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
| Draft as of 2026-05-14 |
{
"resourceType" : "CodeSystem",
"id" : "CXCA.D",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem CXCA.D</b></p><a name=\"CXCA.D\"> </a><a name=\"hcCXCA.D\"> </a><p>This case-sensitive code system <code>http://smart.who.int/cxca/CodeSystem/CXCA.D</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">DE1<a name=\"CXCA.D-DE1\"> </a></td><td>Target age 35 for HPV screening</td><td>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).</td></tr><tr><td style=\"white-space:nowrap\">DE2<a name=\"CXCA.D-DE2\"> </a></td><td>Target age 45 for HPV screening</td><td>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).</td></tr><tr><td style=\"white-space:nowrap\">DE3<a name=\"CXCA.D-DE3\"> </a></td><td>HPV high-risk DNA test</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE4<a name=\"CXCA.D-DE4\"> </a></td><td>Due for HPV screening</td><td>Eligibility outcome: the client meets the criteria to be offered HPV high-risk DNA screening at this encounter.</td></tr><tr><td style=\"white-space:nowrap\">DE5<a name=\"CXCA.D-DE5\"> </a></td><td>Not due — already screened in current cycle</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE6<a name=\"CXCA.D-DE6\"> </a></td><td>Excluded — outside target age range</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE7<a name=\"CXCA.D-DE7\"> </a></td><td>Excluded — prior hysterectomy</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE8<a name=\"CXCA.D-DE8\"> </a></td><td>HPV high-risk positive</td><td>Result: at least one high-risk human papillomavirus genotype detected in the cervical sample.</td></tr><tr><td style=\"white-space:nowrap\">DE9<a name=\"CXCA.D-DE9\"> </a></td><td>HPV high-risk negative</td><td>Result: no high-risk human papillomavirus genotypes detected in the cervical sample.</td></tr><tr><td style=\"white-space:nowrap\">DE10<a name=\"CXCA.D-DE10\"> </a></td><td>Lost to follow-up</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE13<a name=\"CXCA.D-DE13\"> </a></td><td>Cervical cytology test</td><td>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).</td></tr><tr><td style=\"white-space:nowrap\">DE17<a name=\"CXCA.D-DE17\"> </a></td><td>HIV-positive</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE18<a name=\"CXCA.D-DE18\"> </a></td><td>HIV-negative</td><td>Client has a documented negative HIV test.</td></tr><tr><td style=\"white-space:nowrap\">DE19<a name=\"CXCA.D-DE19\"> </a></td><td>HIV status unknown</td><td>Client's HIV status has not been documented. May warrant offering HIV testing alongside cervical cancer screening.</td></tr><tr><td style=\"white-space:nowrap\">DE20<a name=\"CXCA.D-DE20\"> </a></td><td>Current smoker</td><td>Client currently smokes tobacco (any amount, any form).</td></tr><tr><td style=\"white-space:nowrap\">DE21<a name=\"CXCA.D-DE21\"> </a></td><td>Former smoker</td><td>Client has smoked tobacco in the past but has quit.</td></tr><tr><td style=\"white-space:nowrap\">DE22<a name=\"CXCA.D-DE22\"> </a></td><td>Never smoker</td><td>Client has never smoked tobacco.</td></tr><tr><td style=\"white-space:nowrap\">DE23<a name=\"CXCA.D-DE23\"> </a></td><td>Past screening: HPV high-risk DNA test</td><td>Client's most recent prior cervical cancer screening was an HPV high-risk DNA test.</td></tr><tr><td style=\"white-space:nowrap\">DE24<a name=\"CXCA.D-DE24\"> </a></td><td>Past screening: cytology only</td><td>Client's most recent prior cervical cancer screening was cytology (Pap smear) only.</td></tr><tr><td style=\"white-space:nowrap\">DE25<a name=\"CXCA.D-DE25\"> </a></td><td>Past screening: VIA (visual inspection with acetic acid)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE26<a name=\"CXCA.D-DE26\"> </a></td><td>Past screening: normal / negative</td><td>Client's most recent prior screening result was normal / negative for cervical pre-cancer or cancer.</td></tr><tr><td style=\"white-space:nowrap\">DE27<a name=\"CXCA.D-DE27\"> </a></td><td>Past screening: abnormal / positive</td><td>Client's most recent prior screening result was abnormal / positive (any abnormality — finer classification not captured at this level).</td></tr><tr><td style=\"white-space:nowrap\">DE28<a name=\"CXCA.D-DE28\"> </a></td><td>Past screening: result unknown</td><td>Client recalls having been screened but cannot recall the result, or the result is not in available records.</td></tr><tr><td style=\"white-space:nowrap\">DE29<a name=\"CXCA.D-DE29\"> </a></td><td>Cytology: NILM (negative for intraepithelial lesion or malignancy)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE30<a name=\"CXCA.D-DE30\"> </a></td><td>Cytology: ASC-US (atypical squamous cells of undetermined significance)</td><td>Bethesda 2014 ASC-US. Atypical squamous cells of undetermined significance. Triggers colposcopy referral in the HPV+ pathway per A/641 Fig 2.4.</td></tr><tr><td style=\"white-space:nowrap\">DE31<a name=\"CXCA.D-DE31\"> </a></td><td>Cytology: ASC-H (atypical squamous cells, cannot exclude HSIL)</td><td>Bethesda 2014 ASC-H. Atypical squamous cells where high-grade squamous intraepithelial lesion (HSIL) cannot be excluded. Triggers colposcopy referral.</td></tr><tr><td style=\"white-space:nowrap\">DE32<a name=\"CXCA.D-DE32\"> </a></td><td>Cytology: LSIL (low-grade squamous intraepithelial lesion)</td><td>Bethesda 2014 LSIL. Low-grade squamous intraepithelial lesion (corresponds to histologic CIN1). Triggers colposcopy referral in the HPV+ pathway.</td></tr><tr><td style=\"white-space:nowrap\">DE33<a name=\"CXCA.D-DE33\"> </a></td><td>Cytology: HSIL (high-grade squamous intraepithelial lesion)</td><td>Bethesda 2014 HSIL. High-grade squamous intraepithelial lesion (corresponds to histologic CIN2 or CIN3). Triggers colposcopy referral with priority.</td></tr><tr><td style=\"white-space:nowrap\">DE34<a name=\"CXCA.D-DE34\"> </a></td><td>Route: return to routine screening</td><td>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).</td></tr><tr><td style=\"white-space:nowrap\">DE35<a name=\"CXCA.D-DE35\"> </a></td><td>Route: repeat HPV test in 12 months</td><td>Routing decision output: HPV+ with negative cytology re-read; repeat the HPV test in 12 months per A/641 Fig 2.4.</td></tr><tr><td style=\"white-space:nowrap\">DE36<a name=\"CXCA.D-DE36\"> </a></td><td>Route: refer to colposcopy</td><td>Routing decision output: HPV+ with cytology ≥ ASC-US, OR HPV+ at 12-month recheck; refer to colposcopy per Op.Inst. 5.6.</td></tr><tr><td style=\"white-space:nowrap\">DE37<a name=\"CXCA.D-DE37\"> </a></td><td>Colposcopy</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE38<a name=\"CXCA.D-DE38\"> </a></td><td>Recall: HPV sample result timeout (3 weeks)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE39<a name=\"CXCA.D-DE39\"> </a></td><td>Recall: positive result follow-up timeout (4 weeks)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE40<a name=\"CXCA.D-DE40\"> </a></td><td>Recall: biopsy result timeout (4 weeks)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE41<a name=\"CXCA.D-DE41\"> </a></td><td>Recall: treatment timeout after positive biopsy (4 weeks)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE42<a name=\"CXCA.D-DE42\"> </a></td><td>Recall: cytology slide unread timeout (2 weeks)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE43<a name=\"CXCA.D-DE43\"> </a></td><td>Recall: second reminder (4 weeks after first)</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE44<a name=\"CXCA.D-DE44\"> </a></td><td>Recall: missed scheduled examination</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">DE45<a name=\"CXCA.D-DE45\"> </a></td><td>Hysterectomy</td><td>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.</td></tr></table></div>"
},
"url" : "http://smart.who.int/cxca/CodeSystem/CXCA.D",
"version" : "0.0.1",
"name" : "CXCA_D",
"title" : "CXCA Data Dictionary",
"status" : "draft",
"experimental" : false,
"date" : "2026-05-14T00:50:23+00:00",
"publisher" : "Dan Heslinga (independent contributor)",
"contact" : [
{
"name" : "Dan Heslinga (independent contributor)",
"telecom" : [
{
"system" : "url",
"value" : "https://github.com/dhes"
}
]
}
],
"description" : "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.",
"caseSensitive" : true,
"content" : "complete",
"count" : 40,
"concept" : [
{
"code" : "DE1",
"display" : "Target age 35 for HPV screening",
"definition" : "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)."
},
{
"code" : "DE2",
"display" : "Target age 45 for HPV screening",
"definition" : "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)."
},
{
"code" : "DE3",
"display" : "HPV high-risk DNA test",
"definition" : "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."
},
{
"code" : "DE4",
"display" : "Due for HPV screening",
"definition" : "Eligibility outcome: the client meets the criteria to be offered HPV high-risk DNA screening at this encounter."
},
{
"code" : "DE5",
"display" : "Not due — already screened in current cycle",
"definition" : "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."
},
{
"code" : "DE6",
"display" : "Excluded — outside target age range",
"definition" : "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."
},
{
"code" : "DE7",
"display" : "Excluded — prior hysterectomy",
"definition" : "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."
},
{
"code" : "DE8",
"display" : "HPV high-risk positive",
"definition" : "Result: at least one high-risk human papillomavirus genotype detected in the cervical sample."
},
{
"code" : "DE9",
"display" : "HPV high-risk negative",
"definition" : "Result: no high-risk human papillomavirus genotypes detected in the cervical sample."
},
{
"code" : "DE10",
"display" : "Lost to follow-up",
"definition" : "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."
},
{
"code" : "DE13",
"display" : "Cervical cytology test",
"definition" : "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)."
},
{
"code" : "DE17",
"display" : "HIV-positive",
"definition" : "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."
},
{
"code" : "DE18",
"display" : "HIV-negative",
"definition" : "Client has a documented negative HIV test."
},
{
"code" : "DE19",
"display" : "HIV status unknown",
"definition" : "Client's HIV status has not been documented. May warrant offering HIV testing alongside cervical cancer screening."
},
{
"code" : "DE20",
"display" : "Current smoker",
"definition" : "Client currently smokes tobacco (any amount, any form)."
},
{
"code" : "DE21",
"display" : "Former smoker",
"definition" : "Client has smoked tobacco in the past but has quit."
},
{
"code" : "DE22",
"display" : "Never smoker",
"definition" : "Client has never smoked tobacco."
},
{
"code" : "DE23",
"display" : "Past screening: HPV high-risk DNA test",
"definition" : "Client's most recent prior cervical cancer screening was an HPV high-risk DNA test."
},
{
"code" : "DE24",
"display" : "Past screening: cytology only",
"definition" : "Client's most recent prior cervical cancer screening was cytology (Pap smear) only."
},
{
"code" : "DE25",
"display" : "Past screening: VIA (visual inspection with acetic acid)",
"definition" : "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."
},
{
"code" : "DE26",
"display" : "Past screening: normal / negative",
"definition" : "Client's most recent prior screening result was normal / negative for cervical pre-cancer or cancer."
},
{
"code" : "DE27",
"display" : "Past screening: abnormal / positive",
"definition" : "Client's most recent prior screening result was abnormal / positive (any abnormality — finer classification not captured at this level)."
},
{
"code" : "DE28",
"display" : "Past screening: result unknown",
"definition" : "Client recalls having been screened but cannot recall the result, or the result is not in available records."
},
{
"code" : "DE29",
"display" : "Cytology: NILM (negative for intraepithelial lesion or malignancy)",
"definition" : "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."
},
{
"code" : "DE30",
"display" : "Cytology: ASC-US (atypical squamous cells of undetermined significance)",
"definition" : "Bethesda 2014 ASC-US. Atypical squamous cells of undetermined significance. Triggers colposcopy referral in the HPV+ pathway per A/641 Fig 2.4."
},
{
"code" : "DE31",
"display" : "Cytology: ASC-H (atypical squamous cells, cannot exclude HSIL)",
"definition" : "Bethesda 2014 ASC-H. Atypical squamous cells where high-grade squamous intraepithelial lesion (HSIL) cannot be excluded. Triggers colposcopy referral."
},
{
"code" : "DE32",
"display" : "Cytology: LSIL (low-grade squamous intraepithelial lesion)",
"definition" : "Bethesda 2014 LSIL. Low-grade squamous intraepithelial lesion (corresponds to histologic CIN1). Triggers colposcopy referral in the HPV+ pathway."
},
{
"code" : "DE33",
"display" : "Cytology: HSIL (high-grade squamous intraepithelial lesion)",
"definition" : "Bethesda 2014 HSIL. High-grade squamous intraepithelial lesion (corresponds to histologic CIN2 or CIN3). Triggers colposcopy referral with priority."
},
{
"code" : "DE34",
"display" : "Route: return to routine screening",
"definition" : "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)."
},
{
"code" : "DE35",
"display" : "Route: repeat HPV test in 12 months",
"definition" : "Routing decision output: HPV+ with negative cytology re-read; repeat the HPV test in 12 months per A/641 Fig 2.4."
},
{
"code" : "DE36",
"display" : "Route: refer to colposcopy",
"definition" : "Routing decision output: HPV+ with cytology ≥ ASC-US, OR HPV+ at 12-month recheck; refer to colposcopy per Op.Inst. 5.6."
},
{
"code" : "DE37",
"display" : "Colposcopy",
"definition" : "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."
},
{
"code" : "DE38",
"display" : "Recall: HPV sample result timeout (3 weeks)",
"definition" : "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."
},
{
"code" : "DE39",
"display" : "Recall: positive result follow-up timeout (4 weeks)",
"definition" : "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."
},
{
"code" : "DE40",
"display" : "Recall: biopsy result timeout (4 weeks)",
"definition" : "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."
},
{
"code" : "DE41",
"display" : "Recall: treatment timeout after positive biopsy (4 weeks)",
"definition" : "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."
},
{
"code" : "DE42",
"display" : "Recall: cytology slide unread timeout (2 weeks)",
"definition" : "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."
},
{
"code" : "DE43",
"display" : "Recall: second reminder (4 weeks after first)",
"definition" : "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."
},
{
"code" : "DE44",
"display" : "Recall: missed scheduled examination",
"definition" : "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."
},
{
"code" : "DE45",
"display" : "Hysterectomy",
"definition" : "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."
}
]
}