On December 1, 2017, cervical cancer screening in Australia changed from two-yearly Pap testing to five-yearly HPV testing.
Why has cervical screening changed?
We now know that 99% of cervical cancer is caused by persistent infection with certain types of HPV (human papillomavirus).
HPV is a common infection in females and males, with hundreds of different HPV types that affect different parts of the body.
Most HPV infections clear up by themselves without causing any problems. However, if they aren’t cleared naturally by the body, some types of HPV can lead to the development of different cancers.
Cervical cancer is most commonly associated with persistent infection with HPV types 16 and 18. By switching to a test that looks for these and other specific HPV types, we can identify the presence of these HPV infections, often before any cellular changes have even taken place.
How does the cervical screening test work?
All women between 25 and 74 years of age are eligible for regular HPV testing as part of the new Cervical Screening Program.
Sample collection for HPV testing is the same as having a Pap test – a doctor or healthcare professional collects a sample of cells from your cervix, and this sample is then sent to our pathology laboratory for testing.
The laboratory performs an HPV test, and if HPV is found to be present, a cytology slide will also be made. This slide is examined under a microscope to see if there are any abnormal cells.
A cytology slide is also made for women who have had a previous abnormal Pap test, or who have symptoms such as abnormal bleeding.
Test results and repeat testing
Once all the testing is complete, the laboratory sends the result to Mascot Medical with a risk category that indicates when you should have your next test.
LOW RISK – Return for your routine HPV test in 5 years
INTERMEDIATE RISK – Have a repeat HPV test in 12 months
HIGHER RISK – Organise a specialist visit to follow up
UNSATISFACTORY – Return in 6 weeks for HPV testing in 6 weeks
Frequently Asked Questions
What if I have abnormal bleeding or other concerns before my next test is due?
The new cervical screening guidelines allow for additional testing in certain circumstances. This includes women who experience any abnormal bleeding, and young women who were sexually active before they received the HPV vaccination. Please discuss any concerns with your doctor.
If I have had the HPV vaccine, will I still need to have a cervical screening test?
Yes. The vaccine does not protect against all types of HPV infection that are known to cause cancer, so you will still need to have the cervical screening test.
Do other countries screen this way?
While many countries are considering this change, Australia will be one of the first in the world to change from Pap tests to HPV tests. Although the new Cervical Screening Program is based on scientific studies and advanced modelling, the changes are significant and it will be some years before we can collect the data needed to confirm the expected performance of HPV testing in Australia.
It is expected the new cervical screening test will be more effective than the previous Pap test, however, it is worthwhile being aware that all screening tests have limitations.
My doctor previously recommended a ThinPrep® test. Can I still have one?
In the new program, liquid-based cytology tests, like ThinPrep®, only receive a Medicare rebate when HPV is identified in the initial test, or for patients who have symptoms or a history of previous abnormality.
If you would like the added reassurance of a second test, even if your HPV result is ‘low risk’, please ask your doctor whether adding a privately funded liquid-based cytology test, such as ThinPrep®, is appropriate.
What if I don’t want to wait five years between testing?
The HPV test offered under the screening program will only be funded every five years for women who are ‘low risk’, with no symptoms or abnormal history. If you prefer not to wait five years for your next screening test, more frequent cervical screening can be done, but it will not be eligible for a Medicare rebate unless it meets the specific criteria for increased testing. Again, please discuss this option with your doctor.
For further information or if you are experiencing symptoms, including pain, bleeding or discharge, book an appointment with Dr Nav Gill to discuss further.
This article was first published on Douglass Hanly Moir Pathology website.