BC Guidelines

The Cervical Cancer Prevention and Screening guideline provides recommendations for cervical cancer screening in asymptomatic patients without a history of cervical cancer who are or have been sexually active. Screening information applies to individuals who have or have had a cervix. This includes women and Two-Spirit, Transgender, and Gender-diverse (TTGD) people. The guideline also provides recommendations for prevention of cervical cancer, including immunization for all individuals.
 
Key Recommendations

• Ensure all eligible individuals are immunized against HPV. Refer to Immunize BC for specific program information, including grade 6 school immunizations.
• Ensure all asymptomatic patients aged 25-69 without a history of cervical cancer are screened every 3-5 years, depending on clinical history and screening method. Note that screening is indicated for those > 69 years of age if they are immunocompromised or were recently discharged from colposcopy and have not had a cervical liquid based cytology (LBC) sample with a negative cotest result in the previous 12 months.
• Choose a screening and sample collection method based on patient scenario and preferences. Note that screening with a self-collected vaginal sample is as effective as screening undertaken with a provider-collected sample from the cervix.1–5
  • Vaginal Swab for HPV Testing – Collected by patient (self-screening) or provider
  • LBC Sample for HPV and/or Cytology – Collected by provider
• Do not perform cervical cancer screening as a part of routine pre-natal screening. This is only indicated if the patient is due or overdue. If screening is to be done during pregnancy, self-screening is not recommended and instead the provider should collect a cervical LBC sample or vaginal HPV swab.
• Investigate/manage all symptomatic patients following best practices for symptom evaluation, including a speculum examination.
  • If any suspicious abnormality is identified during speculum examination, collect a cervical LBC sample for a cotest (HPV and cytology). Initiate an urgent referral for colposcopic evaluation, without waiting for test results.
  • A vaginal sample for HPV testing alone is not appropriate for symptomatic patients.
• Screen all patients according to program guidelines, paying particular attention to patients with risk factors or those facing barriers to participation to encourage optimal alignment with screening protocols.
• Provide patient education regarding cancer screening, including implications of test results.
• Incorporate a trauma informed and culturally safe approach for all patients.
• Ensure appropriate longitudinal care interactions for patients who were previously accustomed to having a Papanicolaou (Pap) appointment every three years.

Minor revisions to the Chronic Obstructive Pulmonary Disease (COPD) guideline to reflect new PharmaCare regular benefit coverage for Tiotropium.

The Tobacco Use Disorder (TUD) guideline provides evidence-based recommendations for primary care practitioners on managing tobacco use disorder (TUD). This guideline also addresses vaping. While the guideline focuses on TUD in adults (ages ≥ 19), there are some recommendations addressing the youth population (ages 12-18).

• Tobacco use disorder (TUD) (defined in the DSM-5-TR), like other substance use disorders, is a chronic and often relapsing condition. Document smoking history by number of years spent smoking (now considered a better risk indicator than “pack years”). Ask regularly about smoking status and document tobacco use in the patient medical record, including number of cessation attempts.
• Acknowledge that relapse is common and can be expected. If a patient has resumed tobacco use, offer education and review and adjust their smoking cessation plan.
• Continue to provide brief interventions (BI), which are effective when routinely repeated. Consider a motivational interviewing (MI) approach with all patients, including those not yet ready to stop smoking.
• The most effective way to stop smoking is a combination of both pharmacotherapy and counselling. Treatment plans should be individually and collaboratively tailored.
  • Medications: Encourage first-line pharmacotherapy, including nicotine replacement therapy (NRT), varenicline, and bupropion.
  • Counselling: Smoking cessation programs provide support to those who plan to quit smoking. Encourage patients to connect with QuitNow or to the FNHA’s Talk Tobacco Program.
• Ask regularly about and document vaping use (including youth). Advise and support efforts to quit vaping.