Starting 1st of December 2017
By Dr Julia Marcello
The number of cases of cervical cancer has been halved by the very successful Cervical Cancer Screening (Papsmear) Program which was established in 1991. Death from this disease has also been halved during this time.
WHAT- The 2 main types of cervical cancer that are screened for are squamous type and adenocarcinoma. There are other rare forms such as neuroendocrine cancer which cannot be picked up with screening.
WHY THE CHANGE- The screening program showed a major reduction in the squamous type of cancer but not a major reduction in the adenocarcinoma type over the past few decades. And in 2002 the government noticed that the rates of cervical cancer (whilst they had halved since the early 90’s) weren’t really dropping much more. And the rates of invasive, more aggressive cancers were not dropping as much as they had hoped. As a result, in 2011 a government committee examined all the evidence and decided to change the Screening program. The Australian Government predicts that this new screening program will further reduce the cases of cervical cancer by 24-36%.
THE TEST CHANGES- The new screening program as of December 2017 will be as follows;
“The 2 year Pap smear test will be replaced by a 5 yearly Cervical Screening Test (CST)”
“The Cervical screening test screens for types of a virus that can cause cervical CANCER.
The virus is called the Human papilloma virus. The test has been shown to more effectively screen for invasive aggressive cancers.” “The test is performed by placing the sample into a liquid rather than onto a slide (as previously performed). This allows more accurate diagnoses of these virus subtypes. The same liquid sample can also test for chlamydia and gonorrhoea.”
“The sample is taken by your GP in the SAME WAY as the previous papsmear test. This is with an internal speculum examination.”
“ For women over 30 yrs who have never had Pap smear and decline an internal exam by a doctor- they can be offered a self- collected vaginal swab test. This is NOT as accurate as the sample taken by the doctor- but is better than no test at all”
“Screening starts in sexually active women from age 25 until age 70-74 yrs of age. Women can choose to screen longer if they wish. ”
Important To Note
Pap smears were a good opportunity to talk to women about their general, sexual and reproductive health. Sometimes things came up that were abnormal or required attention. Now with the longer time frame between screening tests, this opportunity has changed and so the government has emphasised the importance of women presenting to their GP in the event of ANY type of abnormal vaginal bleeding (for example- in between periods, after intercourse, after menopause).
As a female GP with a special interest in women’s health- I have treated many, busy women over the years. Some women wait months or even years to come to the doctor with abnormal vaginal bleeding. Please let me emphasise the importance of coming to your GP for these issues when they occur BECAUSE THE RARE FORMS OF CERVICAL CANCER CANNOT BE SCREENED FOR.
My other concern about these changes is also the opportunistic screening for sexually transmitted infections that was performed at the time of the papsmear. I have sadly seen a lot of women with fertility issues over the years due to previous infections with chlamydia and gonorrhoea (WHICH OFTEN HAVE NO SYMPTOMS) and here in WA we have some of the highest rates of these infections in the whole country in the 15-25 yr age group. So, I plead with young women to come in and get screened for infection every year if you are sexually active.
WHEN- Have your 1st Cervical screening test (CST) 2 years from your previous test or when it is due and then we will transition you onto a 5yearly recall system. If you are overdue for your smear come and see us soon. And if you have never had a pap or for cultural reasons prefer not to have an internal examination- as mentioned there is a self collected swab option available to you.