Author: Dr Peter England, Obstetrician and Gynaecologist
There has been a change in pap smears and cervical screening. The pap smear program has existed in Australia for many decades. Regular screening and early treatment have seen the number of cases of cancer of the cervix, a particularly nasty disease, continue to reduce. Combined with vaccination programs for HPV (an Australian invention now popular worldwide) the number of cervical cancer cases continues to fall.
What’s new about pap smears and cervical screening?
The new way to screen is called a cervical screening test (CST). The CST is taken by your doctor or gynaecologist and is simple and quick. A soft brush is gently wiped across the cervix and the cells picked up are sent in a liquid container to the lab. The sample is tested for the presence or absence of HPV viral DNA strands. If the HPV test is positive, then a further test the same as the old-fashioned pap smear is done and the cells are examined under the microscope.
There are approximately 200 subtypes of HPV and a small number of them (about 16 so far) are the ones that can injure the skin on the cervix and over time lead to abnormal cell formation.
When should I have a Cervical Screening Test?
The CST should be performed every 5 years on women between the ages of 25 and 74 years of age.
What if my CST is negative (normal)?
You won’t be asked to repeat the test for 5 years. Previously, your routine pap smear was every two years, but the newer testing is more predictive for longer.
What if my CST is positive for HPV but the cells look normal on further testing?
You will need to repeat the CST in 12 months.
What if my CST is positive and the cells are abnormal?
This will depend on which subtype of HPV is detected and whether cell changes are mild (low grade) or more advanced (high grade).
If the cell changes are low grade and the HPV types are in a lower risk category, a repeat in 12 months will be recommended. During that time it is hoped your immune system will clear the virus and heal the mild cell damage.
If cell changes are high grade or the HPV subtype is No 16 or No 18, you should be referred to a gynaecologist for colposcopy.
What is colposcopy?
This examination by a qualified gynaecologist like myself takes place in the consulting rooms. Physically is it like having a pap smear taken, it just takes a little longer and the gynaecologist uses a special microscope to look at the cervix under magnification. Using direct vision, and a couple of solutions/stains applied to the skin it is possible to determine the location and significance of the smear changes. Then a treatment plan can be determined.
Do I have to pay for a CST?
The cost of the laboratory to process a CST is in general covered by Medicare. If it is normal you are eligible to have another CST covered by Medicare after 57 months.
If you wish to have a CST more often, and there are no abnormal symptoms to guide this choice, you will be billed for the cost of the test.
If I have the HPV vaccine, do I still need to have a cervical screening test?
Yes.
The vaccine has been a wonderful advance and covers approximately 80-90% of HPV types that can cause cancer of the cervix. However, 10-20% of high-risk HPV types are not currently covered.
What are the main risk factors for cervical cancer?
HPV, smoking, a weak immune system, and NOT having a regular CST performed.
If the colposcopy shows significant pre-cancerous skin change (known as cervical dysplasia) what is the treatment?
Treatment aims to remove the abnormal skin, creating a margin of healthy skin around the treated area. Surgery can be done via Wire Loop Excision, Laser Ablation or on occasion Cone Biopsy. The treated area recovers over around four weeks growing fresh healthy tissue to replace the removed abnormal cervical skin.
Once treatment has been performed, is there follow-up?
Yes.
Follow-up is vital as 5-10% recurrence occurs in the first 1-2 years post-treatment.
Make an appointment for your Cervical Screening Test.
If your CST is due or you need to discuss the results of a recent screen. Send us a message to arrange an appointment for you or give us a call.
Author: Dr Peter England, Obstetrician and Gynaecologist.
Read more about Dr Peter England
- Free Genetic Testing Before Your Pregnancy
- What are the Reasons and Causes of Miscarriage
- Reasons for Bleeding in Early Pregnancy
- Medications to treat PCOS
- PCOS and Fertility
For more information about Cervical Cancer and CST – see Cancer Council.