A Healthier Future for Australian Women is on the way
Changes to the Cervical Screening Program
From December 2017, the way Australian women will be screened for cervical cancer will change. The Medical Services Advisory Committee (MSAC) have recommended a liquid based collection for HPV DNA testing with a 5 yearly screening interval. Screening will commence at 25 years of age.
Replacement of the Pap Smear with a Molecular HPV Test
Under the new guidelines, a sample of cells is collected from the cervix into the liquid based specimen vial, which will be analysed to identify the presence of HPV viral DNA at the molecular level.
At the end November 2017, the current pap smear on glass slides will be phased out and will incur a private fee, as the MBS will cease to cover the cost.
What Do I Need To know?
Women aged 25 to 74 years will be invited every 5 years to have a primary HPV test. This includes both vaccinated and unvaccinated women.
• If HPV is not detected, cytology will not be performed and a repeat screening in five years is recommended.
• If HPV is detected, a reflex Liquid Based Cytology (LBC) (ThinPrep) will be performed on the same specimen.
There will be a combined report for HPV and cytology (LBC) results, which will include a risk category and the recommended management, in line with the new guidelines.
There are three risk categories:
• Women who are classified as Low risk will be re-invited to re-screen in five years.
• Women who are classified as Intermediate risk will be invited to have another HPV test in 12 months. This is to check that the infection has cleared.
• Women classified at Higher risk will be referred directly to colposcopy for further investigation.
It is important to remember that symptomatic women may have a cervical sample taken at any time, regardless of their age or screening history. Women at any age who have signs or symptoms suggestive of cervical cancer, or its precursors, should have a co-test (LBC and HPV).
The presence of symptoms should be clearly noted on the request form as cytological examination will be performed on these specimens.
Age Increase for First HPV Screening
The renewed program advises both HPV vaccinated and unvaccinated women from the ages of 25 to 74 should participate. This change is based on evidence that cervical cancer in young women is rare and screening patients younger than 25 years of age has not altered the number of cervical cancer cases or deaths in this group. This measure also prevents the over treatment of common cervical abnormalities in young women, which usually resolve naturally.
In addition, HPV vaccination has already and will continue to show significant reduction of these abnormalities amongst patients in this age bracket. If a woman under the age of 25 is symptomatic, a HPV test can be requested that will be covered as a MBS item.
How Order A HPV Test
- Screening for common STIs. Screening for these common STIs at the same time as the Cervical Screening Test is the ideal opportunity, as the same specimen can be used.
Statistics show the rates of Sexually Transmitted Infections (STIs) throughout Australia are rising. Research suggests that 75% of women with Chlamydia infection1, and up to 80% of women with Gonorrhoea infection2 are asymptomatic.
Although these infections may be asymptomatic, they have great potential for long-term harm, being highly associated with pelvic inflammatory disease, infertility and pregnancy complications such as ectopic pregnancy.
The first Cervical Screening Test at 25 years of age is an ideal opportunity to screen for these common STIs, as Chlamydia and Gonorrhoea testing can be performed on the same ThinPrep vial used to collect the Cervical Screening sample. No extra specimen collection is required.
Testing for Chlamydia and Gonorrhoea in Australia is performed using molecular PCR techniques, and is fully Medicare rebatable, both symptomatic referrals and for screening.
References - Accessed 22/09/2018
Watch our Webinars
We have posted a webinar from our expert pathologist, Dr Catherine Uzzell, to explain the changes to the HPV program. The Webinar is pre-recorded and lasts for just over seven minutes and will address all your questions to prepare you for when the changes come into effect.
To view the other parts of the HPV update webinars, click here.
Also available for viewing a webinar on Molecular Screening for Sexually Transmitted Infections, presented by Dr Catherine Uzzell, which is 8 minutes in length.
Carefully follow the sample collection instructions for best results.
Future testing - Self-collect guide for HPV testing
Please note that self-collect has not been included in the December 1st 2017 release of the program and is planned for future release by the National Cervical Cancer Screening Program
Self-collect testing is only available for women who have never been screened or are under-screened, are greater than 30 years old, and it is more than 2 years since the last smear. Self-collect testing tends to only be about 70% as effective as samples taken by a doctor as the method has a lower accuracy for detection of HPV.
Reflex liquid based cytology (LBC) cannot be performed on the sample as it is a dry swab. If the HPV test is positive for HPV 16 or 18, the patient will be referred to a specialist. If the HPV test is positive for other high risk HPV, the patient will need to return to her GP to have a sample taken for LBC.
Self-collects are only to be taken under general practitioner or nurse practitioner supervision, where guidance and counseling of results can be given. Self-collection is contra-indicated in pregnancy.
A Summary Of The New Program From December 2017.
- 5 yearly cervical screening
- Primary HPV molecular test with partial HPV genotyping
- Reflex LBC (liquid based cytology) triage (NOT CO-TESTING)
- HPV vaccinated and unvaccinated women 25 to 69 years with an exit HPV test between 69 & 74 years
- Invitation and reminders will be sent to women
- Provision made for self-collection of a HPV sample for an under-screened or never-screened woman