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About the Data in Your SAR
 

Data Sources

Where does the Screening Activity Report (SAR) get its data?

The report draws upon several data sources. Cancer Care Ontario receives feeds from the following Ministry of Health and Long-Term Care databases:

  • Claims History Database (CHDB)
  • Registered Persons Database (RPDB)
  • Corporate Provider Database (CPDB) and
  • Client Agency Program Enrolment (CAPE)

Cancer Care Ontario has also implemented custom-built tools through which participating laboratories and hospitals upload FOBT results and data on colonoscopy procedures in funded hospitals,respectively.


Are the preventative care exclusion Q codes captured in the SAR?

No, the SAR currently does not exclude patients from cancer screening based on the use of exclusion Q codes.

However, patients in your target population who have had a previous program-specific cancer or surgery, according to the data that we have, will be excluded from screening on your report. For a list of OHIP codes that are used to exclude patients, please see Understand the Data on your Breast/Cervical or Colorectal Report questions below.

CCO recognizes the limitation of not incorporating the use of Q codes and is therefore being considered for future enhancements to ensure the SAR continues to provide meaningful data to primary care providers.


Understanding the Data on your Dashboard:

What does the date mean on the Screening Activity Report (SAR)?

Cancer Care Ontario must select a report cut-off date to produce the report, submit it for quality assurance and release it for distribution. This date is displayed at the top of all reports. Any data received after the cut-off date is not included in the SAR.

For certain screening tests and follow-up procedures, there is a reporting lag between the time of the test or procedure and when Cancer Care Ontario receives this information.


How is my screening rate calculated?

Your screening rate is calculated in alignment with Cancer Care Ontario's clinical guidelines and recommendations. For breast screening, a woman is considered up-to-date if she is 50 to 74 years old and has had a mammogram within 24 months before the report's cut-off date. A woman is considered up-to-date with cervical screening if she is 21 to 69 years old and has completed a Pap test within 36 months of the report. Lastly, a person is considered up-to-date with colorectal testing if he or she is 50 to 74 years old and has had a fecal occult blood test (FOBT) within 24 months, a flexible sigmoidoscopy within 10 years or a colonoscopy within 10 years of the report cut-off date.

The Local Health Integration Network's (LHIN) screening rates differ slightly from those reported in the Cancer System Quality Index (CSQI)—a set of publically reported indicators from the Cancer Quality Council of Ontario (CQCO)—as the CSQI reports on all physicians, while the Screening Activity Report (SAR) comparison data only reports on providers who practice in a patient enrolment model (PEM).​


How does Cancer Care Ontario determine which screening status to assign each eligible and enrolled patient?

For each screening program, an algorithm was developed to determine which screening status an enrolled and eligible patient would be assigned based on the date and result of their most recent screening test at the time of the report's cut-off date. This screening status is intended to assist you in your population health management by providing a quick view of a patient’s screening needs. The screening status, however, is limited by the data that Cancer Care Ontario receives.


What do the categories and colours mean on my dashboard?

For each rostered and eligible patient, a screening status has been assigned to represent his or her cancer screening needs based on Cancer Care Ontario's clinical guidelines. A person will be assigned to one category for each screening program that he or she is eligible for. These screening statuses can assist you in your population health management by allowing you to sort which patients are overdue for screening, who requires follow-up or re-screening, and who is up-to-date with screening.

Red: Action required

Abnormal screen, follow-up needed: Patients who may require follow-up of an abnormal screen.

Invalid result, re-test required: Patients who need to be re-tested due to an invalid result on a screening test (not applicable to breast screening).

Overdue for screening: Patients who are overdue for screening.

Yellow: Due for screening < 6 months

Patients who are due for screening in the next six months. This category only applies to those whose last screening test result was normal.

Yellow: Physician review required

Colonoscopy in the last 10 years or flexible sigmoidoscopy in the last 10 years: Patients who had a colonoscopy in the last 10 years or a flexible sigmoidoscopy in the last 10 years, but are not due for colorectal cancer screening within the next six months.

Review patient history: Patients whose screening result is unknown. This may include screening tests performed outside of the Ontario Breast Screening Program (OBSP), the Ontario Cervical Screening Program (OCSP) or ColonCancerCheck (CCC). Due to these data limitations, patients with unknown results require review by a provider to determine next steps.

Abnormal screen, follow-up underway or completed: Patients who had at least one follow-up procedure after an abnormal screening test. A review by the physician may be required to determine if the patient has completed all the necessary follow-up. Cancer Care Ontario does not collect the results of follow-up activities, with the exception of some breast assessment procedures.

No screening action required: Normal screen

Enrolled and eligible individuals who are up-to-date with recommended screening and are not due for screening within the next six months.

We recognize there are limitations to this report and that clinical judgment and patient choice may result in different decisions from those recommended by the clinical guidelines. Please consider this report a supplement to the other clinical tools that are part of your regular practice.

Understanding the Data on your Enrolled Patient Screening Status Summary

What do the letters "Y", "N" and "X" represent?

These letters describe someone's eligibility for screening in each screening program based on Cancer Care Ontario's clinical guidelines. Each letter represents the following:

  • Y: Yes, a person is eligible for screening based on his or her age, sex and lack of exclusionary criteria
  • N: No, a person is ineligible for screening based on his or her age and/or sex
  • X: A person has been excluded due to a previous program-specific cancer or cancer resection surgery, or is enrolled in the Ontario Breast Screening Program's High Risk Screening Program

Why do some of my patients have a dark grey screening status with "N/D"?

There are a number of reasons a patient may be assigned a dark grey screening status with "N/D" or "no data." Some patients are excluded from screening due to a previous program-specific cancer or surgery. Furthermore, at times Cancer Care Ontario is limited in the data it can provide due to privacy reasons. Please consider the Screening Activity Report as a supplement to your patient charts and other clinical tools that are part of your practice.


Understanding the Data on your Breast: Enrolled Patients (50 to 74) Report

Who is excluded from breast screening on my report?

Women who are within the target age range of 50 to 74 years with a history of breast cancer or who have had a mastectomy are excluded from being assigned a screening status on this report. Women who are enrolled in the Ontario Breast Screening Program's High Risk Screening Program are also excluded from this report.
The following Ontario Health Insurance Plan (OHIP) mastectomy codes were used as exclusion criteria:

  • E546A: mastectomy with axillary node dissection up to level of axillary vein
  • R108A: mastectomy (female) with or without biopsy; simple
  • R109A: mastectomy with or without biopsy; radical or modified radical
  • E506A: mastectomy with axillary sentinel node biopsy
  • R117A: mastectomy (female) with or without biopsy; subcutaneous with nipple preserved
  • E505A: mastectomy with limited axillary node sampling

Why is the breast report missing data related to mammogram results and screening recalls?

If an eligible patient was screened outside of the Ontario Breast Screening Program (OBSP), Cancer Care Ontario does not receive information related to the result of that screen test. The report will provide the date of a mammogram performed outside of the OBSP; however, you will have to refer to your patient charts for result information.,

For women screened outside of the OBSP, the recommended screening recall interval is also unknown because Cancer Care Ontario does not receive this information.


What is the difference between "return annually" and "return 1 Y" under the screening recall column?

Women who have been asked to return in one year as a one-time event will have a screening recall displayed as "return 1 Y"; these individuals will have their recall interval reassessed at their next screening appointment. For those who have been asked to return annually on a permanent basis, "return annually" will be displayed within the screening recall column.

A recommendation to be recalled for screening in one year or annually is based on many factors, including:

  • Risk factors, such as breast density or family history
  • A radiologist's request to follow-up with a patient in a year's time

Why is the final result of a follow-up procedure displayed as "in progress"?

A final result for the follow-up of an abnormal mammogram may appear as "in progress" due to a data lag.


Understanding the Data on your Cervical: Enrolled Patients (21 to 69) Report

Who is excluded from cervical screening on my report?

Women who are within the target age range of 21 to 69 years old who have a history of cervical cancer or who have had a hysterectomy are excluded from being assigned a screening status in this report.

The following Ontario Health Insurance Plan (OHIP) hysterectomy codes were used as exclusion criteria:

  • E862A: hysterectomy performed laparoscopically or with laparoscopic assistance
  • P042A: caesarean section including hysterectomy
  • S710A: hysterectomy with or without adnexa; with omentectomy for malignancy
  • S727A: ovarian debulking for stage 2C, 3B, or 4 ovarian cancer and may include hysterectomy
  • S757A: hysterectromy with or without adnexa; abdominal (total or subtotal)
  • S758A: hysterectomy with or without adnexa, with anterior and posterior vaginal repair
  • S759A: hysterectomy with or without adnexa, with anterior or posterior vaginal repair
  • S762A: hysterectomy with or without adnexa; radial trachelectomy, excluding node dissection
  • S763A: hysterectomy with or without adnexa; radical, includes node dissection
  • S765A: amputation of cervix
  • S816A: hysterectomy with or without adnexa; vaginal
  • S766A: cervical stump; abdominal
  • S767A: cervical stump; vaginal

A patient's most recent Pap came back normal—why is she categorized as "review patient history"?

According to Cancer Care Ontario's clinical guidelines, the recommended follow-up for a Pap showing atypical squamous cells of undetermined significance (ASCUS) is to repeat cytology in six months. Following two consecutive normal follow-up Paps, it is considered safe for women to return to routine screening in three years. If a patient had an abnormal pap within the nine months prior to the report cut-off date, it is recommended to review these patients' history to determine the next steps with regards to the follow-up of their pap test result.

For more details on the recommended follow-up of abnormal cytology, please visit https://cancercare.on.ca/pcs/screening/cervscreening/abnormal_followup.


Understanding the Data on your Colorectal: Enrolled Patients (50-74) Report

Who is excluded from colorectal screening on my report?

Women and men between the target age range of 50 to 74 years old who have a history of colorectal cancer or who have had a colectomy are excluded from being assigned a screening status in this report.
The following Ontario Health Insurance Plan (OHIP) colectomy codes were used as exclusion criteria:

  • S170A: ileostomy plus total colectomy plus abdominal-perineal resection
  • S169A: total colectomy with ileo-rectal anastomosis
  • S172A: total colectomy with mucosal proctectomy with ilieal pouch, ileoanal anastomoses

Why is CT colonography not reflected in the Screening Activity Report (SAR)?

We are working to examine the evidence ffor CT colonography and other colorectal cancer screening modalities to develop a clinical practice guideline for colorectal cancer screening for people at average risk of colorectal cancer. When the guideline is released, CCO will review its position on CT colonography and other screening tests. Any changes to the recommended screening tests will be reflected in the SAR.


Why are there patients listed as requiring follow-up to an abnormal fecal occult blood test (FOBT) if their most recent test came back negative?

Patients with a positive FOBT require prompt referral to colonoscopy. There is no indication to repeat the FOBT as an alternative to colonoscopy. Patients who have had a positive FOBT result that was not followed up with a colonoscopy, even if they have a subsequent negative FOBT result, will be categorized as "red - abnormal screen, follow-up needed", until they do undergo the follow up colonoscopy. Please consider this report a supplement to other clinical tools that are part of your regular practice.


Will this report include patients who were screened using flexible sigmoidoscopy from a registered nurse?

No, test information for patients who were screened by a registered nurse (RN) with flexible sigmoidoscopy will not appear on your report. There are currently nine sites in Ontario offering RN-performed flexible sigmoidoscopy, and Cancer Care Ontario is working on including this data in future reports. Please refer to your records for screening-related information on patients who have received/are receiving screening from an RN.


Other Report Limitations

Why are there deceased patients appearing on my report?

Cancer Care Ontario receives data regularly regarding deceased patients. However, these data sources might not always be up-to-date or might submit their data after the report's cut-off date.


Why are there patients appearing on this report whom I have already followed up?

These records reflect the data available as of the report cut-off date and according to Cancer Care Ontario's clinical guidelines; therefore, there may be information that the Screening Activity Report is missing. Cancer Care Ontario does not receive screening data from public health units or result information processed in some hospital labs.

We acknowledge there may be limitations to the report and physicians may have additional information that Cancer Care Ontario is unaware of or cannot collect. Please consider this report a supplement to other clinical tools that are part of your regular practice.


Can Cancer Care Ontario remove a patient from my report?

At this time, we are unable to remove patients form your report. We acknowledge that this report has limitations and that it may not capture follow-up actions you have taken with every patient. Consider this report a supplement to other clinical tools being used in your practice. The ability to update and revise your report is being considered for future versions of the Screening Activity Report (SAR) to better support your cancer screening practices.

Because the SAR is available in an Excel format, your report can be modified for your own purposes once you have downloaded it to your system. You are free to add or remove rows, or edit the content of cells to make your report more consistent with your own patient records. These sorts of changes, which contain personal health information or personal information (PHI/PI), are for your practice's use only, and should not be sent to Cancer Care Ontario.


Last modified: Tue, Oct 03, 2017
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