What is cervical screening?
Cervical Screening is a public health initiative which aims to reduce the incidence of cervical cancer by detecting and treating changes early. Australia has had a coordinated cervical screening program since 1991. This program, called the National Cervical Screening Program, has been very effective and has halved the incidence of cervical cancer in Australia since it began.
The cervical screening program has recently changed from 2 yearly Pap smears for women aged 18-20 to 70, to the Cervical Screening Test every 5 years for women aged 25 to 74, who have ever been sexually active.
What is the cervix?
The cervix is part of the female reproductive system and is the lower part of the uterus (womb). It is at the top of the vagina. The cervix has a small canal in it which leads from the inside of the uterus to the vagina and allows the passage of menstrual blood out of the uterus, and the passage of sperm into the uterus. It also holds a baby in the uterus during pregnancy and dilates to allow the baby to pass out of the uterus at birth.
What is cervical cancer?
Cervical cancer is cancer which affect the cervix. Cancer is where cells begin to grow abnormally. The most common cervical cancer is called squamous cell cancer.
What causes cervical cancer?
We now know that over 99% of cervical cancer is caused by a virus called the Human Papilloma Virus (HPV). There are some extremely rare cancers which account for less than 1% of cervical cancers which are not caused by HPV. Neither the old Pap test nor the Cervical Screening Test can detect these.
HPV is a very common family of viruses that affects both females and males. There are over 100 types of HPV which can affect humans and about 40 of these HPV types affect the genital area, including the cervix.
HPV is an extremely common infection. It is estimated that up to 90% of people are infected with HPV at some time in their lifetime. Most people get their first HPV infection within the first few years of becoming sexually active. Anyone who has any kind of sexual activity involving genital skin to skin contact could get genital HPV. That means it’s possible to get the virus without having intercourse.
HPV has to stay in the cervix for a long time in order to cause pre-cancerous changes in the cells which may then in turn lead to cervical cancer if not treated. It takes around 10 to 20 years for this to occur.
The majority of people clear the HPV virus themselves. Around 80% of infections are cleared within 2 years.
What is the Cervical Screening Test?
The Cervical Screening Test is a simple test to check the health of your cervix. Whereas the old Pap smear looked for changes in the cells of the cervix, the Cervical Screening Test looks for HPV which causes these changes. The Cervical Screening Test is a better, more accurate test and it is estimated that it will reduce the incidence of cervical cancer by 20-30%.
Why 5 years?
Because the Cervical Screening Test is a more sensitive and accurate test it is safe to have a 5 year interval between tests. By testing for the presence of HPV it is possible to tell if a woman is at risk of developing pre-cancerous changes. We know that if HPV is not detected it is safe for you to wait 5 years until your next test. Waiting 5 years between Cervical Screening Tests is as safe as waiting 2 years between Pap tests. There is an extremely low risk (less than 1%) of you developing any precancerous changes in this time.
Why start at 25?
Research shows that starting cervical screening at 25 is safe.
This is because:
- HPV is a very common infection in young people and the great majority of people will clear the infection themselves
- Cervical screening under 25 can lead to unnecessary treatment for something that would most likely have cleared by itself.
- Cervical cancer is very rare in women under 25
- Cervical screening has not been effective in women under 25 and has not reduced the incidence of cervical cancer in this age group.
- Most (78%) people in this age group in Australia have had the cervical cancer vaccine. This vaccine protects against two types of HPV which cause 70% of cervical cancer. Because of the vaccine have seen the rates of rates of precancerous changes drop dramatically in this age group.
Young women still need a regular sexual health check!
Women under 25 are at higher risk of having a sexually transmissible infection (STI). STIs often have no symptoms and can damage future fertility is left undiagnosed and untreated. If you are under 25 and no longer seeing a health care provider for regular Pap tests it is very important that you still have a regular sexual health check every year, or sooner if you have a change of sexual partner. A regular sexual health check would mainly involve screening for STIs. You can also review your contraceptive options if needed and discuss any concerns or ask any questions you may have about your sexual and reproductive health.
How is a Cervical Screening Test done?
The test is still done the same way as a Pap test, so women will still need a speculum examination in order for their nurse or doctor to see the cervix and collect a sample from the cervix.
For women who have never had a Cervical Screening Test or a Pap test a speculum examination involves talking to your nurse or doctor first then, when you are ready, going behind a screen, taking off your clothes below the waist and lying down on an examination bed with a privacy sheet to cover you.
You will then be asked to bend your knees up and separate your thighs. The nurse or doctor will then gently put a speculum into the vagina and open it up to separate the walls of the vagina (which are very elastic and stretchy) until they can clearly see the cervix. They will then use a brush to gently brush the surface of the cervix and collect a sample. This sample will be placed in a special container to be sent to the laboratory. The speculum will be removed and disposed of and you will be able to get dressed again. This part of your appointment usually takes about 10 minutes.
If you are anxious about the procedure at all it is important that you tell your nurse or doctor so they can respond to your individual needs and make the experience as comfortable as possible. All the nurses and doctors at Sexual Health and Family Planning ACT are female and are experienced practitioners who have had special training in sexual and reproductive health.
Cervical Screening Test results.
If HPV is not detected then you will have your next Cervical Screening Test in 5 years. The National Cancer Screening Register will send you a reminder for your next test 3 months before it is due.
If HPV is detected then it will depend what type of HPV it is as to what happens next. If one of the lower risk HPV types is detected then the laboratory will look at the cervical cells to see if there are changes. If there are no cell changes or only low-grade changes you will be asked to return in 12 months for a follow-up HPV test. If there are high-grade changes in the cells you will be referred to a specialist for a colposcopy.
A colposcopy is a way of examining your cervix more closely. It is similar to the procedure for having a Cervical Screening Test except that it takes a little longer and involves using a colposcope (a machine which has a magnifier) to look at the cervix more closely. The specialist can then take a sample if needed.
If one of the two higher risk types of HPV are detected then you will be also referred to a specialist for a colposcopy.
Who should have a Cervical Screening Test? Anyone aged between 25 and 74 who has a cervix and who has ever been sexually active should have a Cervical Screening Test whether or not they have had the cervical cancer vaccine. This includes women who are same-sex attracted and people who identify as transgender.
Even if you have not been sexually for many years or have been in a long-term monogamous relationship, HPV can remain dormant in the cells and become active again so it is still very important that you have regular screening.
What if I have had a hysterectomy?
If you have had a hysterectomy it will depend on whether or not you still have a cervix, as well as on your past cervical screening history, whether you may need further tests. You will need to see your doctor to discuss this and find out if you still need cervical screening.
When should I have a Cervical Screening Test?
If you are between 25 and 74 and have never had a Pap test or have not had one for over two years then you should have a Cervical Screening Test now. If you have already been having regular Pap tests then you should have your first Cervical Screening Test 2 years after your last Pap test.
Routine screening is for women who have no symptoms. Anyone at any age who has symptoms, such as bleeding between periods, bleeding after sex, bleeding after menopause, abnormal vaginal discharge, or pain with sex should make an appointment with a doctor to discuss this.
Do people with disabilities need cervical screening?
Yes – women with sensory, physical, intellectual or psychiatric disabilities are less likely than other women to have regular cervical screening, but it is just as important for these women to have regular testing.
Women with disabilities may face a range of barriers to getting a Cervical Screening Test including lack of information about testing; lack of support, difficulty in accessing the service or finding that a service that caters to their disability, lack of financial support, reliance on others to assist in accessing, or being understood by the healthcare professional, and having to battle other people’s perceptions and/or values around the person’s sexuality or sexual activity.
It is important to acknowledge and support women with disabilities in obtaining information and accessing services for cervical screening. Making contact with an organisation like SHFPACT can help with suggestions on how to overcome any barriers or support someone in accessing the clinic for a test.
When was your last screening? Make an appointment today by calling 6247 3077 - and consider asking your doctor or nurse for a Chlamydia test while you're there.