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The National Cervical Screening Program

A healthier future for Australian women

The way Australian women are screened for cervical cancer has changed. The Medical Services Advisory Committee (MSAC) recommend a liquid based collection for HPV DNA testing with a 5 yearly screening interval. Screening now commences at 25 years of age.

Cervical Testing with a Molecular HPV Test

A sample of cells is collected from the cervix into the liquid based specimen vial, which is analysed to identify the presence of HPV viral DNA at the molecular level. The traditional glass slide Pap smear has been phased out and now incurs a private fee as the Medicare Benefits Schedule no longer covers the cost and is not recognised by the new guidelines.

What do I need to know?

Women aged 25 to 74 years are 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) is performed on the same specimen.

There is a combined report for HPV and cytology (LBC) results, which includes a risk category and the recommended management, in line with the guidelines.

There are three risk categories:

  • Women who are classified as low risk are re-invited to re-screen in five years.
  • Women who are classified as intermediate risk are invited to have another HPV test in 12 months. This is to check that the infection has cleared.
  • Women classified at higher risk are referred directly to colposcopy for further investigation.


Symptomatic women

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 is performed on these specimens.

Age for first HPV screening

The screening program advises that both HPV vaccinated and unvaccinated women from the ages of 25 to 74 should participate. This age range 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 to order a Cervical Screening Test 

Patient
presents as 
Context Age Sample type Test type What to write on the pathology request form

Asymptomatic

National Cervical Screening Program routine five-yearly screening

  • Only 1 of this MBS item is claimable in a 57-month period

≥ 24yrs
& 9mths

Cervical HPV test Cervical Screening Test (CST)
Asymptomatic

 

 

Screening in specific populations

  • Immune-deficient
  • Early sexual debut, prior to 14 years and not vaccinated prior to sexual debut (only 1 claimable between 20 and 24 years of age)
Any age Cervical HPV test
  • HPV test,
    Immune-deficient
  • HPV test, Early debut HPV

Follow-up test claimable after previous positive screening test (12-month repeat)

Any age

Cervical

HPV test

Follow-up HPV test

Follow-up or post-treatment for clinical management

  • Following treatment of HSIL
    (also called “test of cure”)
  • Following treatment of AIS
  • DES exposed in utero

Any age

Cervical

Co-test (HPV & LBC)
  • Co-test or HPV & LBC, Test of Cure
  • Co-test or HPV & LBC Post-treatment
  • Co-test or HPV & LBC, DES

Symptomatic

For investigation of symptoms, e.g. abnormal bleeding

Any age

Cervical

Co-test (HPV & LBC)

Co-test or HPV & LBC, Symptomatic (specify)
Follow-up for HPV+ self-collect Only claimable within 21 months following the detection of oncogenic HPV (any type) on a self-collected screening test 24yrs
& 9mths
Vaginal LBC HPV+ self-collect follow-up test
Cervical LBC HPV+ self-collect follow-up test
Repeat test following an unsatisfactory test

Following an unsatisfactory test

  • Only claimable when preceded by another cervical or vaginal MBS item
Any age Cervical HPV test HPV test, previous result unsatisfactory
Vaginal HPV test HPV test, previous result unsatisfactory
Cervical LBC LBC, previous result unsatisfactory

Further testing - Screening for common STIs. 

Screening for 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

1. https://www.healthdirect.gov.au/chlamydia

2. http://www.sti.guidelines.org.au/sexually-transmissible-infections/gonorrhoea#clinical-presentation

 

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 7 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 is a webinar on Molecular Screening for Sexually Transmitted Infections, presented by Dr Catherine Uzzell, which is 8 minutes in length.

 

Sample collection

Carefully follow the sample collection instructions for best results.

ThinPrep Collection Instructions

Self-collect guide for HPV testing

From July 1, 2022

The Australian National Cervical Screening Program will be available to anyone undergoing cervical or vaginal HPV screening aged 25-74 years;

  • Must be over 24 years and 9 months
  • Must be due for screening (first test or > 4 years and 9 months since a negative screening result)
  • Must not require co-test
  • Must be collected under the supervision of a healthcare professional

Participants may also be offered self collect sampling for follow up of Intermediate Risk HPV results at the 12 month rescreen interval.

Self collection is not recommended for;

  • Symptomatic patients 
  • Patients undergoing Test of Cure surveillance 
  • Previous total hysterectomy for high grade squamous or glandular lesions
  • Diethylstilbestrol (DES) exposure in utero

Self collected samples must be clearly identified as a self collect sample, as they are not suitable for reflex LBC testing.

Where a self collect specimen is positive for High Risk HPV, the patient will be immediately recommended for colposcopy.

Where a self collect specimen if positive for Intermediate Risk HPV, the patient will require a clinician collected sample taken from the cervix during a speculum examination, for cytological (LBC) examination.

If a self collect specimen is negative for Intermediate and High Risk HPV, the patient will be recommended to rescreen at the usual 5-year interval.

A summary of the Cervical Screening Program

  • 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 all screening participants aged 25 to 74 years