Services
Post-Colposcopy Discharge
For patients discharged from colposcopy with HPV test results available:
Negative HPV Test Result
Low risk for cervical cancer.
Return to routine screening with cytology (every three years for most people).
Positive HPV Test Result
Elevated risk for cervical cancer.
Screen with cytology annually.
Discharged With Unknown HPV Status
Multiple Normal or Negative Cytology Results (NILM)
Low risk for cervical cancer.
Return to routine screening with cytology (every three years for most people).
Combination of ASCUS, LSIL, and/or Normal Cytology
Elevated risk for cervical cancer.
Screen with cytology annually.
Resuming Routine Screening Every 3 Years
Patients can resume screening every three years when:
They have a negative HPV test result.
In the absence of HPV testing, they have three consecutive normal yearly cytology results.
Their risk returns to that of the general population or lower.
Re-Referral of the Colposcopy
When Should Discharged Patients Be Re-Referred to the Colposcopy?
Most patients return to routine screening intervals, typically every three years. However, those who are screened annually due to elevated risk need re-referral based on Ontario Cervical Screening Program guidance.
When Should Patients Be Referred to Colposcopy Based on Cytology Results?
Patients should be referred to colposcopy in the following cases:
Two consecutive ASCUS (Atypical Squamous Cells of Undetermined Significance) results.
Two consecutive LSIL (Low-grade Squamous Intraepithelial Lesion) results.
HSIL (High-grade Squamous Intraepithelial Lesion) cytology.
ASC-H (Atypical Squamous Cells, cannot exclude HSIL) cytology.
Atypical glandular cells (AGC-NOS, AGCN) cytology.
Adenocarcinoma in situ (AIS) cytology.
What is the Recommended Management for First-Time LSIL Results?
First-time LSIL results can be managed in primary care with repeat cytology in 12 months. Abnormal repeat results warrant further evaluation, including referral to colposcopy.
Colposcopy Indications
Pap Test Result: Atrophy
Follow-Up Recommendation:
Atrophy is a normal clinical state.
No increased risk of high-grade dysplasia or cervical cancer.
Action only if clinically necessary (e.g., for vaginal symptoms or cytology reevaluation).
Pap Test Result: Benign Endometrial Cells
Follow-Up Recommendation:
Routine finding; typically, no action required.
Pre-menopausal asymptomatic patients continue usual screening.
Post-menopausal patients require investigations (imaging or endometrial tissue sampling).
Any patient with abnormal vaginal bleeding needs appropriate investigation.
Pap Test Result: “Transformation Zone Components Not Present”
Follow-Up Recommendation:
The absence of transformation zone (T-zone) components alone doesn't require earlier rescreening.
Patients with satisfactory cytology evaluation and negative for intraepithelial lesion or malignancy (NILM) but lacking T-zone components should be re-tested at regular screening intervals.
Patients with abnormal cervical cytology should follow screening recommendations regardless of T-zone components.
