Cervical cancer screening tests
Screening for cervical cancer is very effective at reducing the number of women who develop or die from cervical cancer. In fact, since the National Cervical Cancer Screening Program began in 1991, cervical cancer death rates in Australia have halved.
A new National Cervical Screening Program has been introduced in Australia, and HPV testing will replace Pap smear tests as the primary screening test for cervical cancer.
The new program will improve detection of early cervical cancer and be equally as safe as the Pap test programme. It should be remembered, however, that no screening test is 100 per cent accurate.
It’s also important to remember that screening tests are designed to detect cancers - or precancerous cell changes - at an early, curable stage before any symptoms have developed. If you already have any symptoms such as bleeding, unusual discharge or pain you should see your doctor straight away - don’t wait until your next screening test is due.
Cervical cancer screening tests
From December 2017, screening for cervical cancer will involve having a human papillomavirus (HPV) test every 5 years, from age 25 (or 2 years after first having sex - whichever is later) to age 74. This replaces 2-yearly Pap smear tests from age 18 (or 2 years after first having sexual contact - whichever is later) to 70 years.
With the introduction of the new screening programme, women will be invited to attend for their first HPV test 2 years after their last Pap smear test. If the results are normal, screening will then be recommended every 5 years.
So, in general, the main changes are:
- the age at which you start having cervical cancer screening - 25 instead of 18 years;
- how often you have a screening test - every 5 years instead of every 2 years; and
- the age that you stop being tested - 74 instead of 70 years.
Why has cervical cancer screening changed?
Almost all cervical cancers are caused by persistent infection with certain types of human papillomavirus (HPV), which you can be exposed to through sexual contact.
Pap smear tests can detect abnormal cell changes, but HPV tests detect the infection that leads to these cell changes, even before they develop. So testing for HPV infection in the cervix can help improve early detection and save more lives.
HPV and cervical cancer risk
HPV infection is common, but only some types of HPV lead to changes in the cervical cells that may eventually result in cancer. In addition, it takes several years (often 10 years or more) for these types of HPV to cause cancer. Fortunately, most women clear the virus within 2 years, and have no signs of infection.
HPV vaccines are available on the National Immunisation Program Schedule that protect against the 2 strains of HPV that cause 70 per cent of cervical cancers. However, women who have been vaccinated against HPV still need to have cervical screening tests, because the vaccine does not immunise against all strains of HPV that can cause cervical cancer.
Having an HPV test
The new Cervical Screening Test detects human papillomavirus (HPV) infection. The HPV test is performed on a sample of cervical cells taken from the surface of your cervix. It tests for the high-risk types of human papillomavirus (HPV) that can cause cervical cancer.
The procedure for collecting the cells is basically the same as the procedure for doing a Pap smear test. To collect the sample, your doctor will insert an instrument called a speculum into your vagina. This is so that they can easily see your cervix. Special small instruments are then used to gently take a small sample of cervical cells. The procedure is usually described as uncomfortable, but not painful and only takes a few seconds.
The sample of cervical cells is placed into a container of special liquid and sent to a laboratory. The cells are initially tested for human papillomavirus (HPV). If the test is positive for high-risk types of HPV, the cervical cells are also examined for changes under a microscope. This is known as liquid-based cytology (which is the same as a ThinPrep Pap test).
In selected cases, women who do not want a doctor or nurse to collect a sample of cervical cells for HPV testing may take the sample themselves. This can be done using a self-sampling device under the guidance of a doctor or specialist nurse. While this is not an ideal way of testing, it is a better option than not having an HPV screening test at all.
What if I get an abnormal result?
If an HPV test is positive for certain types of HPV, the cervical cells are tested for changes that could eventually turn into cancer. Depending on the results, repeat HPV testing in 12 months may be recommended, or your doctor may refer you to a gynaecologist (specialist in conditions affecting the female reproductive tract) or gynaecological oncologist (gynaecologist who specialises in cancerous and precancerous conditions) for further testing and treatment.
National Cancer Screening Register
A National Cancer Screening Register will support the new National Cervical Screening Program in Australia. This will replace the Pap smear registers in each state and territory. All women will be invited to participate in the screening program starting from age 25 years. Women will be also be reminded when their next test is due.
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4. Royal College of Pathologists Australia (RCPA). Cytology and the new NCSP
https://www.rcpa.edu.au/Health-Care-Professionals/NCSP/CytNCSP (accessed Jul 2017).
5. NPS MedicineWise. Changes to the National Cervical Screening Program (1 Oct 2015). https://www.nps.org.au/radar/articles/changes-to-the-national-cervical-screening-program (accessed Jul 2017).