PAP tests are changing
The Australian Government is planning to change the National Cervical Screening Program. The current screening program was developed in 1991 and we now know a lot more about cervical cancer.
What happens now?
The current screening program recommends that everyone who has a cervix should have a Pap test every two years, from age 18 or two years after starting sex until the age of 69. When a doctor or nurse does a Pap test cells from the cervix (the neck of the womb) are collected with a soft brush and the cells are put on a glass slide or into a special liquid. Specially trained scientists (cytologists) look at the slides and identify any abnormal cells. If abnormal cells are seen patients will either be asked to repeat the Pap test in 6 -12 months or be referred to a gynaecologist for further investigation.
Why change?
We now know that cervical cancer is caused by some types of the Human Papilloma Virus (HPV). Almost everyone who has sex gets HPV and most people clear the virus without needing any treatment. In some people, the virus stays in the body and over a number of years the virus can cause changes that lead to cancer. It is these people, who are at risk of cancer, that the screening program is trying to find. The new test can detect HPV before any changes in the cells occur. This makes it a better screening test. The new test is more sensitive and accurate than the previous Pap test. Since 2007 we have had a National HPV Vaccination Program for girls. In 2013 boys were also included in the HPV vaccine program. The vaccine prevents infection with HPV type 16 & 18 which cause 70 -75% of cervical cancer.
Who needs to be screened?
Anyone with a cervix and aged between 25 and 74 years who has been sexually active will be invited to attend cervical screening every five years.
| WHAT | NEW CHANGES HAPPENING IN 2018 | PRE 2018 PORGRAM |
| Test | Cervical Screening Test HPV test & if the test is positive cytology will be done on the same sample | Pap test cytology - looking for abnormal cells |
| Sample collection | Speculum examination cells collected from the cervix | Speculum examination cells collected from the cervix |
| Screening Interval | Five years if test is negative | Two years if test is negative |
| Age range | 25 - 74 | 18 - 69 |
| Screening Resister | National – issues invitations & reminders | State based – reminders only |
| Self-testing | For those who have never had a test or who haven’t had a screen for a long time. This must be done in a healthcare setting. | Not available |
What happens during a Cervical Screening Test?
The new test will feel the same as having a Pap test. The doctor or nurse will insert a speculum so that they can see the cervix. A soft brush will be used to collect cells and the sample placed into a liquid. The sample will be sent to the lab to check for HPV. If HPV is found another test will be done on the same sample to look for any changes in the cells.
What if I have a positive test?
If the HPV test comes back positive it does not mean you have cancer. A positive HPV test means that you have the virus and may need further investigation with a gynaecologist, or more frequent screening. Most people will clear the virus without treatment. Your doctor will discuss your results and recommend further care.
When should I have the test?
When the new program is introduced the National Cervical Screening Register will send you out an invitation to be screened. If you are currently having Pap tests the register will send out an invitation a few months before your Cervical Screening Test is due. The timing of the invitation will depend on the results of your most recent Pap test. If you have already had a normal Pap test and are not yet 25 years you will not be invited to have a Cervical Screening Test until you are 25 or two years after your negative Pap test whichever is later. If you are under 25 and not yet had a Pap test you will be invited to participate in the program from the age of 25.
If your last Pap test was abnormal you will receive an invitation for a Cervical Screening Test when your next Pap test is due.
Is it safe for me to wait until 25 for my first test?
YES it is safe because:
- cervical cancer is very rare in this age group
- most young people will clear the virus without needing treatment
- most young people are protected by the HPV vaccine. The National HPV Vaccination Program is reducing the number of HPV infections and cervical pre-cancers in both vaccinated and unvaccinated populations. This impact will increase as more young people are vaccinated
- the current cervical screening program has not shown to make a difference to the detection of cervical cancers for women under 25
- Young people are at risk of overtreatment in the current program
- Almost all countries with organised programs recommend that cervical screening starts at age 25 or 30 years and the International Agency for Research on Cancer (IARC) recommends regular cervical screening begin at the age of 25 If you have had any sexual activity before 14 years of age, you can ask your doctor or nurse about having a Cervical Screening Test at an earlier age.
What if I’ve had the HPV vaccine?
The HPV vaccine does not cover all the types of HPV that cause cancer. It is important that even if you have been vaccinated you take part in the National Cervical Screening Program.
Can I do the test myself?
Four out of five people who develop cervical cancer have either never been screened or have been screened less often than they should. In the new program, a self-collected Cervical Screening Test will be possible within a clinic setting for some people. A self-collected test is less accurate than a Cervical Screening Test performed by a trained doctor or nurse, and for this reason, a clinician-collected sample is preferred. There are several ‘self-testing’ home-based kits being advertised in Australia which are not part of the National Cervical Screening Program and are not recommended.
Is there anything else I need to know?
Please remember that the National Cervical Screening Program is for those without symptoms. If you have any abnormal bleeding: bleeding after sex, between your periods or after menopause this needs to be investigated and treated. These symptoms can be caused by HPV infection and rarely cervical cancer. If you have any questions or concerns it is useful to write them down to ask your doctor or nurse.