Cervical Screening
The Pap test has changed!
As of 1st December 2017 the Pap test has been replaced with the Cervical Screening test. The Cervical Screening test is a new and improved method of detecting changes that can lead to cervical cancer.
Instead of getting a Pap test every 2 years, now Australian women need to have a Cervical Screening test every 5 years. If you’re aged between 25 and 74, you’ll be invited to have your first Cervical Screening test 2 years after your last Pap test. If your results are normal, you won’t have to have another one for 5 years.
How is the Cervical Screening test different?
The Cervical Screening test is the result of the latest medical and scientific evidence about cervical cancer.
While the Pap test was very successful in detecting cervical cancer, it’s now known that almost all cervical cancers are caused by the human papillomavirus (HPV).
The Cervical Screening test looks for HPV infection in the cells of your cervix. As it takes 10+ years for HPV to cause precancerous abnormalities that can develop into cervical cancer, and this new test is more effective at detecting HPV, we can now identify women at higher risk of developing cervical cancer, and monitor them to prevent it from happening.
This is great news for Australian women! It’s expected that routine cervical screening will protect up to 30% more women from developing cervical cancer.
How is HPV linked to cervical cancer?
The human papillomavirus is a common infection that’s spread by skin-to-skin contact during sexual activity. It’s believed that up to 25% of sexually active women will contract HPV.
There are actually over 100 types of HPV infection. HPV types 16 and 18 are responsible for about 70% of cervical cancers, and another 14 types are also associated with the two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma of the cervix.
But having HPV doesn’t mean you’re at risk of cervical cancer. Most of the time, HPV resolves on its own without ever causing any symptoms.
Can HPV be treated?
There is no treatment for HPV. If you’ve got it, chances are your body’s immune system will clear it up in 1-2 years. If it remains active in your body, some types of HPV can cause cervical changes, which is why the Cervical Screening test is so important.
Is HPV the only cause of cervical cancer?
No. Smoking is another major risk factor in the development of cervical cancer. Smoking reduces the body’s capacity to clear the HPV virus.
Also, women exposed in utero to an artificial form of oestrogen called diethylstilbestrol (DES) are also at increased risk.
Is Cervical Screening every 5 years safe?
It usually takes 10-15 years for a persistent HPV infection to cause abnormal cells to develop in the cervix. So screening every 5 years is a safe way to identify if you’re at risk.
That being said, it’s important to remember that if you have unusual bleeding or pain, don’t wait until your next Cervical Screening test to get checked out. See your GP for a referral to a gynaecologist who can investigate the issue.
What does the Cervical Screening test cost?
The cost associated with a cervical screening test is your GP’s consultation fee. You can get a Medicare rebate for this cost if you use a private practice. Alternatively, If you go to a bulk billing doctor, there are no out of pocket costs for you.
If you’re in doubt, just give your GP’s office a call, and the receptionist can let you know what the exact cost will be.
What to expect at your first Cervical Screening test
Is this your first Cervical Screening test? It’s normal to feel a bit anxious. But while cervical screening may feel a little bit uncomfortable, it’s worth it for your cervical health.
The test itself is performed similarly to the old Pap test. While you’re lying back with your knees apart, your GP or gynaecologist will gently insert a speculum into your vagina to hold it open, which makes it easier to see your cervix.
Then they’ll put a small brush up through the speculum. They’ll brush it around a few times to collect some of cells from your cervix. When they’re done, they’ll gently remove the speculum, and put the brush with your cells into a tube to be sent to the pathology lab.
The whole thing takes only about 5 minutes. It can feel a bit weird or uncomfortable, but it doesn’t hurt.
Understanding your Cervical Screening result
There are several different types of cervical screening result:
Return to screen in five years
This result means no HPV infection was detected.
No HPV means the chance of you developing cervical abnormalities within 5 years is very low, so it’s safe to wait for your next test. The National Cervical Screening Program will send you a letter in 5 years when it’s due.
It’s important to remember that if you ever experience unusual bleeding, cramping or abdominal pain, see your GP.
Unsatisfactory result
If your result was ‘unsatisfactory’, it’s not necessarily a cause for alarm. Sometimes your sample can’t be read properly by the laboratory. This can happen for a few reasons, such as too few cervical cells being collected.
If you receive an unsatisfactory result, you’ll need to repeat the Cervical Screening test in 6-12 weeks. This wait is to allow cells in your cervix to renew so another sample can be taken.
Repeat the HPV test in 12 months
This result means that the laboratory found HPV, but types 16 or 18 weren’t detected.
You’ll require another Cervical Screening test in 12 months to check if your body has cleared the infection. If you still have HPV after a year, you might need to see a specialist for further investigation. This doesn’t necessarily mean you have developed cancer. But it’s important to identify any abnormal cells that need treatment to prevent an eventual progression into cervical cancer.
What if I’m pregnant?
The Cervical Screening test is safe for pregnant women, and should be part of your antenatal care when it’s due. It’s important to tell your GP or gynaecologist that you’re pregnant before the test, because they’ll need to use a slightly different tool for gathering cervical cells.
However, if you’re more than 24 weeks pregnant, talk to your gynaecologist about whether to wait until after the baby is born. Most doctors will offer cervical screening as part of your post-natal follow-up care.
But I’ve only had one sexual partner!
Even if you’ve only had sex with one person (male or female), you still are at risk of HPV. So you still need to get tested.
I’ve had a hysterectomy - do I still need a cervical screening?
If your cervix wasn’t removed during your hysterectomy, you’ll still need to be screened every 5 years, or as recommended if a cervical abnormality has been detected previously.
If you had a total hysterectomy for non-cancerous reasons (for example fibroids), you don’t need to get screened. However, if you have had a past history of high-grade squamous intraepithelial lesions (HSIL), you’ll need to have cells tested from your vaginal vault every 12 months until those tests are negative.
Should I have the HPV vaccine?
The human papillomavirus vaccine works best if you get it before you’re sexually active. If you’ve already been exposed to HPV, the vaccine’s benefits may be reduced.
In Australia, the HPV vaccine is now part of a school-based immunisation program. It is delivered over three doses and helps build immunity to protect against 9 types of HPV, which can cause the majority of cervical cancers and genital warts.
If you didn’t get the HPV vaccine in school and want to be vaccinated, talk to your healthcare provider.
Further tests after a high-risk result
If you have been referred to our specialist practice, we will perform a colposcopy to investigate your cervical cells further.
A colposcopy is a close examination of the cervix using a special microscope called a colposcope. Cervical cells are magnified 15-30 times, and a vinegar solution is applied to test cell health. Healthy cells remain pink, while cells that turn white need further investigation.
Treatment for cervical abnormalities
If your colposcopy indicates abnormalities in your cervical cells, you’ll require further treatment. Your gynaecologist will discuss your treatment options with you, and recommend the best course of treatment for your personal circumstances.
- Laser treatment: This involves removing the abnormal cells using heat from a laser beam. The procedure takes about 15-30 minutes under local anaesthetic.
- Cone biopsy: In this minor operation, a cone-shaped section of your cervix which contains the abnormal cells is removed. This is done under a general anaesthetic, and requires a short hospital stay (a day or two).
- Wire loop excision: During this procedure, abnormal cells are removed from your cervix using a wire loop. It can be done under local or general anaesthetic (your choice).
Where can I get a Cervical Screening test?
Your first point of call for having your cervical screening test (CST), is to your general practitioner. They will be able to manage all your screening tests for you. It's only if you have some concerns with your GP performing your CST for you, or that you have had a result that needs investigating that you would be referred to one our specialists.
If you don’t want to see your usual doctor, our female-only gynaecologist practices are located at two convenient locations in North Brisbane. Remember, you will still need to see your GP for a referral to us as well.
Further reading
Women with a histological diagnosis of CIN 2 or CIN 3 should be treated by local ablative or excisional treatments in order to reduce the risk of developing invasive cervical carcinoma.
Please read further below on Colposcopy and LLETZ procedures.
Colposcopy
If you have been advised by your GP that your CST has returned back abnormal you will be referred to a gynaecologist to have a Colposcopy. A Colposcopy can be treated in rooms and we can advise you of the costs associated with this treatment.
The information we provide to our patient’s is contained in the following PDF link;
LLETZ
A Large Loop Excision of the Transformation Zone ( LLETZ ) procedure is performed in hospital and only required should your biopsy from your Colposcopy come back abnormal.
The information we provide to our patients is contained in the following PDF link;
