The Cervical Screening Guidelines Development Committee met to discuss the draft guideline. The group went through the sections of guideline individually and discussed how the evidence supported the recommendations. There was general consensus regarding the recommendation to indicate that liquid-based cytology (LBC) was the preferred screening tool over conventional cytology.
In terms of the initiation of cervical screening, the group extensively discussed the optimal wording of the recommendation. The group chose not to include a specific age to initiate screening because there are women who are not sexually active by 18 or 21 (recommended ages in other guidelines), and did not want to recommend that these women be screened.
For the cessation of screening, the group spent some time discussing the potential high-risk sexual behaviours of older women. Ultimately the group decided not to make recommendations based upon high risk behaviours in older women because the group felt it would complicate the recommendations, also there was no evidence identified to support different screening regimens for high risk older women.
There was some discussion regarding the optimal screening interval especially regarding necessary recall mechanisms for a three-year screening interval. The need for recall mechanisms either within the primary care practice or as part of the provincial registry was emphasized before a three-year interval should be considered.
Unfortunately, there is little evidence regarding cervical screening for women in special circumstances. For this reason, the group decided that it was important to clearly state throughout the guideline where there was evidence and where expert opinion was utilized.
For the recommendations regarding abnormal cytology, the group discussed simply endorsing the American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines because of similarities to the Ontario setting. However, after some debate the group agreed that there are important differences in recommendations in the guideline compared to the ASCCP guidelines. It was important to the group to make the guidelines specific to the population of women in Ontario.