Cervical cancer is one of the most preventable cancers. Routine cervical screening is your best protection against cervical cancer. The Cervical Screening Test is expected to protect up to 30% more women.
Cervical Screening has Changed
In December 2017, a number of changes were introduced to the National Cervical Screening Program (NCSP). These included:
- Replacing the Pap test with the Cervical Screening Test, which detects infection with human papillomavirus (HPV)
- Women whose Cervical Screening Test shows that they do not have oncogenic HPV are classed as ‘low risk’ and are advised to screen every five years
- Women will be invited to start screening at 25 years of age and should have a final (exit) test when they are between 70 and 74 years of age
- Establishing the National Cancer Screening Register (NCSR)
In light of new evidence, changes to the NCSP’s Guidelines for the clinical management of women at intermediate risk came into effect on 1 February.
It is now recommended that women with a 12-month follow up HPV (not-16/18) result with LBC prediction negative, pLSIL or LSIL (intermediate risk result) should be recommended to undertake a further HPV follow up test in 12 months’ time following their previous HPV test instead of referral to colposcopy.
These include:
- Women two or more years overdue for screening at the time of the initial screen
- Women who identify as being of Aboriginal or Torres Strait Islander
- Women aged 50 years or older.
Further information about the changes and the revised cervical screening pathway flowchart is now on the Department of Health website.
Read the Frequently Asked Questions for more on the changes or view the NCSP Clinical Guidelines online.
Resources
We support GPs with a range of primary care quality improvement activities.
Western Sydney health professionals can access Cervical Screening pathways on Western Sydney HealthPathways website. To gain access to contact our HealthPathways team at healthpathways@wentwest.com.au or call 8811 7100.
The National Cervical Cancer Screening Program website has comprehensive information for health professionals including evidence, pathology, the new screening pathway and MBS items. The resource library contains information packs, quick reference guides and other materials which can be downloaded or ordered as hard copies.
A FAQ document for health professionals, covering the most frequently asked questions about cervical screening, is also available online.
The Department of Health advises that clinicians should check with their pathology provider that they are accredited to offer patient self-screening. The Royal Australian College of General Practitioners (RACGP) website also has a series of videos addressing common questions that GPs receive.
Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding can be accessed online.
Information and guidelines concerning screening of women under 25 can be found on the Cancer Screening website. Cancer NSW has also developed a video, which promotes the importance of cervical screening to women. Furthermore, the Australian Cervical Cancer Foundation has developed a Comfort Checklist for health professionals to use to minimise the emotional, cultural and physical barriers that prevent women from engaging in regular screening.
To find out more about Cervical Screening including your role in screening, professional development and resources and publications please visit the Cancer Institute NSW webpage.
National Cancer Screening Register
The National Cancer Screening Register supports Australia’s bowel and cervical screening programs. It enables a single electronic record for each person in Australia participating in cervical and bowel screening. It gives health care providers better access to quality health information and makes it easier for program participants to take control of their health.
Self-collection Update
From 1 July 2022, the National Cervical Screening Program (NCSP) will expand Cervical Screening Test options, offering self-collection as a choice to all people participating in cervical screening.
These changes mean that health care providers may start to see an increase in the volume of requests from patients to use self-collection as an option for their Cervical Screening Test.
- To support these changes, the NCSP: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding (guidelines) have been reviewed and updated to incorporate the self-collection eligibility expansion. The guidelines bring together the best available evidence to prevent, diagnose and manage screen-detected cervical abnormalities.
All NCSP participants aged 25-74 years old will have the choice to screen using either a self-collected vaginal sample or a clinician collected sample from the cervix, accessed through a health care provider in both cases.
- To support these changes, the NCSP: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding (guidelines) have been reviewed and updated to incorporate the self-collection eligibility expansion
- The guidelines bring together the best available evidence to prevent, diagnose and manage screen-detected cervical abnormalities. They also provide recommendations for health care providers with patients in specific situations, such as people displaying symptoms of cervical disease and follow-up treatment for cervical abnormalities where co-testing (HPV test and a cytology test at the same time) is required
- Recent evidence demonstrates HPV tests performed on self-collected vaginal samples are as accurate as HPV tests performed on clinician-collected samples taken from the cervix during a speculum examination
- A self-collected sample is taken from the vagina (not the cervix). It can be tested for the presence of human-papillomavirus (HPV) but not cytology (cervical cell abnormalities). If HPV is detected in a self-collected sample, depending on the type of HPV detected, the patient will either need a speculum examination for liquid-based cytology (LBC) to determine management, or will need to be referred directly for a colposcopy
- Self-collection provides a level of control and choice for patients, removing a significant barrier to participation in screening
- There are some groups that are less likely to screen, including Aboriginal and/or Torres Strait Islander women, culturally and linguistically diverse communities, people who identify as LGBTIQ+, people with disabilities, people who have experienced sexual violence, post-menopausal women and people who have had previous negative cervical screening experiences. Self-collection may be more acceptable to these groups
- A pilot demonstrated that 85.7% of never or under-screened women who declined an examination, agreed to HPV self-collection when the test was offered to them in a sensitive and culturally appropriate manner and with appropriate follow-up advice
- Health care providers will continue to play a critical role in assessing patient risk and using clinical judgement to recommend testing and follow-up, as well as offering a consultation for cervical screening whether it be a self-collected vaginal sample or clinician-collected cervical sample
- Health care providers will need to explain to patients how to collect a self-collected sample and provide the correct swabs for collection of the sample. It is imperative that patients are presented with clear information about the likelihood of HPV being detected and, if so, what follow-up will be required
- Wherever a patient takes their sample, the health care provider remains responsible for sending the sample to the pathology laboratory for processing and for informing patients of results and any follow-up required
- Health care providers should make contact with their local pathology laboratory to confirm the correct swab type for self-collected samples and any other handling/processing considerations