Cervical Screening

Cervical screening in Australia underwent significant changes in December 2017 when the National Cervical Screening Program (NCSP) transitioned from the two-yearly Pap test to the five-yearly Cervical Screening Test (CST). The current guidelines are part of an effort to provide a more effective and efficient screening process based on the latest evidence and understanding of human papillomavirus (HPV) and its role in cervical cancer.

  1. Eligibility for Screening:
    • The Cervical Screening Test is recommended for women and people with a cervix aged between 25 and 74 years.
    • Individuals are invited to start screening at the age of 25 or two years after their last Pap test if they were already participating in the program.
    • The screening is for those who have ever been sexually active, which includes intercourse and any genital skin-to-skin contact.
  2. The Cervical Screening Test:
    • The new test looks for the presence of HPV, the virus that can cause cervical cell changes, which may lead to cervical cancer.
    • If HPV is found, the same sample is checked for any abnormal cervical cells, which is known as reflex liquid-based cytology (LBC). The LBC result can be:
      • Normal or pLSIL -> ok to watch for a year
      • pHSIL -> colposcopy
      • Inadequate -> repeat in 6 weeks
    • If a self collect specimen is positive for HPV an immediate formal recollect by a doctor using a speculum is required
  3. Frequency:
    • The screening is conducted every five years, as HPV infections and related cell changes typically develop slowly.
    • More frequent screening may be recommended if HPV is detected or if there are other risk factors or previous abnormal results.
  4. After the Test:
    • If no HPV is detected, the next test is due in five years.
    • If 16/18 is detected -> colposcopy (regardless of LBC)
    • If HPV non 16/18 is detected we need LBC which may require a formal collection if sample was self collect.
      • The patient is then asked to return for another HPV test in 12 months to check if the HPV infection has cleared unless pHSIL is found on LBC (which requires colposcopy)
      • If the LBC is inadequate it is repeated in 6 weeks
    • If HPV 16/18 is detected a second time then we repeat the original process of formal collect for LBC (if self collect) and retest in 12 months if < pHSIL unless:
      • Referral for coposcopy is recommended for
        • Age > 50
        • ATSI
        • Overdue by > 2 years (effectively cycle 3)
    • If HPV 16/18 is detected a third time  a referral for a colposcopy is made
    • If HPV 16/18 is not detected on the 2nd or 3rd test we go back to 5 yearly screening.
  5. Exit from the Program:
    • After the age of 74, individuals who have had two negative screening tests in the last 10 years are considered safe to exit the program.
    • Those with a recent history of significant abnormality will be advised to have one final exit test.
  6. Special Populations:
    • Different guidelines apply for those with symptoms, a history of cervical abnormalities, or who are immunocompromised.
      • Women who are spotting between periods need formal collection for HPV/LPC and Beta hCG
    • Women > 50, ATSI or 2 years late for a second non 16/18 detected follow up test all proceed to colposcopy rather than have a 3rd HPV test a year later.
    • Women who have had a total hysterectomy may not need further cervical screening, depending on their medical history.
  7. Self-collection:
    • Self-collection of samples for HPV testing is available to all individuals eligible for the program.
    • In the event HPV is detected a formal speculum collected sample is required to provide cervical cells for cytology
  8. Records and Reminders:
    • The National Cancer Screening Register (NCSR) keeps records of screening participation and sends reminders to individuals when they are due for their next test.
  9. Implementation:
    • The NCSP provides culturally safe and accessible cervical screening for Aboriginal and Torres Strait Islander people.
    • GPs play a critical role in educating and encouraging individuals to participate in cervical screening.

The updated cervical screening program is expected to protect up to 30% more women from cervical cancer and is a testament to Australia’s commitment to preventive health care and evidence-based medical practices.