Who should be screened for cervical cancer?If you meet all of the criteria below, then you are eligible for cervical screening in Australia.
Thanks to the National Cervical Screening Program in Australia, the impact of cervical cancer on both patients and the health system has reduced significantly since 1991  . Regular screening tests provide women and people with a cervix the best way to protect themselves, with early detection offering the best opportunity to manage the condition. However, over the last 30 years the program has changed, the tests have improved and HPV (human papillomavirus) vaccines have now become available.
So, How Has Cervical Screening changed?The original cervical screening procedure was called a Pap Smear. Pap Smears involved the collection of a swab sample from the cervix. The swab was smeared onto a slide and sent for pathology testing. The test checked for changes or abnormalities in the cells that could indicate the presence or development of cervical cancer. In 2017 the Pap Smear was replaced with the Cervical Screening Test (CST), which is the current standard cervical screening test. This new test still involves the collection of a swab sample from the cervix. However the sample is prepared in fluid and tested for the various strains of the Human Papillomavirus (HPV). HPV is a risk factor for cervical cancer. Because of this difference, the new test can indicate who is at the greatest risk and who has the lowest risk of developing cervical cancer, so testing can be adjusted accordingly.
- For patients with a low risk, the regular screening intervals changed from 2 years for the Pap Smears, to 5 years for the Cervical Screening Test.
- For patients with a higher risk, doctors could recommend more frequent testing and use more specialised tests earlier on.
Does the HPV vaccine have an impact on screening recommendations?The HPV vaccines protect against up to 9 strains of HPV, with early vaccines covering fewer strains than newer vaccines. However, there are strains not covered by any of the vaccines which can cause cervical cancers. So, you should still participate in regular cervical screening even if you were vaccinated against HPV. There are no differences in screening recommendations for HPV vaccinated or unvaccinated people.
Self-Collect Cervical Screening TestsPrior to the introduction of the Self-collect screening tests the Medical Services Advisory Committee (MSAC) evaluated and assessed the accuracy of self-collected samples. Finding the testing method to be just as accurate as using clinician-collected samples, MSAC supported the addition of self-collect testing to the existing National Cervical Screening Program  . Except when ineligible for self-collect, patients can now choose between the two options of self or practitioner collected testing.
Self-collect vs Practitioner-collected Cervical Screening TestsSelf-collect Cervical Screening offers a number of benefits. Firstly, it is considered just as accurate at detecting HPV as practitioner-collected samples, and it is just as safe. Secondly, some patients will also find this option more comfortable and agreeable for them. Consequently it is hoped that this new screening method will encourage more patients to participate in regular screening. Finally, it gives patients choice and control, which can benefit patients with lingual, cultural, sexual or psychological barriers towards practitioner-collected testing. One limitation is that the self-collect test only detects the presence of HPV. It cannot be used for more advanced testing to determine cell changes. So, follow-up testing for high-risk patients still requires samples to be collected by a medical practitioner.
Who is not eligible for self-collect screening?If the following criteria apply to you, then you are unlikely to be eligible to self-collect.
- You are symptomatic (you have symptoms that require investigation)
- Previous you had an abnormal pap smear result
- You’ve tested positive to HPV strains 16/18 previously
- You are returning for a 12 month review after testing positive to HPV
- When you return following treatment or for a “test of cure”