In December 2017 Australian national guidelines changed the pap smear test for cervical cancer to a cervical screening test in order to also detect for Human Papilloma Virus (HPV) and extending repeat tests from two years to five years.
Prior to this pap smears had been recommended to commence at 18 years or two years after the first instance of sexual intercourse. Now, the cervical screening test starts at 25 years old. The previous finishing age had been 70, now revised to 75.
This update is to monitor the immune status for young adults who were immunised as teens using Gardasil against the strains HPV 16, 18, 6 and 11. Australia was the first country to initiate Gardasil into the national public vaccination program, which began in 2007.
Obstetrician and gynaecologist Dr Anu Kaur discussed the changes to the screening test, and what women need to know about it.
"HPV testing every five years is more effective, just as safe, and is expected to result in a significant reduction (24%-36%) in the incidence and mortality from cervical cancer in Australian women, compared with the program it replaces, which is based on two yearly pap smears," said Dr Kaur.
Dr Kaur said the testing program has changed because of the success of the vaccination program, which has led to lower rates of cervical abnormalities in this age group. Cervical cancer in this group is rate, and specialists are also trying to avoid over-treatment at a younger age, in order to reduce future pregnancy complications.
"A person under the age of 25 who is symptomatic ie. abnormal periods, bleeding between periods or bleeding with intercourse, should check with a doctor, who may decide to undertake a cervical smear test earlier than the normal starting age of 25.
"If an early test is done and returns negative, then the next test should be done at the age of 25," she said.
If the test is unsatisfactory, the standard procedure is to either perform a repeat smear test or refer the patient to a specialist for a colposcopy which allows the gynaecologist to examine the cells of the cervix in more detail. Repeat screenings will also be carried out.
"The body gets rid of the HPV virus in about 8-10 months' time. It's just a virus, it's acquired through sexual activity, but it's not a sexually transmitted disease. It's like acquiring a common cold. That's why we check the patient in 12 months' time to ensure the patient has cleared herself of HPV.
"If she gets a HPV of any strain in 12 months' time, she will get referred to a specialist for a colposcopy," said Dr Kaur.
Persistent infection with high-risk HPV types can remain in the body without obvious symptoms but can result in the development of a range of anogenital tumours including cancers of the cervix, anus, penis, vulva and vagina. HPV infection is also associated with squamous cell carcinomas of the head and neck, particularly oropharyngeal cancers.
Cervical screening tests also examine for cancer and pre-cancer changes in the cervix, results rated as either normal, low-grade or high-grade.
"Some of the high-grade changes would need surgical intervention so that they don't progress into cancer. This is a minor surgery."
Suspicious cells are taken for a biopsy to examine in the lab. The turnaround time is a maximum of two weeks.
Common misconceptions about smear tests
"People think that if they have had the Gardasil vaccine, they do not need cervical screening tests – that is wrong," said Dr Kaur.
"The early Gardasil only covered four strains, there is a new one that covers nine, but there are thousands of kinds of HPV, and that is why having a cervical smear test is very important.
"Those in same sex relationships still need have their screening. I still advise same sex couples to have cervical smear tests as part of their health program. HPV is so common that it could be considered a normal consequence of being sexually active as most people will have genital HPV at some time and remain unaware of it.
For women who have had hysterectomies, if their last few smears and cytology reports have come back as normal will not need any more smears, but those with a history of abnormal smears may be advised to continue having smears from the top of the vagina. This part is usually not removed in a hysterectomy and has the same cells as the cervix.
Some people who have changed from the process of receiving a smear every two years to every five years feel that this is not frequent enough, however Dr Kaur says this is not necessary, and while patients can ask for more frequent testing, Medicare will not cover tests done before the five-year interval unless an abnormality is being investigated.
For more information visit HealthShare, a joint venture with Fairfax to improve the health of regional Australians.