Recommendations from the BC Cancer Agency.
Regular Pap tests are important for preventing cervical cancer.
When does the BC Cancer Agency recommend women start having Pap tests?
Screening should begin at age 21 or approximately three years after first sexual contact. Sexual contact includes touching and intercourse because the human papillomavirus (HPV) is transmitted though sexual contact, not just sexual intercourse. HPV causes nearly all cervical cancers.
How often do women need Pap tests?
Once a year until she has 3 normal results in a row, then every 2 years.
Why is regular screening needed?
Pap tests find most cases of abnormal cervical cells, but no screening test is perfect. Repeat testing ensures accuracy.
When can women stop having Pap tests?
After age 69, women are at low risk of developing cervical cancer. She can stop having Pap tests if she had:
3 or more normal results in a row in the last 10 years, and no history of moderately or severely abnormal Pap test results.
Do women need cervical screening after a hysterectomy?
In general, women who had a total hysterectomy (surgery to remove the entire uterus with cervix) can stop having Pap tests. But it also depends on previous Pap tests results, so talk to a health care provider about what is best for you.
If you are unsure if you need cervical screening, talk to your health care provider.
Women under age 40 with a strong family history of breast cancer may be referred for a screening by their doctor.
The value of regular screening mammograms should be discussed with you. Generally, screening mammograms are less effective in women ages 40‐49 because younger women tend to have denser breasts. About 25% of cancers are not seen by a screening mammogram in this age category, compared with about 10% in older women. If you decide to begin regular screening mammograms, once in the Program, you will receive mailed reminders when it is time for another exam.
About 70% of cancers occur in women age 50 and older who have no risk factors other than being an aging female. Regular screening mammograms are highly recommended and there is clear evidence that regular mammograms save lives – particularly within this age group. Once in the Program, you will receive mailed reminders every two years.
Women in this age category are at a higher risk of developing breast cancer. However, you may have other conditions. Therefore, screening decisions may depend on your general level of health and preference. Women receive mailed reminders every two years.
Women in good health (life expectancy of 10+ years) may be referred for screening by your family doctor. The possible benefits of screening mammograms in relation to other potential health concerns at this age will be discussed.
Screening for colorectal cancer should occur after risk stratification which determines the appropriate screening test and interval.
Fecal immunochemical test (FIT) every 1 - 2 years for average-risk individuals aged 50 - 74 years.*
Follow-up of ANY positive fecal occult blood test (FOBT) with colonoscopy.
Use of FOBT is not appropriate when frank blood is present.
Colonoscopy every 10 years is an acceptable alternative to FOBT for screening.
Patients followed by colonoscopy do not require other screening modalities (i.e., FOBT).
* There is not yet strong evidence to indicate what testing interval would be preferable (at this time the Medical Services Commission has approved a FIT test every 1-2 years).
Please see this document.
Currently, there is some controversy about what should be done about prostate cancer screening. The BC Cancer agency does not have a population-wide screening program, but does give the following recommendation:
The Genitourinary Cancer Tumour Group (GUTG) of the BC Cancer Agency and the Vancouver Prostate Centre (VPC) recommend that asymptomatic men 50 years of age or older, with an estimated life expectancy of more than 10 years, who are well informed about the risks of over-diagnosis and over-treatment, consider PSA testing for the early diagnosis of prostate cancer.
The GUTG and VPC do not support unselected, population-wide PSA screening because of the potential for over-diagnosis, over-treatment and detriment to quality adjusted survival.
There is evidence from randomized controlled trials that the chance of dying of prostate cancer decreases with PSA screening and subsequent treatment. However, a significant number of men will need to be treated (with all the risks that that entails) who would otherwise not have had a problem with prostate cancer in their lifetime.
The decision to use PSA for the early detection of prostate cancer should be individualized.
Abnormal results should trigger referral to a urologist.
Early detection of prostate cancer should be linked to a treatment algorithm that includes discussion and prioritization of active surveillance for men with low risk prostate cancer.
While the statement above represents the consensus view of the GU Tumour Group, it should not be interpreted as a policy or position of the BC Cancer Agency.