommendation to be recalled for screening in 1 year or annually is based on many factors, including:

• risk factors, such as breast density or family history
• a radiologist's request to follow up with a patient in a year's time

A final result for the follow-up of an abnormal mammogram may appear as "in progress" due to a data lag.

People who are within the target age range of 21 to 69 years who have a history of cervical cancer or who have had a hysterectomy are not assigned a screening status in this report.

The following Ontario Health Insurance Plan hysterectomy codes were 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 Cancer Care Ontario's clinical guidelines, the recommended follow-up for a Pap showing atypical squamous cells of undetermined significance is to repeat cytology in 6 months. Following 2 consecutive normal follow-up Paps, it is considered safe for participants to return to routine screening in 3 years. If a patient had an abnormal Pap within the 9 months before the report cut-off date, we recommend that you review the patient’s history to determine next steps for follow-up of their Pap test result.

For more details on the recommended follow-up of abnormal cytology, please see the Recommendations for Follow-Up of Abnormal Cytology on page 2 of the Ontario Cervical Screening Guidelines Summary.

People between the target age range of 50 to 74 years who have a history of colorectal cancer or who have had a colectomy are not assigned a screening status in this report.

The following Ontario Health Insurance Plan colectomy codes were 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 program conducted a systematic review on the available clinical evidence for colon cancer screening tests, including computed tomography (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 ColonCancerCheck program and is not included in the Screening Activity Report.

No, test information for patients who were screened by a registered nurse with flexible sigmoidoscopy will not appear on your report. There are 9 locations in Ontario offering nurse-performed flexible sigmoidoscopy, and Cancer Care Ontario is working on including this data in future reports. Please refer to your records for screening-related information on patients who have received/are receiving screening from a registered nurse.

Cancer Care Ontario receives data regularly 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.

These records reflect the data available as of the report cut-off date and according to Cancer Care Ontario's clinical guidelines; therefore, there may be information that the Screening Activity Report is missing. Cancer Care Ontario does not receive screening data from public health units or result information processed in some hospital labs.

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

At this time, we are unable to remove patients form 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. The ability to update and revise your report is being considered for future versions of the Screening Activity Report to better support your cancer screening practices.

Because the Screening Activity Report is available in an Excel format, your report can be modified for your own purposes once you have downloaded it to your system. You are free to add or remove rows, or edit the content of cells to make your report more consistent with your own patient records. These sorts of changes, which contain personal health information or personal information, are for your practice's use only, and should not be sent to Cancer Care Ontario.

You may have difficulty viewing the report if you are not using current versions of your operating software or web browser. The report is optimized for access on recent Windows and Macintosh operating systems, as well as recent versions of Internet Explorer, Mozilla Firefox, Google Chrome and Safari. You may have to upgrade to a more recent software or browser version, or accept a compatibility message before being able to download the reports.

The Excel version of your Screening Activity Report is formatted for current versions of Microsoft Office (the spreadsheet is in an .xlsx format). Versions older than Excel 2007 may not be able to open the report. If you have an earlier version of Excel, you can download a compatibility pack that will allow you to open the report on your PC, edit it and save it. 

No, the report is not configured or supported for viewing on smartphones or tablets. The website and the report have been developed specifically for viewing on a laptop or desktop computer.

If you receive an error message after you have logged in to the Screening Activity Report website, 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 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.

Delegates will get an error message in the following situations:

• There are no physicians who have 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 site has timed out for security reasons.
• The site is under maintenance.

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 eHealth Ontario at 1-866-250-1554 (24 hours a day, 7 days a week) or email their service desk at servicedesk@ehealthontario.on.

If your question is related to logging in, password issues, changes to your ONE®ID profile or delegates, please call eHealth Ontario at 1-866-250-1554 (24 hours a day, 7 days a week) or email their service desk at servicedesk@ehealthontario.on.ca.

If you are interested in registering to access your Screening Activity Report online, contact ONEIDBusinessSupport@ehealthontario.on.ca

Registration appointments will be scheduled based on location and/or the date of your request.

For any questions related to the Screening Activity Report website or your report, please contact the Cancer Care Ontario Screening Contact Centre at 1-866-662-9233 (Monday to Friday 8:30 a.m. to 5 p.m.) or screenforlife@cancercare.on.ca. Please do not send personal health information or personal information to this email address.

Additional support information is available on the Screening Activity Report page.

For all of your billing-related inquiries, please contact the Ontario Medical Association toll free at 1-800-268-7215 and ask to be connected to the Economics Department.