It may have come to your attention that the cervical screening test is changing. This is to bring Australia in line with current European practice. The new cervical screening program will protect up to 30% more women from cervical cancer than the current system. Cervical cancer is rare and it usually takes 10 or more years for the cancerous cells to develop.
The current PAP smear requires abnormal cells to be identified by someone looking down a microscope, which leaves a reasonable margin for error. The new screening process uses a machine to test the sample for HPV infection. HPV is the human papilloma virus and it is associated with 99.7% of all cervical cancers. There are over 100 strains. 40 strains of which infect the genital area. 15 of these strains have been implicated in the development of cervical cancer.
HPV is a very common infection that is spread through genital skin to skin contact during sexual activity. Therefore, all women should be tested for HPV. Condoms provide some protection but do not cover all the genital skin. Because it is so common many people will have it at some point in their lives and never know. In the majority of cases the body’s immune system will clear the virus within 1 – 2 years. Persistent infection is the risk factor for developing cervical cancer.
The new screening test therefore detects HPV infection that can cause abnormal cell changes long before the development of cancer. Because it is such a good test, testing is only required every 5 years.
But what do the changes mean for you?
Firstly, the test is performed in exactly the same way as the current PAP smear. An option for self-testing is being considered but it doesn’t give your doctor the opportunity to examine you and look for other potential problems such as polyps or abnormal skin changes; and your self-taken sample won’t be from the entrance to the cervix so if you test positive for HPV, another PAP smear will need to be taken to get a sample of cells.If you have had a PAP smear in the past 2 years your next cervical screening test will still be 2 years from that date.
You do not need the new test prior to that, unless you have symptoms which require investigation. If you test negative for HPV your next test will be 5 years from that date. If you test positive for HPV, but not for the strains strongly linked to cervical cancer, you will be advised to have a repeat test in 12 months. If you test positive for one of the worrying strains you will be immediately referred to a gynaecologist. Dependent upon the result, and also your personal history, it is likely that the gynaecologist will organise further investigations, most commonly a colposcopy. A colposcopy allows for the cervix to be looked at more closely and small samples of tissue to be taken. You are positioned similarly to having a PAP smear and the process usually takes 10 – 15 minutes. As with a PAP smear, it may be uncomfortable, but not painful.
The new cervical cancer screening will be offered to women aged over 25 years. Cervical cancer is extremely rare in younger women and over 70% of young women in Australia are now vaccinated against the most dangerous strains of HPV. The vaccine is called Gardasil and has been routinely offered to Australian teenagers through the school based immunisation program since 2007. It is offered to both males and females and works best if it is given before exposure to HPV, i.e. Prior to commencing sexual activity. However, it is available for females aged 9 – 45 and males aged 9 – 26, so you may wish to discuss vaccination further with your doctor.
I hope this has clarified the new cervical cancer screening process but if you have further questions, please do not hesitate to talk to your doctor.
Author – Dr. Freyja Page
MB,BS (London), DCH
Dr Freyja Page is a GP Registrar with over 10 years hospital experience and 3 years consulting within the General Practice environment. She has diplomas in Obstetrics from The Royal College of Obstetricians & Gynaecologists and in Family Planning and Sexual health from Sexual Health and Family Planning Australia.
© Townsville & Suburban Medical Practice, 2018.