OCSP for Healthcare Providers

The North Bay Regional Health Centre Laboratory is the Ontario Health procured Lab Service Provider for HPV and test cytology testing for OCSP eligible patients in Northeastern Ontario.

Ontario Health and the Ministry of Health (MOH) are introducing evidence-based improvements to the Ontario Cervical Screening Program (OCSP)

Effective March 3, 2025:

1. The human papillomavirus (HPV) test will become the primary test for cervical screening and will also be utilized for follow up testing of abnormal results in colposcopy.
2. All OCSP-related tests (HPV testing and cytology) for the northeast will be performed by North Bay Regional Health Centre (NBRHC).

Eligibility

Someone is eligible for cervical screening as part of the OCSP if they:

• Have a cervix¹, including women, Two-Spirit people, transmasculine people and nonbinary people, as well as people who have undergone a subtotal hysterectomy and retained their cervix
• Are age 25 to 69 (some people may screen until age 74)²
• Have ever been sexually active³
• Have Ontario Health Insurance Plan (OHIP) coverage⁴
• Have no symptoms suggestive of cervical cancer, such as abnormal vaginal bleeding or discharge, bleeding after sexual activity^c and pelvic pain.

People immunized for human papillomavirus (HPV), pregnant people and menopausal people who meet the OCSP eligibility criteria listed above still require cervical screening.

Testing that falls outside the scope of the OCSP will continue to be performed at NBRHC. Please use an NBRHC Cytology Testing Requisition.

¹ Screening is not recommended for people born without a cervix and transfeminine people with a neovagina because it may not be clinically or scientifically indicated. Routine screening is not recommended for people who have had their cervix removed as a result of hysterectomy; for more information refer to the OCSP’s Vaginal Vault Testing Guidance.

² People with one negative HPV test result from age 65 to 69 can stop cervical screening, with a few exceptions. The following people should screen until age 74: people who were not screened from age 65 to 69, immunocompromised populations, and people who have been discharged from colposcopy, but who have not yet met the criteria to return to routine cervical screening by age 69.

³ Sexual activity is defined as any sexual contact with another person’s genitals (private parts). This contact can be with the hands, mouth or genitals. Providers should define what is meant by sexual contact so their patients understand that it includes people who have had sexual contact with only one person, have had the same sexual partner for a long time, have not had sexual contact in a long time or have had sexual contact with someone of the same sex.

⁴ To help someone get OHIP coverage, visit ontario.ca/page/apply-ohip-and-get-health-card, call Service Ontario toll-free at 1-800-267-8097 or text toll-free TYY at 1-800-268-7095 for more information.

HPV Testing in the OCSP

In screening: HPV testing will be performed as the primary screening test, with reflex cytology performed automatically on samples testing positive for HPV

In colposcopy: HPV testing will be performed as a co-test with cytology (both tests concurrently performed) to determine eligibility or discharge and the screening interval in primary care post-discharge

Partial genotyping (HPV types 16, 18/45 vs. HPV [other high-risk types]) will be used in both screening and colposcopy, and will guide referral threshold to colposcopy

Test Ordering Process

Requisitions:

All patient specimens must be accompanied by a fully completed, signed OCSP requisition.

HPV and cytology tests requisition form – for cervical screening

HPV and cytology tests requisition form instructions – for cervical screening

HPV and cytology tests requisition form – colposcopy for follow-up of cervical screening-related abnormalities

HPV and cytology tests requisition form instructions – colposcopy for follow-up of cervical screening-related abnormalities

The new OCSP cervical requisitions (Screening and Colposcopy) must be used to order program-related HPV and cytology tests for eligible participants.

Providers will not be able to order OCSP-funded testing using any other requisition.

The requisitions are also available on the HPV testing implementation resource hub at ontariohealth.ca/hpvhub.

Ontario Health (Cancer Care Ontario) is working with OntarioMD (OMD) to make the requisition form available through certified electronic medical records (EMRs).

Supplies, Courier Pickup and Delivery

Your lab service provider will not change as a result of the HPV testing launch

Your main lab provider and contact for the OCSP program will be the same lab that you currently work with now for all your lab services. Your main lab provider will continue to provide you with collection devices for HPV/Cytology samples and courier services to pick up samples and transport them to the testing laboratory.

If NBRHC is your current lab provider, fax completed OCSP Supplies order form to 705-495-7988.

Allocation of testing and reporting results

In Northeast Ontario, North Bay Regional Health Centre will conduct OCSP testing and report results. If your current lab provider is LifeLabs or Dynacare, they will continue to provide you with collection devices for HPV/Cytology samples and courier services to pick up samples and transport them to North Bay Regional Health Centre.

If you have any questions about lab or courier services, please contact your current lab provider.

Physician Consultation/Inquiries

Consultations with a Pathologist or Technical Specialist are available by calling 705-474-8600 extension 8111 or 888-418-6430.

Report Distribution

Report delivery options include auto-fax or electronically into your Electronic Medical Record (EMR) system through the regional electronic report distribution (POI).

Providers who have access through ONE HITS Expanse HIS, can view results electronically in the EMR.

Authorized health care providers can view lab results from OLIS via Connecting Ontario Clinical Viewer.

Specimen Collection Instructions

OCSP: How to Collect a Cervical Sample

Special Considerations when switching from BD SurePath^Ⓡ to Hologic ThinPrep^Ⓡ collection devices

1. Avoid certain types of lubricant or use water to lubricate: using too much lubricant or using lubricants that contain carbomer or Carbopol^Ⓡ polymers (thickening agents) may cause an invalid test result. To minimize the risk of an invalid test result:

• Use lukewarm water to warm and lubricate the speculum.
• If a lubricant gel needs to be used for patient comfort:
  • Use a dime-sized amount of water-soluble and carbomer-free gel lubricant
  • Apply the lubricant on to the outer sides of the speculum blades, avoiding contact with the tip and inner sides of the speculum
  • A list of lubricant brands that have been validated by Hologic Inc. for use with the ThinPrep^Ⓡ system can be found here.

2. Do not leave any part of the collection device, including the head of the broom, the head of the endocervical brush or the spatula, in the vial. Unlike BD SurePath^Ⓡ, the ThinPrep^Ⓡ system does not allow any collection devices to be left in collection vials. Samples with devices left inside the vial will be rejected by the laboratory.

Tips for Collecting Cervical Samples

1. Remember to label all samples with the patient’s full legal name (first and last), date of birth and the date of specimen collection
   1. If the patient’s legal name and date of birth on the label do not match the requisition, testing will be delayed or the sample will be rejected by the laboratory. A pre-printed label is preferred.
2. Remember to check the expiry date of the collection vial before you collect the sample
   1. Cervical samples collected using expired medium will be rejected by the laboratory.

Specimen Holding Temperatures

PreservCyt Solution with cytologic sample intended for ThinPrep Pap testing can be stored between 15°C and 30°C for up to 6 weeks.

Helpful Websites

Human Papillomavirus (HPV) Testing in Ontario: Implementation Resource Hub

Cervical Screening FAQs for Healthcare Providers