Cervical screening: what’s changed?
Have you, like me, been tempted recommending to low risk women that they defer their due pap smears until after 1 December 2017?
Or, have you considered changing cervical screening recalls for low risk women to five years as they start coming through?
The strong message is “Don’t!”
General Practitioners (GPs) are being reminded to continue screening our female patients for cervical cancer with pap smears as they are due until 1 December 2017.
By now, you may be familiar with some of the changes that the renewed National Cervical Cancer Screening Program (NCSP) will bring, but let’s recap:
- Pap smears as primary screening will be replaced by Human Papillomavirus (HPV) Polymerase Chain Reaction (PCR) test with partial genotyping and reflex liquid-based cytology.
Gone are glass slides and wooden spatulas, however we continue to collect a cervical sample with a plastic spatula, broom brush and cytobrush combination of our choice. This sample is transferred into the liquid-based media that we are familiar with: SurePath or ThinPrep. Both HPV PCR and follow up reflex cytology, if needed, are performed from this liquid sample.
- Women aged 25-69 years, both HPV vaccinated and unvaccinated, will be invited to commence cervical screening using a primary HPV test with partial genotyping and reflex liquid-based cytology.
- Women will be offered an exit HPV test between 70-74 years of age and may cease cervical screening if their result is negative.
- Screening intervals will be recommended from the results of the first test and all subsequent tests: for women whose results are assessed as low risk this will extend to five years, intermediate risk to one year and high risk will be recommended to proceed to colposcopy.
- Self-collection of a HPV sample will be available as an alternative screening option for eligible under-screened or never before screened women who have declined invitations and reminders to participate in conventional screening. The following eligibility criteria applies for self-collection of a HPV sample:
- must be aged 30 years or over
- has declined a clinician-collected sample in the past
- has never participated in the NCSP or is overdue for cervical screening by two years or longer.
Unlike a cervical sample, the self-collected sample is vaginal and can be obtained by cotton swap without a liquid-based medium. Only a HPV PCR with partial genotyping will be performed on the sample, and if positive, women may be directed back to their GP for gold standard cervical sampling or directly for colposcopy.
- Women will subsequently be managed using a risk-based approach that is dependent on the cervical screening test results.
- State based Cervix Screening Registries will be replaced by a National Cervical Cancer Screening Register.
Did you know?
If we are investigating women with abnormal vaginal bleeding, the first line investigation is a co-test of HPV and liquid-based cytology.
If we have a pregnant asymptomatic patient due for screening, we will screen with co-test of HPV and liquid based cytology, avoiding the cytobrush. They are not eligible for self-sampling.
There is no evidence that women who have experienced early sexual intercourse will benefit from commencing cervical screening before the age of 25 years. Hence to reiterate, all women who are, or have been, sexually active should start screening at age 25.
Yes, there will also be detailed guidelines for:
- cervical cancer screening after hysterectomy
- transitioning patients who are currently under investigation and follow up for cervical cytological abnormalities found on pap smear.
If, like me, you’re feeling a bit overwhelmed taking all this in, don’t despair.
In the lead up to these changes, you will notice a glut of face-to-face education sessions scheduled.
- GPEx GP Extend workshops in Port Lincoln and Mount Barker for GPs and other healthcare professionals, as part of a collaboration with Country SA Primary Health Network (PHN). For more information and to register your attendance, visit the GP Extend website.
- A six-unit online learning program through NPS Medicinewise on the National Cervical Cancer Screening Program (I can personally recommend this one as well)
- Web-based guidelines were recently released on Cancer Council Australia, Cancer Guidelines Wiki: National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding
Bring on 1 December 2017, but until then..
Let’s keep screening all eligible women as they are due for pap smears and start conversations with our patients about the coming changes.