Cervical Screening in Australia

In the past, it was recommended that sexually active women have Pap smear tests every two years. The Pap smear test has been replaced by the new Cervical Screening Test (CST).

Cervical screening saves lives by preventing cervical cancer.

Cervical cancer is the growth of abnormal cells in the lining of the cervix.

Cervical cancer may develop following persistent infection with the human papillomavirus (HPV) that causes changes in cervical cells which may lead to cervical cancer, usually after 10–20 years.

HPV is acquired by genital skin-to-skin contact most commonly through sexual intercourse, but any genital contact may be sufficient.

HPV infection is extremely common in men and women who have had sex. Four out of five people will have HPV infection at some time in their lives and usually won’t know about it.

In nearly all women (98%) the HPV clears without treatment, but in a small number it persists.

The new CST detects cancer-causing (oncogenic) HPV infection that may lead to cervical cancer.

There are 14 oncogenic types of HPV that the CST can detect.

The CST specifically identifies HPV types 16 and 18 that cause about 70% of all cervical cancers; women with these types of HPV are considered to be at higher risk of developing cervical cancer.

The vast majority of women, eight to nine out of ten, will have a negative test (HPV is not detected) and will be advised to have another screening test in 5 years.

A smaller number of women, in whom HPV is detected, will require further investigation by colposcopy or follow-up testing.

What is cervical cancer?

Cervical cancer is an abnormal growth of cells in the cervix. If left untreated, it can grow and spread in the body, causing symptoms such as abnormal vaginal bleeding or discharge. There are two main types of cervical cancer. The most common type arises in the squamous cells of the cervix, accounting for about 80% of all cases. Adenocarcinoma arises from the glandular cells (cells that produce a secretion), and accounts for about 20% of cases. There are some other very rare types that are not easily detected by cervical screening. Nearly all cases of cervical cancer are caused by a persistent HPV infection.

Can cervical cancer be prevented?

Girls can be protected against the most common types of HPV (16 and 18) that cause cervical cancer by having HPV vaccination while at school.

Women can be screened using the Cervical Screening Test for the presence of HPV infection in cervical cells.

If detected, treatment for cervical cell abnormalities is simple and successful.

A repeat test in one year to see if the infection is persistent may be required or further investigation by colposcopy. This is the examination of the cervix using a colposcope, which gives a magnified view of the cervix. It is usually performed by a specialist gynaecologist and can detect abnormalities that may require treatment.

If a woman has a colposcopy and a cervical abnormality is confirmed, then treatment will be recommended.

Who should have a Cervical Screening Test?

Any woman, aged between 25 and 74, who has ever been sexually active, including same-sex relationships, even if they have received HPV vaccination.

Why do women who have been HPV vaccinated need the Cervical Screening Test?

The HPV vaccine does not protect against all of the HPV types that can cause cervical cancer, so it is very important that all women, vaccinated or not, continue to have a Cervical Screening Test every 5 years.

How is the sample of cervical cells obtained?

This involves an internal vaginal examination, similar to the Pap test examination. A special instrument, a speculum, is inserted very gently into the vagina, so that your cervix can be seen and the cell sample obtained, most commonly using a soft brush (Figure 1). This examination should not be painful, but can be a little uncomfortable and embarrassing.

How is the Cervical Screening Test done?

A sample of cervical cells is obtained from the cervix and placed in liquid in a small container. In the laboratory, the cells are tested for the presence of HPV infection. If HPV is detected, the laboratory will automatically examine the cell sample for any abnormality (cytology). The combination of the HPV test and the cytology test, if performed, will allow the laboratory to issue a report and make recommendation about any follow up, if needed.

How often should women have the Cervical Screening Test?

The test should be performed every 5 years. Some specific groups of women may require screening more often, but you will be advised by your doctor if this is necessary.

What happens if the test results are abnormal?

Your doctor will make a recommendation about the need for further tests or investigation:

If the HPV test is negative, you should have a further cervical screening test in 5 years.

If HPV is detected, you will need earlier follow up, as recommended by the laboratory and your doctor. This may involve referral to a specialist for colposcopy or a repeat HPV test in 12 months.

DISCLAIMER: This information is intended to be used as a guide of general nature, having regard to general circumstances. The information presented should not be relied on as a substitute for medical advice, independent judgement or proper assessment by a doctor, with consideration of the particular circumstances of each case and individual needs. This information reflects information available at the time of its preparation, but its currency should be determined having regard to other available information. RANZCOG disclaims all liability to users of the information provided.