Cancer Screening Information for Healthcare Providers

Screening Guidelines 
Program Operations 
Reports 
Education & CME 
Supporting Patients
Pap Test Clinic Registration
Resources
Contact the Screening Programs

BreastCheck, CervixCheck and ColonCheck are the population-based screening programs operated by CancerCare Manitoba. Our goal is to reduce the rates of incidence and mortality from breast, cervical and colon cancers by screening eligible Manitobans at intervals that maximize the benefit and minimize the potential harms of each screening test. To read more about us, click here.

Screening Guidelines

The evidence-based recommendations listed below apply to most of the eligible population for each screening test. To read about specific exceptions to these guidelines, click below.

News

CervixCheck Provider Numbers

Registered Nurses (RNs), Physician Assistants (PA), and Clinical Assistants (CL.A) should obtain a CervixCheck Provider Number at such point cervical cancer screening becomes part of their practice. The CervixCheck Provider Number identifies the specimen taker on the cytology requisition form, and links them to the cervical cancer screening test (i.e. Pap test) and any subsequent follow-up. To request a CervixCheck provider number click here.

Canada Post

If a Canada Post disruption occurs, we will:

- not mail letters until Canada Post resumes regular services.

- contact patients by telephone if they have an abnormal result.

If a patient has received a home screening test from ColonCheck, they should wait to begin the test until the postal disruption is over.

If a patient has started a home screening test and are unable to send it in due to the Canada Post work disruption, ask the patient to contact ColonCheck.

Pap Test Competency Training

Registration for the next training is open. See below for details and registration.

Program Operations

BreastCheck, CervixCheck, and ColonCheck operate population-based registries which allow us to:

  • identify individuals eligible for cancer screening,
  • send letters of invite, recall, reminder and result notification,
  • monitor data, and
  • evaluate program operations.

Invitation strategies used include:

  • direct mail,
  • collaborating with healthcare providers, and
  • health promotion activities.

Each program sends a variety of letter types on a pre-determined timeline.

TYPE DESCRIPTION BREAST CERVIX COLON
NOTIFY Advise eligible individual that they will receive a test unless they contact the screening program     checkmark
INVITE Encourage eligible individual to participate in screening for the first time checkmark checkmark checkmark
RECALL Invite an eligible individual to participate in screening at the recommended interval checkmark checkmark checkmark
REMIND Sent after the initial invite to the eligible individual as a reminder to do the test checkmark checkmark checkmark
RESULT* Inform an individual of their screening test result. checkmark checkmark checkmark

*CervixCheck will send a result letter to a patient if they have a high-grade abnormal result or if the patient does not have appropriate follow-up listed in the CervixCheck registry.

For more information on each program's correspondence pathway, click below:

BreastCheck (pdf) | CervixCheck (pdf) | ColonCheck (pdf)

 

The CancerCare Manitoba Screening Programs have a team of Health Educators that plan, implement, and evaluate various education and health promotion activities for the public and providers on breast, cervical and colon cancer screening. Click below to:

Reports

BreastCheck

Participation Rates by Community (pdf)

2015 | 2014 | 2013 | 2012

Participation Rates by RHA (pdf)

Northern Burntwood 2014 | 2013 | 2012
Northern Norman 2014 | 2013 | 2012
Southern Central 2014 | 2013 | 2012
Southern South Eastman 2014 | 2013 | 2012
Interlake-Eastern Interlake 2014 | 2013 | 2012
Interlake-Eastern North Eastman 2014 | 2013 | 2012
Prairie Mountain Assiniboine 2014 | 2013 | 2012
Prairie Mountain Parkland 2014 | 2013 | 2012

Winnipeg 2014 | 2013 | 2012
Brandon 2014 | 2013 | 2012

Education & Continuing Medical Education (CME)

The CancerCare Manitoba Screening Programs facilitate learning opportunities to increase your knowledge about screening for breast, cervical and colon cancer. As a clinician or other healthcare professional, each of these events will help you become familiar with the provincial screening guidelines, get up to speed on what's new in screening, and understanding how BreastCheck, CervixCheck, and ColonCheck can support you in your cancer screening practice.

Education

Pap Test Learning Module for Health Care Providers

The Pap Test Learning Module is a resource for all healthcare providers in Manitoba seeking to:

  • initiate learning about cervical cancer screening and competency to perform Pap tests,
  • mentor colleagues to become competent in screening for cervical cancer, and/or
  • review current research, details and techniques about cervical cancer screening in Manitoba.

CLICK image to view entire module, or select a specific chapter below.

Legal Disclaimer & Terms of Use
Table of Contents
Chapter 1 Introduction
Pre-Test  
Chapter 2 Disease Burden & Cervical Screening in Manitoba
Chapter 3 Screening
Chapter 4 Counseling & Education
Chapter 5 Facilitating an Inclusive Environment
Chapter 6 Physiology, Anatomy, Abnormal Findings
Chapter 7 Health History
Chapter 8 External & Speculum Exam
Chapter 9 The Papanicolaou Test
Chapter 10 Cervical Cancer Screening Results
Chapter 11 The HPV Vaccines, Liquid Based Cytology & HPV Testing
Chapter 12 Cervical Cancer Screening Access
Chapter 13 Who Can Perform a Pap Test? Links to Colleges & Licensing Bodies
Chapter 14 Medicolegal Issues
Post-Test  
Glossary  
Appendix 1 Education
Appendix 2 Forms
Appendix 3 Assessment Tools
Appendix 4 Case Studies

Videos:

At Your Cervix: What is Normal Anyway? (Dr. R. Lotocki)

Surepath Liquid Based Cytology Collection

ThinPrep Liquid Based Cytology Collection

Pap Test Competency Training

CervixCheck hosts training for healthcare providers (e.g. registered nurses, advanced practice nurses, licensed practical nurses, physicians, physician assistants or clinical assistants) in Manitoba seeking to:

  • initiate or refresh learning and competency about cervical cancer screening, or
  • mentor colleagues to become competent in screening for cervical cancer.

Prior to registering for the training, CervixCheck requires healthcare providers have:

  1. the support of their clinical team, and
  2. have secured a clinical preceptor for post-training consultation. For more information about preceptorship click here (pdf).

Note:

  • We want to train healthcare providers who are or will be practicing cervical cancer screening on a regular basis.
  • Space is limited and healthcare providers are accepted on a first-come, first-serve basis.
  • There is no registration fee for the training.
  • Learners are responsible to cover all parking, food, transportation, and, if applicable, accommodation costs.
  • If you have questions about the training, contact a Health Educator.

Training Date(s):

Wednesday, January 16, 2019
11:30am - 4:30pm
University of Manitoba, Bannatyne Campus
Winnipeg, Manitoba

Click here to register.

If the current session date is not suitable for your schedule and you would like to participate in a future training, we invite you to register on our waitlist. Those on the waitlist will be:

  • contacted if a spot becomes available for the above training, and
  • invited to register for the next training before registration is open to all other clinicians.

Future training dates are yet to be confirmed. If you would like to be placed on a wait list, click here.

Videos

Webinars

St. Elizabeth First Nations, Inuit and Metis Program GetChecked Manitoba Webinar Series(2014)

Supporting Patients

As a healthcare provider, your recommendation impacts your patient's decision to participate in cancer screening. The CancerCare Manitoba Screening Program Screening Guidelines aim to ensure individuals receive thegreatest benefit from cancer screening while minimizing the potential harms. We encourage healthcare providers to facilitate this discussion with patients to:

  • foster the patient's understanding of the test, its benefits and potential hards, and
  • support patient participation in the clinical decision - one that is informed and consistent with the individual's preferences and values.

To support your patient discussions we publish education and health promotion resources. Click here to order resources online. Below is a list of information to assist you in facilitating an informed decision-making process for each screening test.

BreastCheck

  • Most women age 50-74 should have a screening mammogram every 2 years.
  • Routine clinical breast exams and breast self-exams are notrecommended. Encourage women to know how their breasts normally look and feel.
  • The balance of benefits and harms differs by age. Refer to the Canadian Task Force on Preventive Health Care Recommendations and Public Health Agency of Canada Aid for Breast Cancer (English | French) (pdf) to support decision making.
  • Women at higher risk for breast cancer should have individualized assessment as general screening recommendations do not apply. Higher risk is based on factors such as:
    • previous diagnosis of breast cancer,
    • significant family history, and/or
    • mutations in the BRCA1/BRCA2 genes.
  • The sensitivity of mammography is about 80% and the specficity is about 95%.

Potential Benefits

  • Randomized controlled trials (RCT) have demonstrated a 21% reduction in deaths from breast cancer among women who are screened. For women screened through BreastCheck the reduction was 23%.
  • Detecting cancer at an early stage may result in simpler treatment, more treatment options, and less need for chemotherapy.
  • May provide peace of mind knowing cancer was not found on a screening mammogram.

Potential Harms

  • False positives.
  • False negatives.
  • Screening and follow-up may cause anxiety.
  • Overdiagnosis. Screening may result in detection of conditions which may not have become clinically significant in a patient's lifetime and may result in unnecessary interventions and/or treatment.
  • Discomfort or pain from the mammogram.
  • Radiation exposure.
  • Diagnostic mammogram
  • Ultrasound
  • MRI
  • Biopsy
  • Surgical consultation

To read more about further testing, click here.

  • Clients are encouraged to call 1-855-95-CHECK to make a screening mammogram appointment. No referral is required.
  • Clinicians can also refer eligibile clients age 50-74 who are unlikely to make their own appointment. Clinicians can complete this form (pdf) and fax to BreastCheck.
  • There are 4 fixed screening mammography clinics in Winnipeg, Thompson, Brandon and Morden/Winkler. To view when the BreastCheck mobile will be in or nearby your community, click here.

CervixCheck

  • Most females age 21-69 who have ever had sexual contact.
  • Sexual contact can include oral, genital and/or rectal skin-to-skin contact, or sex with sex toys.
  • 90% of HPV infections will spontaneously regress within 2 years.
  • High grade lesions and cervical cancer are very rare in young women <21 years of age.
  • There is a long latent period between exposure to HPV infection and the development of precancerous lesions and invasive cervical cancer.
  • Annual screening offers little benefit over screening performed at 2 to 3 years intervals and exposes women to unnecessary risks and anxieties.
  • The sensitivity of the Pap test is about 51% and the specificity is about 98%.

Potential Benefits

  • Observational data have shown declines of up to 80% in cervical cancer mortality following introduction of organized screening with Pap tests.
  • Cervical dysplasia can be removed with procedures during colposcopy.
  • Detecting cancer at an early stage may result in simpler treatment, more treatment options, and less need for chemotherapy.

Potential Harms

  • False positives.
  • False negatives.
  • Screening and follow-up may cause anxiety.
  • Discomfort or bleeding may result from the Pap test or colposcopy.
  • Treatment with cold knife conisation and large loop excision of the transformation zone (LLETZ) may increase a woman's risk for pre-term delivery, low birth, caesarean section, and premature rupturing of membranes.

To read more about results and follow-up tests, click here.

Patients with high-grade and persistent low grade/unsatisfactory Pap test results are referred to colposcopy. Colposcopy identifies sub-clinical abnormalities of the cervix using a binocular scope with a high density light. Identification of abnormalities are based on epithelial density (white epithelium) and vascular patterns (punctation,etc.).

Using these parameters, an area of abnormality can be identified in order to direct a tissue biopsy by one of the following methods:

  1. laser surgery (uses an intense, narrow beam of light to remove abnormal cells),
  2. LEEP (loop electro surgical excision procedure; an electrical wire loop is inserted into the vagina where abnormal tissue is removed), or
  3. cone biopsy (the removal of a cone-shaped piece of tissue).

If you have a patient in need of a referral to colposcopy, below is a list of colposcopists to whom you can refer.

Colopscopy Services in Manitoba (pdf)

Brandon Clinic
620 Dennis Street, Brandon MB, R7A 5E7
F: 204-571-7216

Dr. O. Akintola
P: 204-728-4440

Dr. B. Helms
P: 204-728-4440

Dr. G. Parr
P: 204-571-7135

Dr. M. Rutherford
P: 204-571-7135

Dr. J. Sutter
P: 204-728-4440

Wheat City Clinic
Unit C1-1711 Kirkcaldy Drive, Brandon MB, R7A 0B9
P: 204-727-1711 ext 400
F: 204-717-0485

Dr. Shunmugam

Dauphin Medical Clinic
622-3rd Street SW, Dauphin MB, R7N1R5
P: 204-638-6445
F: 204-638-5670

Dr. K. Pernarowski

Clandeboye Medical Clinic
210-B Clandeboye Avenue, Selkirk MB, R1A 0X1
P: 204-808-9898
F: 204-808-9899

Dr. S. Ziaei Saba

The Pas Health Complex
Box 240, 111 Cook Avenue, The Pas MB, R9A 1K4
P: 204-623-9609
F: 204-1534

Dr. Z. Al Moumen

Northern Consultation Clinic
871 Thompson Drive South, Thompson MB, R8N 0C8
P: 204-677-5314
F: 204-677-5339

Dr. L. Azzam
Dr. A. Mustafa

C.W. Wiebe Medical Centre
385 Main Street, Winkler MB, R6W1J2
P: 204-325-4312
F: 204-325-4594

Dr. S. Alhayjaa*
Dr. A. Dyson*

*NOTE: Drs. Alhayjaa and Dyson perform colposcopies at Boundary Trails Health Centre, but all referrals, pre-op visits and post-op follow-ups are completed at C.W. Wiebe Medical Centre

Health Sciences Centre
RS425-810 Sherbrook Street, Winnipeg MB, R3A 1R8
P: 204-787-4936
F: 204-787-2314

Dr. A. Altman
Dr. E. Dean
Dr. S. Kean
Dr. R. Lotocki
Dr. S. Popowich
Dr. C. Robinson

Dr. M. Sinha
120 Marion Street, Winnipeg MB, R2H0T1
P: 204-237-6482
F: 204-237-6478

Manitoba Clinic
790 Sherbrook Street, Winnipeg MB, R3A 1M3

Dr. M. Bernier
P: 204-788-5701
F: 204-784-4124

Dr. M.L. Boroditsky
P: 204-788-5707
F: 204-784-4127

Dr. Corbett
P: 204-788-5503
F: 204-784-4130

Dr. H. Diamond
P: 204-788-5745
F: 204-784-4132

Dr. V. Lee
P: 204-788-5716
F: 204-784-4153

Dr. A. Maksymowicz
P: 204-788-5733
F: 204-784-4117

Winnipeg Clinic
425 St. Mary Avenue, Winnipeg MB, R3C 0N2
F: 204-943-1900

Dr. Z. Al Moumen
P: 204-957-3232

Dr. D. Dubyna
P: 204-957-3233

Dr. G. Lefas
P: 204-957-3323

Dr. I. Masoud
P: 204-957-3313

Dr. A. Awadalla
DC Obstetrics & Gynecology
47 Marion Street, Winnipeg MB, R2H 0S8
P: 204-925-3600
F: 204-925-3616

Dr. Debnath
Isabel Clinic, 110 Isabel Street, Winnipeg MB, R3A 1G4
P: 204-415-6397
F: 204-505-2126

Dr. H. Benning
St. Boniface Clinic, 343 Tache Avenue, Winnipeg MB, R2H 2A5
P: 204-925-9546
F: 204-233-4271

 

  • Clients are encouraged to make an appointment with their regular healthcare provider.
  • Clients can also visit our website or call 1-855-95-CHECK to find a Pap test clinic.
  • If you would like to host a Pap test clinic, register with CervixCheck using the form below.

CervixCheck partners with health care providers to offer increased access to Pap test services across Manitoba. Clinics may offer service by appointment, walk-in or both and are encouraged to do so as frequently as their resources allow.

By registering your Pap clinic with CervixCheck your Pap test services will be listed on the ‘How do I get checked?' page on our website. Your participation helps increase Pap test access for Manitoban women.

Note:

  • Notify CervixCheck if any of your Pap test clinic or contact details change.
  • The site contact will be contacted 1x per year to confirm all Pap test clinic information.
  • An email confirmation will be sent once your registration is received and posted on the website.

Pap Test Access:

Site Contact (this information will not be posted on the website):

All fields marked with an asterisk (*) are mandatory.
 

ColonCheck

  • Most people age 50-74 should do a home screening test (FOBT) every 2 years unless they have:
    • done an FOBT in the past two years, or
    • had a colonoscopy in the past 5 years.
  • Evidence shows that screening regularly with the FOBT will lead to a reduction in mortality from colorectal cancer (CRC).
  • A colonoscopy is recommended for any individual with a positive FOBT. As bleeding from cancers or adenomas may be intermittent, any positive result must be investigated. Further FOB testing for an indivdiual with a positive result is unwarranted and does not rule out serious pathology, even it it is negative.
  • For the Hemoccult II Sensa, the sensitivity ranges from 64% - 85% and the specificity ranges from 87% - 95%.
  • Double contrast barium enema or CT colonography may be an alternative in individuals with a positive FOBT if colonoscopy is refused, or are medically unsuitable for a colonoscopy or have had an unsuccessful colonoscopy.

Potential Benefits

  • RCTs have shown regular screening with the FOBT can reduce deaths from colorectal cancer (CRC) by up to 25%.
  • Polyps and other abnormal tissue can be removed during a colonoscopy.
  • Detecting cancer at an early stage may result in simpler treatment, more treatment options, and less need for chemotherapy.

Potential Harms

  • False positives.
  • False negatives.
  • Screening and follow-up may cause anxiety.
  • Colonoscopy, recommended for individuals with a positive FOBT result, can cause bleeding and perfortation of the colon.

For more information about follow-up testing, click here.

Clients can request a home screening test through ColonCheck by:

Screening Programs

Contact us with any questions.

#5-25 Sherbrook Street
Winnipeg MB, R3C 2B1
Toll Free: 1-855-95-CHECK
GetChecked@cancercare.mb.ca

For program specific contact information, you can contact the individual screening programs at:

BreastCheck
BreastCheck@cancercare.mb.ca

CervixCheck
CervixCheck@cancercare.mb.ca

ColonCheck
ColonCheck@cancercare.mb.ca

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