Q: Why have pap smear tests changed from every two years to every five years?
Everyone is fairly familiar with the old pap smear screening program which was recommended to be done every two years for low-risk women with previously normal results.
However, now we have a new kind of test called the Cervical Screening Test (CST), and it works a bit differently.
One of the reasons for change is that we have been vaccinating against the Human Papilloma Virus (HPV) for over ten years and we know that this is the biggest risk factor for developing cervical cancer.
Now the cervical screening test is looking for the presence of the HPV virus and in particular the high-risk strains of that virus. It is important for vaccinated women to still have a CST.
While women used to enter the pap smear program at 18 years old, the cervical screening program now starts at 25 (and ends at 70-74 years old).
A negative result indicates a low risk of developing HPV-related cervical cancer.
For those under 25 who do develop symptoms such as abnormal bleeding, bleeding after sex or between periods, we can investigate for the rarer cancers or other causes of bleeding such as polyps, fibroids or endometriosis through consultation with a gynaecologist.
It is important to visit your GP if you do have any abnormal bleeding, regardless of how long it has been since your last CST.
Since we have started screening for HPV we are finding some distress in older women who have had normal pap smears all their life and now suddenly they have tested positive for HPV.
Having been with the same partner for 30 or 40 years, they don't understand how they could get a sexually transmitted virus, but it's probably been present all that time and it's just been dormant and not actively changing the cells.
This is a case where patient education is really important, to reassure them that it's okay and doesn't mean there has been an affair.
Another important point is to remind women to still get a CST if the scheduled date falls during their pregnancy, especially if it's in the first trimester.
It is perfectly safe and is recommended because if you wait until the end of the pregnancy you could be more than a year overdue.
How does the cervical screening test (CST) work?
As with your previous pap smears, your doctor will take a brushing of cells from the cervix to be tested.
If HPV strains are all negative, you will be told your results are normal, and you simply need to repeat the test in five years.
If you return a positive result for one of the high-risk strains your cells will be examined closely, and your doctor will usually get you to repeat the test in 12 months rather than wait for five years.
If after 12 months you test positive again or there is concern you will be referred to a gynaecologist to have a closer look at the cervix and they'll do something called a colposcopy, which is an examination of the cells under a microscope to check the appearance of the cells and they'll grade them as to whether the cells look normal or have low grade or high grade changes. This will then help direct management decisions.
- Today's answer is provided by Sydney obstetrician and gynaecologist Dr Robyn Lloyd, through HealthShare, a digital company dedicated to improving the health of regional Australians. Submit questions, and find more answers, at healthshare.com.au.