Pap smear testing guidelines have changed

December 2017 saw the Pap test being replaced with the Cervical Screening Test in an effort to combat cervical cancer.  

Eight-hundred-and-ninety-eight new cases of cervical cancer were diagnosed in Australia in 2014, and one in 167 women will be diagnosed with cervical cancer by the age of 85. In 2016, 259 women lost their lives to cervical cancer, according to Cancer Council Australia.

“The prior recommendation of the National Cervical Screening Program was that every woman from the age of 21, or from the age they become sexually active should have a pap smear every two years,” Queensland-based gynaecological oncologist Dr Piksi Singh said.

The Cervical Screening Test is only needed every five years because it is “more accurate”, according to the National Cervical Screening Program.

“We now know that 99.7 per cent of cervical cancers are caused by HPV, the human papillomavirus, which cannot be detected by a Pap test,” Singh said.

While the Pap test “just [looked] at the cells of cervix,” the new Cervical Screening Test detects HPV DNA.  

“If the results are HPV-negative, the [patient] does not need to have the smear repeated for another five years. If the results are HPV-positive, a recommendation will be given on when their next Cervical Screening Test should [take place].”

The starting age is 25, with the test “entirely covered” by Medicare. The exit age is 74, if all results have been normal, Singh said.

A female’s first Cervical Screening Test is due two years after her last Pap test.

“Cervical cancer in women under 25 is rare and the data shows that screening of this age group has not reduced [disease-incidence]. Moreover, most people under 25 have strong immune systems which can clear the HPV infection without any treatment,” Singh said.

“Most women under…25 in Australia have [also] been immunised with Gardasil,” under the National HPV Vaccination Program.

“The Gardasil HPV vaccine provides protection against some types of HPV, including the two strains responsible for [most] HPV-related cancers. However, there are types of HPV not covered by the vaccine, which can still cause cancer. Young women may also have been exposed to HPV through sexual activity prior to receiving the vaccine.”

“It is exactly the same,” Singh said, with the smear being collected from the cervix.

The only other change is that there is a ‘self-collection’ option available to women over 30 who have never participated in the screening program, or if they are overdue for screening by two years or more, she said.  

Self-collection involves the patient collecting the sample in their own privacy at their GP or Gynaecologist’s practice.

“Self-collection is not recommended, but has been introduced to encourage participation.”

“We believe we will be reducing incidences of cervical cancer by 20 per cent with the Cervical Screening Test, [which] detects HPV strains most likely to cause [cervical] cancer,” Singh said.

If the test results are positive for HPV strain 16 or 18 or abnormal cells are detected, further investigations such as a colposcopy (a minor procedure examining the surface of the cervix) will be recommended.

“If you detect [HPV] sooner, [the sooner] you can move to investigations designed to identify abnormal cells and treat them before they evolve into a cancer,” Singh said.