Cervical Cancer Screening Guidelines Across Canada Environmental Scan August 2014 Background August 2014 Quarterly, the Canadian Partnership Against Cancer collects information from the provinces/territories and international organizations on the status of population-based cervical cancer screening programs and/or strategies. This information compares current guidelines and evidence-based recommendations in order to identify leading practices. Presentation Outline August 2014 Canadian Task Force on Preventive Health Care Guidelines Provincial and Territorial Guidelines Cervical Cancer Screening Programs in Canada Follow-up Test for Abnormal Results Detection Methods Colposcopy Services or Standards Across Canada HPV DNA Testing HPV Immunization Information Technology Solutions in Cervical Screening Programs Canadian Task Force on Preventive Health Care Guidelines The Canadian Task Force on Preventive Health Care (2013) recommends the following for cervical cancer screening: For women aged <20, routine screening not recommended (Strong recommendation, high quality evidence) For women aged 20 to 24, routine screening not recommended (Weak recommendation; moderate quality evidence) For women aged 25 to 29, routine screening is recommended every 3 years. (Weak recommendation; moderate quality evidence) For women aged 30 to 69, routine screening is recommended every 3 years. (Strong recommendation; high quality evidence) For women aged ≥70 who have been adequately screened (i.e. 3 successive negative Pap tests in the last 10 years), routine screening may cease. For women aged 70+ who have not been adequately screened should continue screening until 3 negative test results have been obtained. (Weak recommendation; low quality evidence) For more information please visit: http://canadiantaskforce.ca/ Cervical Cancer Screening Programs: Provincial and Territorial Guidelines Start Age Interval Stop Age Nunavut (NU) Age 21 or 3 years post-first sexual contact Every 2 years after 3 consecutive annual negative tests Age 70 with 3 negative tests in previous 10 years Northwest Territories (NT) Age 21 or 3 years post first sexual contact, whichever occurs first Every 2 years after 3 consecutive annual negative tests Age 69 with 3 negative tests in previous 10 years Yukon (YK) British Columbia Cancer Agency guidelines British Columbia Cancer Agency guidelines British Columbia Cancer Agency guidelines British Columbia (BC) Age 21 or 3 years post first sexual contact, whichever occurs first Every 2 years after 3 consecutive annual negative tests Age 69 with 3 negative tests in previous 10 years or 3 annual negative tests (for women inadequately screened) Alberta (AB) Age 21 or 3 years post first sexual contact, whichever occurs later Within 5 years, with 3 negative tests at least 12 months apart and then continue every 3 years Age 69 with 3 negative tests in previous10 years or 3 annual negative tests (for women with no screening history) Saskatchewan (SK) Age 21 or 3 years post first sexual contact, whichever occurs later Ever y 2 years until 3 consecutive negative tests than every 3 years Age 69 with 3 negative tests in previous10 years or 3 annual negative tests (for women with no screening history) Manitoba (MB) Age 21 for all women who have ever been sexually active Every 3 years Age 70 with 3 negative tests in previous 10 years August 2014 Cervical Cancer Screening Programs: Provincial and Territorial Guidelines, cont’d Start Age Interval Stop Age Ontario (ON) 21 years of age for women who are or have ever been sexually active. Every 3 years Age 70 with adequate negative screening history in previous 10 years (i.e. 3 or more negative tests) Québec (QC) Age 21 Every 2-3 years Age 65 with 2 negative tests in previous 10 years New Brunswick (NB) Age 21 or 3 years post first sexual contact, whichever occurs later Every 2 -3 years after 3 consecutive annual negative tests Age 69 with history of adequate negative tests in previous 10 years or 3 annual negative tests (for women with little/no screening history) Nova Scotia (NS) Age 21 or within 3 years of first vaginal sexual contact whichever comes last Every 3 years Age 70 with adequate negative screening history in the previous 10 years (i.e. 3 or more negative tests). Prince Edward Island (PEI)* Age 21 if sexually active Every 2 years 65 with adequate normal Pap history in the previous 10 years Newfoundland & Labrador (NL) Age 20 Every 3 years after 3 consecutive annual negative tests Age 70 with 3 negative tests in previous 10 years or 3 consecutive negative tests (for women with no screening history) ** PEI guidelines revised October 2013 Cervical Cancer Screening Programs in Canada Program Start Date Program Name Agency Responsible for Program Administration Nunavut (NU) N/A Program not available Northwest Territories (NT) N/A Program not available Yukon (YK) N/A Program not available Government of Yukon British Columbia (BC) 1960 Cervical Cancer Screening Program BC Cancer Agency Alberta (AB) 2003 Alberta Cervical Cancer Screening Program Alberta Health Services Saskatchewan (SK) 2003 Prevention Program for Cervical Cancer Saskatchewan Cancer Agency Manitoba (MB) 2000 CervixCheck CancerCare Manitoba Ontario (ON) 2000 Ontario Cervical Screening Program Cancer Care Ontario Québec (QC) N/A Program not available Direction québécoise de cancérologie, Ministère de la santé et des services sociaux du Québec New Brunswick Cervical Cancer Prevention and Screening Program New Brunswick Cancer Network (NB Department of Health) New Brunswick (NB) 2014-2015 Government of Nunavut Department of Health & Social Services Nova Scotia (NS) 1991 Cervical Cancer Prevention Program Cancer Care Nova Scotia Prince Edward Island (PEI) 2001 PEI Pap Screening Clinic Health PEI Funded. Administered by Dr. D.I. Stewart. Newfoundland and Labrador (NL) 2003 Cervical Screening Initiatives Program Cancer Care Program, Eastern Health Cervical Cancer Screening Practices Nunavut 4. No Does the screening program send reminders for follow up after abnormal Pap test results? Northwest Territories 1. Yes to care providers only Yukon Information currently not available British Columbia 1. Yes to care providers only Alberta 1. Yes to care providers and/or women Not direct to patients. Cytology lab sends follow-up letters to clinicians for abnormal smears on which they have not received a follow-up smear within a specific time frame. Saskatchewan 1. Yes to care providers only Manitoba 3. Yes, to women and care providers Ontario 4. Yes, to women only Letters sent to providers and women where recommended follow up has not been performed Nova Scotia 1. Yes, to care providers only Reminder letters are sent to the health care provider who performed the pap test, when recommended follow-up has not been performed. Prince Edward Island 3. Yes, to women and care providers from lab services (not program) Quebec 4. No New Brunswick 4. No Abnormal Results correspondence to primary care providers and women planned to begin 2014/2015 Newfoundland/Labrador 3. Yes to health care providers, then women Options 1. Yes, to care providers only 2. Yes, to women only 3. Yes, to women and care providers 4. No And further comments (if any) Cervical Cancer Screening Practices Nunavut Detection methods in routine use in cervical cancer screening programs Northwest Territories Liquid Based Cytology Liquid Based Cytology Reflex HPV testing for ASCUS in women ages >30 HPV triage for certain Pap test abnormalities Saskatchewan Manitoba Conventional cytology Nova Scotia Conventional cytology and one district who is piloting Liquid Based Cytology testing Conventional cytology and liquid based cytology Yukon British Columbia Conventional cytology Alberta Liquid Based Cytology HPV triage for certain Pap test abnormalities** Ontario Quebec New Brunswick Liquid Based Cytology Conventional cytology Liquid Based Cytology Liquid Based Cytology and conventional cytology HPV triage for certain Pap test abnormalities* (not an insured service) HPV triage for certain Pap test abnormalities. HPV triage is already available in some laboratories and will be made available for all ASCUS related cases in the entire province by 2014 HPV triage for certain Pap test abnormalities** Prince Edward Island Newfoundland/Labrador Conventional cytology Liquid Based Cytology *triage in case of ASC-US/borderline dyskaryosis only **triage in case of ASC-US/ borderline dyskaryosis or LSIL/ mild dyskaryosis Reflex HPV testing for ASCUS in women >30 years old Cervical Cancer Screening Practices When is a woman sent for a referral to colposcopy in your cervical cancer screening program? Colposcopy Result NU NT* YK BC AB SK MB ON QC NB NS PEI NL ASC-US/borderline dyskaryosis (1st result) (LSIL Age >30) LSIL/mild dyskaryosis (1st result) Age >30 & 2nd result 2130* (for In women > 21 years of age AGC HSIL+ * Refer to Territorial Guideline persistent ASCUS/LSIL for 2 years women >/=50 years LSIL and HPV + result Postcoital bleeding or cervicitis women > 50 years with LSIL and HPV + result ASC-US and HPV+ result Repeated ASCUS/LSIL after previous ASCUS/LSIL Other: (for women >/= 30) women >/= 30 yrs) Persistent Unsat results due to inflammation or obscuring blood LSIL repeat in 6 months with ASCUS =colposc opy Colposcopy Services or Standards Across Canada Province/ Territory How are colposcopy services provided in your province/territory (e.g. Are there any formal programs, what facilities are delivering colposcopy services)? NT No formal program for colposcopy, but referral to Ob/Gyn. Only Ob/Gyns perform colposcopy for entire territory BC The Provincial Colposcopy Program consists of 24 hospital-based clinics located throughout BC. Colposcopists affiliated with the Provincial Colposcopy Program are certified and have agreed to use a uniform reporting system with standardized terminology. AB Sixty-one colposcopists work out of 34 colposcopy clinics / sites participating and submitting colposcopy report forms to the ACCSP SK Colposcopy services are provided by individual practitioners, which includes gynecologic oncologists as well as general gynaecologists. MB 4 formal colposcopy clinics (2 rural, 2 in wpg) based out of hospitals, remaining colposcopy services are in private offices ON Colposcopy services are provided by individual practitioners, including general gynecologists and gynecologic oncologists. QC Colposcopy services are conducted in hospital settings. Referrals are done by the hospital and there are no formal programs. NB Colposcopies are provided by each of the 8 regional hospitals across NB. Colposcopies are operationalized by the Regional Health Authorities. NS Colposcopy is delivered in NS primarily in hospital based clinics. There are a few private office based clinics that provide initial assessment with treatment performed in a hospital setting. PEI Colposcopies are done through a referral to a Gynaecologist. They are mostly conducted in the OB/GYN offices. NL Colposcopy services are provided in eleven sites within the four regional health authorities. There are also some colposcopy services available in private practice. A comprehensive environmental scan of colposcopy services is underway with a plan in development for next steps based on best practice models. Colposcopy Services or Standards Across Canada Which colposcopy services/standards are offered in your province/territory (check all those that apply) Province/ Territory Training Programs (please specify) CME certification opportunities (please specify) NT Collection of quality indicators related to colposcopy (please specify) Other (please specify) Same indicators collected as Alberta but not recorded centrally BC Certified through the Provincial Colposcopy Program AB All physicians doing colposcopy in Alberta meet College of Physicians and Surgeons of Alberta (CPSA) education standards SK No formal training programs MB limited *Nunavut and Yukon excluded due to no data available ACCSP sponsors Annual Colposcopy meeting accredited by the Royal College of Physicians and Surgeons of Canada The ACCSP Colposcopy Quality Improvement Committee has identified three Colposcopy Quality Practices (CQP) and eight Colposcopy Quality Measures (CQM) as detailed in the Colposcopy Component – ACCSP Quality Management Program Documentation CervixCheck collects and distributes colposcopy quality indicator reports to all MB colposcopists which include, a) time to colposcopy, and b) impressionhistology correlation. Standards also supported by the Society of Obstetricians and Gynaecologists of Canada Colposcopy Services or Standards Across Canada, cont’d Which colposcopy services/standards are offered in your province/territory (check all those that apply) Province/ Territory Training Programs (please specify) CME certification opportunities (please specify) ON Collection of quality indicators related to colposcopy (please specify) Scheduled to begin collecting data to support indicators April 2014. QC certain residency programs in gynecology are offered 3 months of training dedicated to colposcopy certain professional associations offer such certifications (AOGQ, SPGQ, GOC, ASCCP)** NB Responsibility of the Regional Health Authorities Responsibility of the Regional Health Authorities Varies per Regional Health Authority Colposcopist Working Day (CME credits) Colposcopist performance reports. *For details see below NS Program is planning to collect basic data of Colposcopy service date by 2014/2015. N/A – completed through OB/Gyn offices PEI NL Other (please specify) 3 performance indicators * NS: Colposcopy Histopathology vs. Visual Follow Up Visit and Zoneseen = Yes - By Physician and Aggregate; Colposcopy Pre-Treatment Biopsy Result vs. Treatment Result – By Treatment - By Physician and Aggregate; Treatment Success By 12 Month Post Treatment Result – By Treatment - By Physician and Aggregate; % of ECC’s Performed By Physician and Aggregate **Association des obstétriciens et gynécologues du Québec (AOGQ); Société des obtétriciens et gynécologues du Canada SPGQ, (SOGC); Society of Gynecologic Oncologists of Canada (GOC); American Society for Colposcopy and Cervical Pathology (ASCCP). HPV DNA Testing Nunavut Aids triage in women >30 with ASCUS on Pap Saskatchewan 2. Personal request (only) 3. Pilot trials/Research Nova Scotia 3. Pilot trials/Research August 2014 Is the use of HPV DNA testing a standard of practice in your province or territory? If yes, in what capacity is it being used? Northwest Territories 3. Pilot trials/ Research 4. Follow up for treatment 5. Triage in women > 30 with ASCUS or postmenopausal women with LSIL/ASC-US Manitoba 3. Pilot trials/Research Prince Edward Island 2. Personal Request (only) at the cost to the woman. Guidelines suggest HPV testing following a ASCUS for women over 30 but not funded at this time. Yukon Information currently not available Ontario British Columbia 3. Pilot trials/Research 4. Follow up for treatment Quebec Alberta 4. Triage in women > 30 with ASCUS or women > 50 with LSIL. (HPV triage) New Brunswick 3. Pilot trials/Research 3. Triage in women > 30 with ASCUS in 2014 Newfoundland/Labrador Options 1. Routine primary screening 2. Personal request (only) 3. Pilot trials/Research 4. Follow up for treatment 5. Other (specify) 4. ASCUS Triage for women over 30 years of age 4. Triage in women > 30 with ASCUS or women > 50 with LSIL HPV Immunization Province/ Territory Immunization program details ( Check all those that apply) Are adverse effects reported? Are vaccines available outside program? NU NT Is there a catch-up strategy? Is there a schoolbased strategy? Grade 6 girls only Is there a committee in place? A general NWT Advisory Committee on Immunization YU BC AB Determined by each regional health authority (boys will be included fall 2014 SK MB ON QC NB NS (commercially available for purchase) Personal request and paid by PEI (boys will be included fall woman NL Chief Public Health Officer 2013) HPV Immunization: Date , age first cohort immunized and catch-up Nunavut Northwest Territories Yukon British Columbia Alberta Date 2010 Fall 2009 November 2009 December 2008 December 2008 Age Grade 6 or >/= 9 yrs old Grade 4, 5 or 6 Grade 6 Grade 6, 9 Grade 5 A three year catch-up starting with Grades 11& 12 in 2009/10 , Grades 10& 11in 2010/11, Grades 9&10 in 2011/12 and ending with Grade 9 in 2012/13 & 2013/14 Grades 7 and 8 catch-up Catch-up Saskatchewan Manitoba a three-year catch-up offered to Grade 9 (ages 14 – 15) girls starting (2009/2010 school year) Ontario Quebec New Brunswick Date December 2008 December 2008 December 2007 September 2008 December 2008 Age Grade 6 Grade 6 Grade 8 4th year (age 9-10) of primary school, and girls under 18 in the general population (+ immunosuppressed woman up to 26 years of age). Since May 2014, the vaccine is available for boys ages 9-26 who are immunosuppressed and infected with HPV. Grade 7 Females who missed the vaccine in gr 6 and are born on or after January 1, 1997. Females born between 1986 and 2005 with increased risk of HPV infection who started the vaccine series before March 31, 2014. In 2012, the catch-up program was revised so that females who did not complete, or who did not receive, the HPV vaccine series in grade 8 are eligible to complete the series by end of grade 12 The catch-up program for girls of 3rd year of secondary school (age14-15) ended in June 2013. However, the vaccine is still systematically offered to partially or unvaccinated females. Females who did not receive or complete the series of HPV vaccine in grade 7 are eligible to complete the series until the end of grade 12 Catch-up August 2014 HPV Immunization: Date , age first cohort immunized and catch-up Nova Scotia Prince Edward Island Newfoundland/Labrador Date 2007 2007 December 2007 Age Any female born after October 1st 1993 and previously missed or refused HPV immunization, Female Grade 7 students when provided through the school program Grade 6 *Fall 2013, Grade 6 boys to be included. All girls born since 1994 have been offered the vaccine, offered to grade 6 females. Catch-up 2009-2010, Grade 10 August 2014 *vaccinations offered to a cohort of boys 2008-2009, Grade 9 catch-up offered to girls August 2014 HPV Immunization: Size of population & 1st dosage received Nunavut Northwest Territories Yukon British Columbia Alberta Size of population (Current) Information currently not available Approximately 900 girls would be in the Grade 4, 5 & 6 cohort Information currently not available 2011-12:21460 2012-13: 21285 2013-14: 21071 Information may be obtained from Population and Public Health of Alberta Health Services Number to receive first dose (or estimate) (current) Information currently not available HPV coverage estimates among grade 7 girls, NWT 2009/10 – 46% 2010/11 - 38% 2011/12-44% 2012/13-30% 2013/14-47% Information currently not available GR 6: 2009 61.8%, 2010 59.9%, 2011 68.2%, 2012 68.7%, 2013=69.1% GR 9: 2009 62.1%, 2010 58.1%, 2011 61.7%, 2012 and 2013=uptake results are included in the grade 6 results for 2009 and 2010 as these girls were provided with their 3rd dose when they were in grade 6. Numerator includes girls who received the vaccine through a school based public health program. 2010-2011 GR 5: receiving series of 3 doses of HPV is 60.2%, GR 9: receiving series of 3 doses of HPV is 60.1% August 2014 HPV Immunization: Size of population & 1st dosage received, cont’d Saskatchewan Size of population (current) Information currently not available Manitoba Eligible HPV vaccine cohort size is 8,000 Ontario GR 8 Quebec Fourth grade: 36225 New Brunswick Eligible girls in GR 7 and 8 in public school (2008-2009) Eligible Girls in GR 7 in public school since 2010 Number to receive first dose (or estimate) (current) 73% GR 6 girls received at least 1 dose Ranges from 65% of eligible cohort in 2009 to 72% of eligible cohort in 2012. As of Aug 1st, 2014, 67.8% of females received 1st dose for 2013/14 school year. HPV coverage estimate for 2012–13 is 80.2% Nova Scotia** Prince Edward Island Newfoundland/ Labrador Size of population (current) GR 7 –approximately 5000 GR 6 girls Boys start 2013. 2500 GR 6 girls (from 2007-present) 2500 Grade 9 girls (in the two catch-up years 2008/09 and 2009/10) Number to receive first dose (or estimate) (current) Coverage rate** for the 2012-2013 school year First dose=93.5% All 3 doses=77% Estimate – 80% First dose=92% GR 6; 84% coverage GR 9. 1st dose: 30 021 (83%) girls and 2nd dose: 28 578 (77,5%) * Data from school-based vaccination campaigns in 2013-2014 (August 22, 2014) 2008-9: 72.8% rec’d complete series, 5.6% incomplete 2009-10: 71.2% rec’d complete, series 5.6% incomplete 2010-11: 73 % rec’d complete series, 4.7%Incomplete 2011-12: 75.8% rec’d complete series, 3.3 % incomplete 2012-13: 75.2% complete series, 5.1% incomplete 2013-2014 – Stats unavailable until August 2014 *GR = school grade **For Nova Scotia **Unpublished data HPV Immunization Registry/ Database NU Does you cervical cancer screening program collect information for the following: NT YK BC AB SK MB ON** QC NB NS PEI** NL * * *** Number of doses Age at vaccination Age at each dose (will (Under evaluati on) (will collect by 2015) collect by 2014) HPV vaccination status HPV vaccine type (quadrivalent/ bivalent) Participation rates by HPV vaccination status (planning phase) (Under evaluati on) (will collect by 2016) * Through self-report data & school-based immunization program/ HPV School based registry (Public Health) ** This information is not collected by the screening program but could be collected through Public Health Records ***Through medical record data Information Technology Solutions Used in Cervical Cancer Screening Programs Which IT system/solution do you currently use in your cervical cancer screening program? Province/ Territory Name of Information Technology System/Solution NT Manual only. No system BC IT system was developed in house. AB Alberta Cervical Cancer Screening application and colposcopy databases contains all records of referral cytology SK Integrated Screening Information System or ISIS MB ISIS-CSP – Artificial Intelligence in Medicine ON Cytobase QC Cervical cancer screening is opportunistic and therefore, there is no cervical cancer screening program nor is there an information system. Since 2013, data on high-grade cervical lesions are collected through the Quebec cancer registry. NB Custom Designed Solutions– CCPSR (Cervical Cancer Prevention & Screening Repository) and CS-IIS (Cancer Screening – Integrated Information System) NS Ccasper (Oracle relational database) PEI N/A – no IT system at this time NL ISIS August 2014 First Nations, Inuit & Métis Strategies and Data Collection Do you collect First Nations, Inuit, and/or Métis cervical cancer data in your screening program (e.g. is there a FNIM identifier at the individual level in your screening database)? Do you have strategies/studies pertaining to such populations? If so, Province/ Territory Are FNIM data being collected (Yes/No)? If ‘Yes’, what data are being collected and for which population (list variables below)? Which FNIM based strategies/studies have been implemented (provide details below)? Nonaboriginal, Dene, Metis and Inuit mammography screening uptakes No, all health services in NWT are delivered in an integrated fashion. We do not have separate strategies NU NT YK BC Yes First Nations, Inuit & Métis Strategies and Data Collection Do you collect First Nations, Inuit, and/or Métis cervical cancer data in your screening program (e.g. is there a FNIM identifier at the individual level in your screening database)? Do you have strategies/studies pertaining to such populations? If so, Province/ Territory Are FNIM data being collected (Yes/No)? If ‘Yes’, what data are being collected and for which population (list variables below)? Which FNIM based strategies/studies have been implemented (provide details below)? Individual level – No Community level – Yes through Enhanced Access to Cancer Screening (EACS) pilot project. Served 9 FNIM communities and will reach an additional 5 before the project is over EACS related service data -# of FNIM communities/yr -clinic attendance for cervical screening, -Alberta Cervical Cancer Screening Program has SK Yes We identify if a women has federal status Education and promotion at First Nation events and health fairs to inform about screening MB No AB developed culturally appropriate educational resources for the FNIM population which are available via www.screeningforlife.ca and in print. -Enhanced Access to Cancer Screening (EACS) Project is +being piloted to provide cervical and colorectal cancer screening in tandem with the ST mobile mammography service in several FNIM communities. Partners with First Nation Metis Inuit Cancer Control Program, CCMB, First Nations Inuit Health Branch and Northern Nursing Stations and communities for all First Nation recruitment and education activities. First Nations, Inuit & Métis Strategies and Data Collection Cont’d Do you collect First Nations, Inuit, and/or Métis cervical cancer data in your screening program (e.g. is there a FNIM identifier at the individual level in your screening database)? Do you have strategies/studies pertaining to such populations? If so, Province/ Territory ON Are FNIM data being collected (Yes/No)? No If ‘Yes’, what data are being collected and for which population (list variables below)? Which FNIM based strategies/studies have been implemented (provide details below)? N/A • Anishinabek Cervical Cancer Screening Study (ACCSS) – led by Thunder Bay Regional Research Institute; CCO has supported the KTE and advised on the sustainability of the participatory action research project investigating the factors underlying the cervical cancer burden in First Nation women in Northwestern Ontario Initiatives being implemented across the colorectal, breast, and cervical cancer screening programs: • Improving Cancer Screening among First Nations and Métis Communities research project – collaboration between CCO’s ACCU and Sunnybrook Research Institute (SRI); funded by CIHR and CCO; over 3 years, project will develop a comprehensive action plan to improve cancer screening among high density First Nation and Metis communities; the action plan will draw on findings from related project aims: an analysis of cancer screening health policy, community based cancer screening research, and evaluation of Under/Never Screened initiatives • Building regional capacity to address FNIM cancer screening through the development Regional Aboriginal Cancer Plans. The plans were developed through direct engagement and feedback from the FNIM communities, the Regional Cancer Programs and CCO. An example of an initiative from a plan includes opportunities to address access to screening using existing Mobile coaches and clinics to reach remote and underserved FNIM communities. • Developed a recommendation report to build organizational capacity and plan to develop FNIM identifiers to inform and support cancer screening; • Supported and informed the 4 Under/Never Screened regional pilots to address screening rates with FNIM communities First Nations, Inuit & Métis Strategies and Data Collection Cont’d Do you collect First Nations, Inuit, and/or Métis cervical cancer data in your screening program (e.g. is there a FNIM identifier at the individual level in your screening database)? Do you have strategies/studies pertaining to such populations? If so, If ‘Yes’, what data are being collected and for which population (list variables below)? Province/ Territory Are FNIM data being collected (Yes/No)? QC N/A NB No N/A NS No However, CCNS provides screening and other cancer related data to several first nations communities in Nova Scotia through linkage with the First Nations Client Registry (unique in Canada). Success of this work has led to an expanded project: Strengthening Numbers Project - Improving Aboriginal Health Information for Nova Scotia First Nation Communities. Strategy under development for hard-to-reach population CCNS also collaborates with First Nations and Inuit Health, Health Canada and Tui’kin Partnership regarding educational resources for cervical cancer screening. PEI No NL Not available Which FNIM based strategies/studies have been implemented (provide details below)? N/A Reference Slide Please use the following reference when citing information from this presentation: Cancerview.ca. Cervical Cancer Screening Guidelines Across Canada: Environmental Scan. Toronto: Canadian Partnership Against Cancer; [enter date]. Available from: [enter URL link] August 2014