Changes to the way we screen for cervical cancer

Two-yearly Pap smears are being replaced with a five- yearly HPV test. We answer women’s important questions on the changes. By Kirsten Braun.

Female doctor with female patient

From 1 December 2017, important changes will be made to the National Cervical Screening Program, the program that aims to prevent cervical cancer by detecting early changes in the cervix. 

The key changes to the program are:

  • The Pap smear test will be replaced with a human papillomavirus (HPV) test

  • Screening will start at age 25 (up from current age of 18)

  • The time between tests will change from two to five years

  • Women will be invited to screen until 69 years of age and then invited to exit the program if they have a further negative HPV test between 70 and 74 years of age

  • A national screening register will be established, replacing the current State and Territory-based Pap smear registers. Invitations and recall letters will be sent out to encourage participation

  • New tests will be available on the Medicare Benefits Schedule (MBS).

To better explain the changes and how they will affect women, Women’s Health has answered a number of frequently asked questions.

Why has the Pap smear test been replaced by a test for HPV?

It is known that almost all cervical cancers are caused by persistent infection of HPV.  HPV is an extremely common sexually transmitted infection (STI). Most people’s immune system will clear the HPV virus on their own within a year. However, for some women the HPV infection will persist, causing precancerous cell changes. Most of these precancerous cell changes will also return to normal with no treatment. In rare cases, however, the precancerous changes can eventually progress to cervical cancer but this takes between 10 to 15 years. 

Since the introduction of cervical screening in Australia in 1991, a large body of scientific evidence has been accumulated, demonstrating that the HPV test is more effective than the Pap smear test for cervical screening. The current Pap smear test looks for precancerous changes in the cells of the cervix. The HPV test, however, actually looks for the presence of the HPV virus which causes these precancerous changes to the cells.

Why the switch to five-yearly tests? Is this still safe?

As the Pap smear test was looking for precancerous changes to the cells it needed to be done every two years. The HPV test detects the virus that causes the precancerous changes and, therefore, is more effective. Women can, therefore, be screened less often, every five years instead of every two years. It is estimated that over a woman’s lifetime the number of tests she will have will drop from 26 to approximately 10.

Screening every five years avoids detecting HPV infections that are likely to clear up on their own within a year. Under the two-yearly screening program, precancerous changes that would usually resolve on their own may have been treated, with some of these treatments increasing the risk of pregnancy complications. Moving to a five-yearly system reduces the chances of this occurring.

Cervical cancer is a very slow progressing cancer. The precancerous stage can last for many years before the development of invasive cancer. Therefore, it is safe for women to have five-yearly screening rather than two-yearly screening.

If women display any symptoms of cervical cancer (i.e., bleeding between periods, bleeding after intercourse, or unusual vaginal discharge or pain), in the years between tests they should see their doctor. 

Why has the age to start screening changed to 25?

The age to begin screening has increased to 25 for a number of reasons. The introduction of the cervical cancer vaccine has meant that women aged 20-24 now have a substantially lower risk of cervical cancer. These women would have been offered the vaccination at school and the take-up rate for vaccination in these women is high. The vaccine protects women from the two types of HPV that cause about 70% of cervical cancers.

Cervical cancer is very rare in women under the age of 25, in both HPV vaccinated and unvaccinated women. It is estimated that in 2016, there were 738 new cases of cervical cancer in Australia, with only 13 of these occurring in women aged 20-24.

In addition, evidence shows that since the introduction of cervical screening in 1991, the number of cases or deaths from cervical cancer in women under 25 has not changed. This means that screening women younger than 25 for more than 20 years has had no effect on preventing cervical cancer in this age group. As discussed in the question above, some treatments for precancerous changes can increase the risk of pregnancy complications later in life. Therefore, as the risks of screening this age group (pregnancy complications) appear to outweigh the benefits, the age to begin screening has been raised to 25.

What if a woman first had sex when she was very young or was the victim of sexual abuse - should these women have their first HPV test earlier than age 25?

As the incidence of cervical cancer is very rare in women under the age of 25, even women with these circumstances can wait until age 25 to have their first HPV test. If a woman experiences symptoms of cervical cancer (i.e., bleeding between periods, bleeding after intercourse, or unusual vaginal discharge or pain), before the age of 25, they should visit their doctor. Women under the age of 25 with symptoms of cervical cancer would be offered an HPV test. Women who have no symptoms but wish to have an HPV test before the age of 25 are still able to but will not be entitled to Medicare funding, so would need to pay for it themselves. 

What does having the HPV involve? Is it very different from a Pap smear?

For women the actual test will look and feel the same. Women will still need to get undressed from the waist down, have a speculum inserted into the vagina and have a small sample of cells taken from their cervix. The difference will be the way the sample is examined in the laboratory. The same health professionals who provided Pap smear tests (doctors, nurses, midwives, Aboriginal health workers) will conduct the HPV test.

What will the new HPV test cost?

When the new National Cervical Screening Program is implemented, the HPV test will be covered under the MBS. Similarly, it is expected that pathology companies will bulk-bill the test. This means the actual test will be free. However, women may still have to pay for the doctor’s appointment itself, if their doctor doesn’t bulk-bill. Women can ask when they book their doctor’s appointment if they will have any out-of-pocket expenses.

What will happen after I have the HPV test?

If a woman’s test is negative (no HPV present), her next test will be in five years. If a woman’s test is positive to HPV, the same sample will undergo further testing. Depending on the type of HPV and if there are any cell changes, a woman may be referred for a colposcopy (a thorough examination of the cervix) or advised to have a repeat test in 12 months. 

I had the cervical cancer vaccine. Do I still need to worry about cervical cancer screening?

While having the cervical cancer vaccine will reduce the risk of cervical cancer, the current vaccine only protects women from two types of HPV that cause about 70% of all cervical cancers. As the vaccine doesn’t provide complete protection, vaccinated women still need to have cervical cancer screening.

My Pap smear is due now? Should I wait until the new screening program begins?

Until the new screening program is in place it is essential that women keep having regular two-yearly Pap smears. Women should not delay having their Pap smear until the new program is implemented. Approximately 80% of women diagnosed with cervical cancer have never been screened or have not had regular Pap smears.

What happens next? How will I know when to have the new HPV test?

From 1 December 2017, women aged 25 or over who have never had cervical screening will receive an invitation to have the HPV test from the new National Cancer Screening Register. Women over 25 who had a Pap smear test in the past will receive an invitation to have an HPV test when they are within three months of the date when they would have been due for their Pap test. Women will also receive a reminder from the National Cancer Screening Register if they are three months overdue for their test.

At what age can I stop having HPV tests?

Women between the ages of 70 and 74 who have had regular screening and negative results will have an exit (final) HPV test. If this test is also negative they can then leave the cervical screening program and won’t need to have a further HPV test.

 Take home messages

  • Move from a Pap smear test to an HPV test which is more effective

  • The time between tests will change from two to five years

  • Women can wait until they are 25 to start screening

  • Having the new screening test will look and feel the same as a Pap smear test

  • Women will receive an invitation to have the test

  • For more info on the changes call the Cervical Health Info Line on 1800 017 676 or 07 3216 0376.

Last updated: March 2017

© Women's Health Queensland Wide Inc. This article was written by Kirsten Braun and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey 2017 Issue 1.

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