News
Cervical screening: what are the changes?
Aug 23, 2017
By Dr Christopher Smith
The Pap test will no longer be available for cervical screening in Australia from December this year. It is being replaced by an oncogenic HPV test with partial genotyping and liquid based cytology (LBC) triage to colposcopy. The new test will be known as the Cervical Screening Test (CST).
What are the main changes to the National Cervical Screening Program?
| |
Now |
December 2017 |
| Test |
Pap smear test |
HPV test with reflex LBC |
| Interval |
2 years |
5 years |
| Start Age |
18 years |
25 years |
| Exit Age |
69 years |
70-74 years |
| Register |
Reminder |
Invitation and Reminder |
| Self-collection |
No |
Yes |
What are the new recommendations for the management of CST abnormalities?
The majority (approx 90%) of cervical screening HPV test results will be low-risk and these women will be re-screened in 5 years. The intermediate risk group is very similar to the women who currently have a Pap test result of low grade abnormality, and they will be advised to return for repeat Pap test in 12 months. The new intermediate group is in fact at less risk as these women have HPV type not 16/18, and the women with higher risk oncogenic HPV types 16/18 have already been selected out and referred directly for colposcopy. Persistent HPV detection at 12-month follow-up, with LBC result, is an indication for colposcopy.
The recommended management of oncogenic HPV test results:
| Risk of significant cervical abnormalities within next 5 years |
Oncogenic HPV test result |
Reflex LBC result |
Recommended management |
| Low risk result |
HPV not detected |
Not required |
Routine Cervical Screening Test in 5 years. |
| Intermediate risk result |
HPV (not 16/18) detected |
Negative, possible LSIL or LSIL |
Repeat HPV test in 12 months.
At this time:
If HPV not detected – repeat CST in 5 years
If HPV (any type) detected - refer for colposcopy |
| Higher risk result |
HPV (not 16/18) detected |
Possible HSIL or HSIL or any glandular abnormality |
Refer for colposcopy |
| HPV (16/18) detected |
Any LBC result or unsatisfactory LBC test |
Refer for colposcopy |
| Other |
Unsatisfactory HPV test |
Not performed |
Retest Cervical Screening Test within 6 weeks |
| |
HPV (not 16/18) detected |
Unsatisfactory LBC Test |
Retest LBC only within 6 weeks |
How will women transition into the renewed program?
- Women who had a normal Pap test at their previous visit should attend for screening at the next scheduled test date (i.e. 2 years after their last Pap test) and this will be a CST
- Women who had an abnormal Pap test at their previous visit and were recommended to have a follow-up Pap test in 12 months, should attend at the scheduled due date, at which time she will have a CST
- Women who have been treated for high grade squamous abnormalities should attend at the scheduled due date for follow-up and continue or commence ‘test of cure’
Summary of changes:
In December this year, Australia will move to a primary HPV based cervical screening program, commencing at age 25 and finishing by age 74 years. Women will be invited and reminded to participate in the renewed program, which is anticipated to further reduce the incidence and mortality due to cervical cancer by up to 30%.
For more information, please see Dr Smith's profile on the North Shore Private Hospital website.