Renewal of the National Cervical Screening Program
In Australia cervical cytology remains a cost effective test for reducing incidence and mortality of cervical cancer by the detection and subsequent treatment of its precursors. General practitioners have a great role in recruitment of women who has never been screened or under screened.
Renewal of the national cervical screening program
The cervical screening program will change from every 2 years pap smear for women aged 18-69 to a 5 yearly HPV test for women aged 25-74 years.
So the major change in clinical practice is that conventional cytology is replaced by HPV testing and LBC for follow up of women with histologically confirmed LGSIL CIN1. The high negative predictive value of HPV testing allow a significant proportion of women to return to routine cervical screening earlier than was possible under the pre renewed NCSP.
Referral of women with a positive HPV (16/18) test result and reflex LBC pHSIL/HSIL. Women with a positive oncogenic HPV (16/18) test result and reflex LBC prediction of pHSIL/HSIL should be referred for colposcopic assessment at the earliest opportunity, ideally within 8 weeks.
Women with positive HPV 16,18 and negative LBC, repeat HPV test in 12 months by medical practitioner. If the result is again positive then for colposcopy.
Management after repeat HPV test at 12 months, following initial positive oncogenic HPV (not 16/18) test result.
At repeat HPV testing 12 months after a positive oncogenic HPV (not 16/18) test result with reflex LBC negative or pLSIL/LSIL:
- If a woman has a positive oncogenic HPV (any type) test result, reflex LBC will be performed and she should be referred for colposcopic assessment
- If oncogenic HPV is not detected, the woman should be advised to return to routine 5-yearly screening.
Women with HPV 16&18 positive with LBC showing invasive squamous cell carcinoma or glandular lesion should be referred to Gynaecology oncology ideally in 2 weeks. Total hysterectomy after completed Test of Cure.
Women who have had a total hysterectomy with no evidence of cervical pathology, have previously been successfully treated for histologically confirmed HSIL and have completed Test of Cure, do not require further follow-up. These women should be considered as having the same risk for vaginal neoplasia as the general population who have never had histologically confirmed HSIL and have a total hysterectomy.
If unexpected LSIL or HSIL is identified in the cervix at the time of hysterectomy, then these women require follow-up with an annual co-test on a specimen from the vaginal vault until they have a negative co-test on two consecutive occasions. Total hysterectomy after adenocarcinoma in situ (AIS)
Women who have had a total hysterectomy, have been treated for AIS, and are under surveillance, should have a co-test on a specimen from the vaginal vault at 12 months and annually thereafter, indefinitely.
Women who have a total, hysterectomy as completion therapy or following incomplete excision of AIS at cold-knife cone biopsy or diathermy excision, should have a co-test on a specimen from the vaginal vault at 12 months and annually thereafter, indefinitely.
Positive oncogenic HPV (not 16/18) test result with LBC pHSIL/HSIL or any glandular abnormality in pregnancy
Screening in pregnant women
Positive oncogenic HPV (not 16/18) test result with LBC negative or pLSIL/LSIL in pregnancy.
Pregnant women who have a positive oncogenic HPV (not 16/18) test result with a LBC report of negative or prediction of pLSIL/LSIL should have a repeat HPV test in 12 months.
Pregnant women who have a positive oncogenic HPV (not 16/18) test result with a LBC prediction of pHSIL/HSIL or any glandular abnormality should be referred for early† colposcopic assessment.
Primary HPV screening will commence from 1st of December 2017
The major changes in new cervical screening program (NCSP)
- Five yearly cervical screening using a primary HPV test with partial HPV genotyping and reflex liquid based cytology LBC triage for HPV vaccinated and unvaccinated women 25-69 years of age with exit of testing at the age of 74 years.
- Self-collection of HPV samples for an under screened or unscreened women which has been facilitated by a medical practitioner or a nurse.
- Invitation and reminder to be sent to women 25-69 years and exit communication to be sent to women at the age of 70-74 years.
- National cancer screening registry, will be introduced in 2017 and all colposcopy will be sent to the registry for bench marking and quality assurance.
- Delisting of existing cervical test MBS item.
There is strong evidence that the proposed changes in the screening will result in further 30% reduction in the cervical cancer over time.
Dr Tahrir Basheer
Obstetrician & Gynaecologist
28 Mercury Street
Wollongong NSW 2500
P: 02 4226 2844
F: 02 4226 2840