Cervical screening tests, explained

by | Men's Health, Women's Health

A speculum is an instrument used during a cervical screening test

Dr Michela Sorensen

B. Med, FRACGP, Dip Family Medicine

Did pap smears get a new name, or is cervical screening a completely different test? Maybe you’ve had a cervical screening test, but couldn’t figure out why your doctor didn’t call it a pap smear anymore, or maybe you felt alarmed when your GP assured you, you didn’t need another test for five years. If this sounds familiar, you’re not alone. The guidelines around screening for cervical cancer have changed a lot over the past six years, but many women aren’t aware of the updates. That’s why we spoke to two GPs who specialise in women’s health to explain exactly what’s changed, what to expect from a cervical screening test and why screening has never been simpler, or more effective.

Why does nobody talk about pap smears any more? 

In case you missed it, the two-yearly pap smear in Australia was replaced by a five-yearly cervical screening tests back in 2017. 2 . “When you go and see the doctor and have your cervical screening test, from a patient experience perspective, it’s the same process as a pap smear,” says Dr Michela Sorensen, a GP specialising in women’s health. “You’ll have the same examination and it feels like that same physical test. How it differs is how it’s processed at the lab.”

The cervical screening test looks for the presence of human papillomavirus (HPV) in the vagina which can lead to changes in the cervix that can progress to cervical cancer. “It’s a screening test that saves lives by preventing you from ever getting cancer,” explains Sunshine Coast-based GP Dr Suzette Pyke.

The old pap smear test was used to detect cellular changes caused by an existing HPV infection which is why more frequent testing was necessary. In simple terms, the new tests catch abnormalities much, much earlier which is why you don’t need to be tested as regularly. Human papillomavirus (HPV) is a viral infection transmitted through sexual contact.It can cause genital warts in women and men, and lead to the development of cancer of the cervix in women and people with a cervix.

Do I still need a test if I’m not currently sexually active?           

Cervical screening tests are for women or people with a cervix aged between 25 and 74.2 “Even if you’re not having sex or if you’ve only ever had one partner, you still need to be tested,” Dr Pyke says. “The same goes if you’re a woman who has only ever had sex with women, you still need to be tested.” 

Why is testing time different to the old pap smear test?

“With the timeframe from getting HPV to developing cervical cancer, we’re generally talking 10 years or more,” Dr Pyke says. “That’s why if you have a cervical screening test that does not show HPV, we can comfortably leave it for five years. ”The longer gap between testing is also possible because many Australian women are immunised against HPV.”

“The other reason we are able to stretch it out is because of the introduction of the Gardasil 9 vaccine against HPV which lasts for life,” Dr Sorensen explains. “We now give it to all girls and boys in year seven at school.”

While most Australian women under 30 have had the HPV vaccination, you can still be vaccinated up to the age of 45, according to The Australian Immunisation Handbook so talk to your GP about whether immunisation is appropriate for you. 3

Why is self-collection an option now? 

One of the most exciting developments around cervical screening is the introduction of self-collection. Inviting women to decide whether they’d prefer to do their own vaginal sample collection or have a doctor do it comes down to providing greater choice.4 “Some women prefer to have a GP collect the sample and other women love being able to do their own,” Dr Pyke says. “A big motivation is to reach our under-screened population. Unfortunately, as with other aspects in healthcare, a lot of under-screened people are Aboriginal and Torres Strait Islander women, women with disabilities and the LGBTQIA+ population. As word spreads, hopefully more people can get tested and have the better healthcare outcomes.”

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What happens if my cervical screening test detects HPV?

“Depending on which strain of HPV is detected, you will be required to have a cervical examination,” Dr Pyke says. “Sometimes the GP will ask you to come back in and they’ll do it or they’ll refer you to a gynaecologist.”  

Either way, a cervical examination involves taking off your underpants and reclining on the medical examination table with your legs parted to allow the doctor to insert a device called a speculum into the vagina. “The speculum examination allows a doctor access to your cervix and take a sample of cells from the cervix,” Dr Pyke says. “It will be familiar to women who’ve previously had a pap smear.”

That sample of cervical cells will be sent to pathology for testing. “Abnormal cervical cells can be cervical cancer, but thankfully that’s rare, especially if you are getting five yearly cervical screening tests,” Dr Pyke says. 

If you’re worried about the procedure, or concerned about the frequency of screening, talk to your GP. “For most things you might think, ‘Five years is a long time! My health is very different to what it is to how it is now!’ But the thing with cervical cancer is, it is really slow growing,” says Dr Sorensen “Australia is shaping up to be the first nation to eradicate cervical cancer. The rates of decline are incredible and we are leading the world. Regular screening is at key to making cervical cancer history.”

References

1.     Australian Government Department of Health and Aged Care. Human papillomavirus (HPV). July 12, 2022. Accessed September 3, 2023. https://www.health.gov.au/diseases/human-papillomavirus-hpv

2.     Australian Government Department of Health and Aged Care. National Cervical Screening Program. July 21, 2023. Accessed September 3, 2023. https://www.health.gov.au/our-work/national-cervical-screening-program

3.     Australian Government Department of Health and Aged Care. Gardasil 9. The Australian Immunisation Handbook. June 4, 2018. Accessed September 3, 2023. https://immunisationhandbook.health.gov.au/vaccines/gardasil-9

4.     Australian Government Department of Health and Aged Care. Self-collection for the Cervical Screening Test. [nd] Accessed September 3, 2023. https://www.health.gov.au/self-collection-for-the-cervical-screening-test