The National Cervical Screening Program is changing. From 1 December 2017:
- the Pap smear will be replaced with the more accurate Cervical Screening Test known as molecular testing for oncogenic Human Papilloma Virus (HPV)
- the time between tests will change from two to five years
- the age at which screening starts will increase from 18 years to 25 years
- women aged 70 to 74 years will be invited to have an exit test.
Women of any age who have symptoms such as unusual bleeding, discharge and pain should see their Health Care Professional immediately.
HPV vaccinated women still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.
A 2015-16 Australian Government Budget commitment provides funding to implement these recommended changes to the National Cervical Screening Program and establish a National Cancer Screening Register to support the new program.
The new program will commence from 1 December 2017 when the new Cervical Screening Test will become available on the Medicare Benefits Schedule.
The changes to cervical screening test is due to better understanding of how cervical cancer developed. It is now known the HPV is a necessary, but not sufficient, cause of this disease.
Although infection with HPV is extremely common, the development of cervical cancer is not. It is estimated that 80% of all people will be infected with HPV at some time, but the majority will clear the infection naturally. For those women with persistent HPV infection and unable to clear naturally, they are at most risk of developing cervical cancer. It is estimated around 10% of people infected will become persistent HPV carriers.
HPV testing is more sensitive compared to previous conventional pap smear. One negative HPV testing will give assurance that development of high grade cervical disease is unlikely.
Special circumstances of HPV test to qualify for Medicare benefit:
- A woman presenting with abnormal vaginal bleeding, intermenstrual, or post-coital, at any age and irrespective of screening interval, will need testing.
- She will be offered a co-test, that is an HPV test and a liquid based cytology performed at the same time, irrespective of the HPV result.
- If these are both negative, the patient then returns to normal screening. If either is positive, the woman will need gynaecological referral.
- These women are able to be screened more often. It is recommended they have HPV testing every three years.
Women under the age of 25
- Special provisions have also been made for screening women under the age of 25 who may have history of early onset of sexual activity or unwanted sexual activity before the age of 14 and not vaccinated prior to sexual debut (only one claimable between 20 to 24 years of age)
Women currently being followed for treated disease
- The test for cure for histologically proven high-grade disease will still apply.
- These women need to have two negative HPV and cytology tests one year apart before returning to the recommended screening interval.
- The test for cure will apply to glandular lesion as well, but it is recommended these women have testing annually for life.
Screening after total hysterectomy:
- If a woman has a normal prior screening history and has had a hysterectomy for benign gynaecological disease, and no cervical pathology is found on that specimen, the woman requires no further screening.
- If a woman has had a past history of high-grade squamous intraepithelial lesion and has completed the test of cure, and the hysterectomy is for benign disease and no cervical pathology is found on hysterectomy specimen, she does not need further HPV screening.
- If a woman has a history of adenocarcinoma in situ, even if it has been treated and the residual hysterectomy specimen showed no disease, she is still eligible for annual follow-up with co-testing.
- If the hysterectomy is being performed for known high-grade disease that has either not managed or not followed-up properly, the woman is to be offered the test of cure.