Screening for Cervical Cancer

The National Cervical Screening Program aims to prevent cervical cancer by detecting persistent oncogenic HPV infection and precancerous cervical changes before invasive cancer develops. The Cervical Screening Test (CST) replaced the 2-yearly Pap smear in 2017 and is substantially more sensitive because it tests primarily for HPV rather than cytological abnormalities.

The National Cervical Screening Program aims to prevent cervical cancer by detecting persistent oncogenic HPV infection and precancerous cervical changes before invasive cancer develops. The Cervical Screening Test (CST) replaced the 2-yearly Pap smear in 2017. HPV testing is more sensitive than cytology for primary screening.

  1. Who should be screened
    • Women and people with a cervix aged 25–74 years who have ever had sexual contact.
    • Routine screening is every 5 years when HPV is not detected.
    • Screening remains necessary after HPV vaccination.
    • For expanded detail: Immunisations
  2. How the Cervical Screening Test is collected
    • Eligible people should be offered a choice of:
      • self-collected vaginal sample, or
      • clinician-collected cervical sample.
    • Both are tested for HPV.
    • A self-collected sample cannot provide cervical cytology.
    • If LBC is required, a clinician must collect cells from the cervix.
    • Self-collection can be used during pregnancy for routine screening.
    • Self-collection is not appropriate when a co-test is required.
  3. HPV not detected
    • Return to routine screening in 5 years.
    • If aged 70–74 years, this will usually be the exit test.
  4. HPV 16 or 18 detected
    • Refer for colposcopy.
    • If the original sample was self-collected, LBC does not need to be collected before referral; cervical cytology can be obtained at colposcopy.
    • The indication for colposcopy remains regardless of the LBC result.
  5. HPV not 16/18 detected
    • Cytology determines the next step.
    • Negative / pLSIL / LSIL → repeat HPV test in 12 months.
    • pHSIL / HSIL / glandular abnormality or worse → colposcopy.
    • If the original sample was self-collected, a clinician-collected cervical sample is required when LBC is indicated.
  6. Persistent HPV not 16/18
    • At the 12-month follow-up:
      • HPV not detected → return to routine 5-yearly screening.
      • persistent HPV not 16/18 with negative/low-grade cytology → management depends on risk.
    • Refer directly to colposcopy at 12 months if persistent HPV is present in:
      • people aged ≥50 years
      • Aboriginal and/or Torres Strait Islander people
      • people who were ≥2 years overdue for screening at the initial positive test.
    • Otherwise repeat HPV testing again in 12 months.
    • Persistent oncogenic HPV at the subsequent 24-month follow-up → colposcopy.
  7. Unsatisfactory samples
    • Repeat an unsatisfactory HPV or LBC sample in approximately 6–12 weeks.
  8. Symptoms are not screening
    • Symptoms suspicious for cervical cancer require diagnostic assessment, regardless of age or previous screening.
    • Important symptoms include:
      • unexplained postcoital bleeding
      • persistent intermenstrual bleeding
      • postmenopausal bleeding
      • persistent unexplained unusual vaginal discharge
      • abnormal cervix suspicious for cancer.
    • These patients require a clinician-collected co-test: HPV + LBC, not routine self-collection.
  9. Co-testing
    • A co-test means HPV + LBC from the same clinician-collected cervical specimen.
    • Important indications include:
      • symptoms suspicious for cervical cancer
      • follow-up after treatment for adenocarcinoma in situ (AIS)
      • DES exposure in utero.
    • Routine screening does not require co-testing.
  10. After treatment for HSIL
    • From the 14 April 2025 guideline update, Test of Cure after treated HSIL uses annual HPV testing.
    • Begin approximately 12 months after treatment.
    • Continue annually until 2 consecutive HPV tests are negative.
    • Then return to routine 5-yearly screening.
    • AIS follows a different surveillance pathway.
  11. HPV vaccination
    • Persistent oncogenic HPV causes almost all cervical cancers.
    • Vaccination substantially reduces HPV infection and cervical precancer.
    • HPV vaccination does not replace cervical screening.
  12. National Cancer Screening Register
    • The National Cancer Screening Register (NCSR) records cervical screening and follow-up.
    • It supports invitations, reminders and clinical follow-up.
    • Check previous screening history when uncertain.

A useful exam skeleton is:

  • 25–74 → HPV every 5 years
  • HPV negative → 5 years
  • 16/18 → colposcopy
  • non-16/18 + low-grade/negative LBC → 12 months
  • persistent at 12 months + age ≥50 / ATSI / initially ≥2 years overdue → colposcopy
  • everyone else persistent → another 12 months
  • HPV still present at 24 months → colposcopy

And the collection rule is:

  • Self-collected = HPV only.
  • Cervical sample = HPV ± LBC.

Current Key Resources

Women with symptoms such as abnormal bleeding, discharge, or pain should seek medical advice irrespective of their age and screening history.

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