SMART DAK Cervical Cancer Screening
0.0.1 - ci-build

SMART DAK Cervical Cancer Screening, published by Dan Heslinga (independent contributor). This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/dhes/smart-dak-cxca/ and changes regularly. See the Directory of published versions

CodeSystem: CXCA Data Dictionary

Official URL: http://smart.who.int/cxca/CodeSystem/CXCA.D Version: 0.0.1
Draft as of 2026-05-14 Computable Name: CXCA_D

Data elements for the cervical cancer screening Digital Adaptation Kit (DAK). Contains clinical concepts referenced from the screening pathway, recall logic, and pre-cancer management decision tables.

This Code system is referenced in the content logical definition of the following value sets:

  • This CodeSystem is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

This case-sensitive code system http://smart.who.int/cxca/CodeSystem/CXCA.D defines the following codes:

CodeDisplayDefinition
DE1 Target age 35 for HPV screening First binding age at which a woman becomes a target for primary HPV high-risk DNA screening per Mongolia MOH Order A/641 (2020) section 2.2 (HPV-test-capable facilities).
DE2 Target age 45 for HPV screening Second binding age at which a woman becomes a target for primary HPV high-risk DNA screening per Mongolia MOH Order A/641 (2020) section 2.2 (HPV-test-capable facilities).
DE3 HPV high-risk DNA test A laboratory test that detects high-risk human papillomavirus DNA from a cervical sample. The careHPV test (used in the April 2026 Khan-Uul pilot) is one such platform. Detects 14 high-risk HPV genotypes in pooled form.
DE4 Due for HPV screening Eligibility outcome: the client meets the criteria to be offered HPV high-risk DNA screening at this encounter.
DE5 Not due — already screened in current cycle Eligibility outcome: the client is in the target age range, but has had a recent valid HPV screening result and is not due for re-screening at this encounter.
DE6 Excluded — outside target age range Eligibility outcome: the client is not in the binding target age range (per A/641 section 2.2). For HPV-test-capable facilities, the binding ages are 35 and 45 only.
DE7 Excluded — prior hysterectomy Eligibility outcome: the client has had a hysterectomy for non-cervical-cancer indication with a documented negative post-operative vaginal-smear cytology, and is therefore exempt from cervical cancer screening per A/641 section 2.2.
DE8 HPV high-risk positive Result: at least one high-risk human papillomavirus genotype detected in the cervical sample.
DE9 HPV high-risk negative Result: no high-risk human papillomavirus genotypes detected in the cervical sample.
DE10 Lost to follow-up Service was expected (e.g., follow-up cytology after a positive HPV result) but did not occur because the patient could not be contacted or did not return for care. Generic LTFU reason; specific causes (phone disconnected, distance, declined) may be added as sub-codes in future iterations.
DE13 Cervical cytology test A laboratory test in which cervical cells are collected, stained (Papanicolaou or liquid-based), and examined microscopically. Used as a primary screening test in cytology-only facilities (per A/641 section 2.2 cytology pathway) and as a follow-up to a positive HPV result (per A/641 Fig 2.4).
DE17 HIV-positive Client has a documented positive HIV test or active HIV diagnosis. Per WHO Mongolia, women living with HIV are approximately 6× more likely to develop cervical cancer; HIV+ status is a significant risk modifier for screening intensity and follow-up urgency.
DE18 HIV-negative Client has a documented negative HIV test.
DE19 HIV status unknown Client's HIV status has not been documented. May warrant offering HIV testing alongside cervical cancer screening.
DE20 Current smoker Client currently smokes tobacco (any amount, any form).
DE21 Former smoker Client has smoked tobacco in the past but has quit.
DE22 Never smoker Client has never smoked tobacco.
DE23 Past screening: HPV high-risk DNA test Client's most recent prior cervical cancer screening was an HPV high-risk DNA test.
DE24 Past screening: cytology only Client's most recent prior cervical cancer screening was cytology (Pap smear) only.
DE25 Past screening: VIA (visual inspection with acetic acid) Client's most recent prior cervical cancer screening was VIA. Note: VIA is used in some low-resource settings; it is not part of the A/641 (2020) Mongolia binding pathway but may appear in client history from prior years or other countries.
DE26 Past screening: normal / negative Client's most recent prior screening result was normal / negative for cervical pre-cancer or cancer.
DE27 Past screening: abnormal / positive Client's most recent prior screening result was abnormal / positive (any abnormality — finer classification not captured at this level).
DE28 Past screening: result unknown Client recalls having been screened but cannot recall the result, or the result is not in available records.
DE29 Cytology: NILM (negative for intraepithelial lesion or malignancy) Bethesda 2014 NILM. Cytology shows no evidence of pre-cancerous or cancerous change. In the HPV+ pathway this returns the patient to a 1-year repeat HPV cycle per A/641 Fig 2.4.
DE30 Cytology: ASC-US (atypical squamous cells of undetermined significance) Bethesda 2014 ASC-US. Atypical squamous cells of undetermined significance. Triggers colposcopy referral in the HPV+ pathway per A/641 Fig 2.4.
DE31 Cytology: ASC-H (atypical squamous cells, cannot exclude HSIL) Bethesda 2014 ASC-H. Atypical squamous cells where high-grade squamous intraepithelial lesion (HSIL) cannot be excluded. Triggers colposcopy referral.
DE32 Cytology: LSIL (low-grade squamous intraepithelial lesion) Bethesda 2014 LSIL. Low-grade squamous intraepithelial lesion (corresponds to histologic CIN1). Triggers colposcopy referral in the HPV+ pathway.
DE33 Cytology: HSIL (high-grade squamous intraepithelial lesion) Bethesda 2014 HSIL. High-grade squamous intraepithelial lesion (corresponds to histologic CIN2 or CIN3). Triggers colposcopy referral with priority.
DE34 Route: return to routine screening Routing decision output: no abnormality detected; return the patient to the routine screening cycle per the binding pathway (HPV at 35/45 or cytology at the 11-age cycle).
DE35 Route: repeat HPV test in 12 months Routing decision output: HPV+ with negative cytology re-read; repeat the HPV test in 12 months per A/641 Fig 2.4.
DE36 Route: refer to colposcopy Routing decision output: HPV+ with cytology ≥ ASC-US, OR HPV+ at 12-month recheck; refer to colposcopy per Op.Inst. 5.6.
DE37 Colposcopy A diagnostic procedure in which the cervix is examined under magnification (typically with acetic acid application) to identify lesions for biopsy. Per A/641 Op.Inst. 5.6.
DE38 Recall: HPV sample result timeout (3 weeks) Recall trigger: an HPV sample was dispatched to the lab more than 3 weeks ago and no result has been entered into the registry. Per A/641 section 2.3, this triggers a reminder to follow up with the lab and (if the result is in but not yet entered) the entering staff.
DE39 Recall: positive result follow-up timeout (4 weeks) Recall trigger: a positive screening result was entered into the registry more than 4 weeks ago and no follow-up examination has been recorded. Per A/641 section 2.3, this triggers a reminder to the patient and the obstetrician-gynaecologist.
DE40 Recall: biopsy result timeout (4 weeks) Recall trigger: a biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Per A/641 section 2.3.
DE41 Recall: treatment timeout after positive biopsy (4 weeks) Recall trigger: a positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Per A/641 section 2.3.
DE42 Recall: cytology slide unread timeout (2 weeks) Recall trigger: a cytology slide was received at the lab more than 2 weeks ago and no cytologist conclusion has been entered. Per A/641 section 2.3.
DE43 Recall: second reminder (4 weeks after first) Recall trigger: a first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Per A/641 section 2.3 a second reminder should issue.
DE44 Recall: missed scheduled examination Recall trigger: the patient had a scheduled examination that they did not attend. Per A/641 section 2.3, immediate flag — does not wait for a timeout.
DE45 Hysterectomy Surgical removal of the uterus. The cervical-cancer-screening exclusion in A/641 section 2.2 applies only when the hysterectomy was for a non-cervical-cancer indication and the post-operative vaginal-smear cytology was negative.