Recommendations for Follow-Up of Abnormal Cytology

Management and Follow-Up

• Repeat cytology in 12 months. If the result is:
  • Greater than or equal to ASCUS, refer to colposcopy.
  • Normal, repeat the cytology again in 12 months. If the result is:
    • Normal, return to routine screening in 3 years.
    • Greater than or equal to ASCUS, refer to colposcopy.

• Currently HPV testing is not an insured test in Ontario. However, HPV testing is available in Ontario though patient-pay or in some hospitals. HPV testing for someone with a first time ASCUS or LSIL is not required (repeat cytology in 12 months is safe and acceptable). However, those who make an informed decision to have an HPV test after a low-grade cytology result can follow these management recommendations:
  • People with a cervix who are HPV 16/18 positive can be referred directly to colposcopy
  • People with a cervix who are HPV non-16/18 positive should repeat their cytology in 12 months
  • People with a cervix who are HPV negative should return to routine screening with cytology in 3 years
• See evidence for Repeat Cytology Interval recommendation

Management and Follow-Up

Colposcopy

Management and Follow-Up

Colposcopy and/or endometrial sampling

Management and Follow-Up

• Repeat cytology in 12 months, if the result is:
  • Greater than or equal to ASCUS, refer to colposcopy.
  • Normal, repeat the cytology again in 12 months. If the result is:
    • Normal, return to routine screening in 3 years.
    • Greater than or equal to ASCUS, refer to colposcopy.
• Currently HPV testing is not an insured test in Ontario. However, HPV testing is available in Ontario though patient-pay or in some hospitals. HPV testing for someone with a first time ASCUS or LSIL is not required (repeat cytology in 12 months is safe and acceptable). However, those who make an informed decision to have an HPV test after a low-grade cytology result can follow these management recommendations:
  • People with a cervix who are HPV 16/18 positive can be referred directly to colposcopy
  • People with a cervix who are HPV non-16/18 positive should repeat their cytology in 12 months
  • People with a cervix who are HPV negative should return to routine screening with cytology in 3 years
• See evidence for Repeat Cytology Interval recommendation

Management and Follow-Up

Colposcopy

Management and Follow-Up

Colposcopy

Management and Follow-Up

Repeat cytology in 3 months

Management and Follow-Up

Routine screening in 3 years; no immediate recall required

Management and Follow-Up

• Pre-menopausal women who are asymptomatic require no action (continue to follow usual screening guidelines).
• Post-menopausal women require investigations, including adequate endometrial tissue sampling.
• Any woman with abnormal vaginal bleeding requires investigation, which should include adequate endometrial tissue sampling.

The colposcopist should provide specific and individualized screening recommendations when a woman is discharged from colposcopy:

• Women eligible for discharge from colposcopy who have normal, ASCUS or LSIL cytology and a negative HPV test are at average risk and should be screened every 3 years.
• Women eligible for discharge from colposcopy who have normal, ASCUS or LSIL cytology and a positive HPV test are at elevated risk and should have annual surveillance.
• Women eligible for discharge from colposcopy, whose HPV status is not known, should be screened according to risk-based recommendations made by the colposcopist.

Re-referral to colposcopy should be based on screening results (cytology), as per current guidelines.