Screening for Cervical Cancer

The Cervical Screening Program in Australia aims to reduce morbidity and mortality from cervical cancer by detecting and treating early changes in the cervix that might lead to cancer. Here is an overview of the program:

  1. Change from Pap Smear to Cervical Screening Test (CST): Historically, women were advised to have a Pap smear every two years. However, in December 2017, Australia transitioned from the two-yearly Pap smear to the 5-yearly Cervical Screening Test (CST). The CST is a more accurate test and can detect human papillomavirus (HPV), which is the cause of approximately 99% of cervical cancers.
  2. Eligibility for Screening: The program targets people aged 25 to 74 years who have a cervix, irrespective of gender or sexual activity history. This includes those who have had the HPV vaccine, as the vaccine doesn’t protect against all types of HPV that can cause cervical cancer.
  3. Self-collection: Universal self collection is now allowed however it is important to recognise that LBC (Liquid Based Cytology) can NOT be done without a speculum assisted collection from the cervix.
  4. Frequency:
    1. If the CST result is negative (i.e., no HPV detected), the individual is advised to have their next CST in five years.
    2. If the CST result is positive (i.e. HPV is detected), reflex (automatic), Liquid Based Cytology (LBC) will be performed unless the sample is self-collected, in which case a formal speculum-assisted collection must be done.
    3. The CST and LBC results will inform further investigations
      1. pLSIL: possible low-grade squameous intraepithelial lesion
      2. pHSIL: possible high-grade squameous intraepithelial lesion
      3. Non 16/18 HPV
        1. Unsatisfactory -> recollect in 6/52
        2. Negative or pLSIL (low grade) -> repeat in 12 months
        3. pHSIL (high grade) -> Colposcopy
      4. 16/18 HPV
        1. Unsatisfactory -> Colposcopy
        2. Any LBC result -> Colposcopy
  5. Special Cases: For Non 16/18 HPV patients where their 12-month repeat CST remains positive, direct referral to colposcopy is recommended for women
    1. 50+ years
    2. ATSI women
    3. Women overdue for screening by at least 2 years at the initial screen
  6. Reminder System: Many states and territories in Australia have a Cervical Screening Register, which sends reminders to individuals when they are due for their next test and can notify healthcare providers about their patients’ screening results.
  7. Safety of the HPV Vaccine: The introduction of the HPV vaccine (Gardasil) in Australia has significantly reduced the prevalence of HPV in young Australians and, in turn, has reduced the incidence of high-grade cervical abnormalities. However, vaccination doesn’t entirely eliminate the risk of cervical cancer, so cervical screening remains essential even for those who have been vaccinated.
  8. Follow-up and Treatment: If an individual’s test detects HPV or other cervical abnormalities, they will be advised on the next steps, which might include further testing, close monitoring, or treatment procedures like a colposcopy or cervical excision.
  9. Education and Awareness: The program also emphasizes educating individuals about the importance of regular cervical screening, understanding the link between HPV and cervical cancer, and being aware of symptoms related to cervical cancer.

Early detection and intervention remain the most effective strategies to prevent the development and progression of cervical cancer. The Australian Cervical Screening Program, through its changes and continued efforts, aims to improve cervical cancer outcomes in the country.

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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