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Clinic 66

Cervical cancer screening at Clinic 66, in our Sydney Clinic

Cervical cancer is preventable. Early changes in your cervical cells can be spotted early using cervical cancer screening tests. If necessary a colposcopy can be performed, a biopsy taken and a diagnosis is made. After diagnosis, treatment maybe required which is usually curative. By screening and treating, the transition of abnormal cells to cancer cells, is stopped, and cancer does not develop. For this reason, many countries around the world provide cervical cancer screening programmes for women, to detect early changes which could possibly progress to cancer if left untreated.

Detection of abnormal cells on the cervix (caused by human papilloma virus or HPV) is the key to alerting women to the need for more treatment, which stops them from getting cancer.

Currently in Australia, the cervical screening programme recommends all women who have ever been sexually active, to have a regular 2 yearly Pap test between the ages 18-70 years. The cervical screening programme in Australia has been highly successful. Since it commenced, the death rate of women from cervical cancer has more than halved. Pap tests offer a simple, easy way to detect early (potentially dangerous) changes in the cervix (neck of the womb).

A Pap test involves a pelvic examination with a speculum insertion in the vagina to view the cervix and a sample of the cells of the cervix is taken. This should not be painful or uncomfortable, and all our doctors or practice nurse can do this for you.

We can provide all types of Pap test screening, both conventional (glass slide) and additional testing (liquid based cytology). From December 2017 there will be HPV testing as the recommended screening test. For women who don't have Medicare cover, we can do cervical cancer screening for you too! There may be a small cost for the lab tests, but these are usually covered by health insurance. It is very easy to screen for infection, (such as chlamydia) at the same time a Pap test or HPV swab is taken.

Does the HPV virus cause cancer?

There are over 100 types of Human Papilloma Virus (HPV) and around 40 of them can be transmitted sexually. HPV infection is very common-80 % of men and women who have ever been sexually active have been exposed to HPV. You can get HPV by having direct genital skin contact with an infected person. Sexually transmitted HPV can occur with vaginal, oral or anal sex. Genital HPV infection is often transient, causes no symptoms and resolves spontaneously. Some types of HPV cause simple genital warts (condylomata). Genital warts are usually caused by low risk HPV types most commonly HPV types 6 and 11.

There are about 15 high risk types of HPV, of which HPV types 16 and 18 cause about 70 % of cancer. Persistent infection with high risk HPV can trigger a cancer process in the skin lining of the body cavity or genital skin covering (i.e. vulva, vagina, cervix, anus, penis, mouth and throat.) The virus enters the skin cells that are on the outside and infect them, causing them to produce a protein, which interferes with cell growth. These infected cells become rogue and, like other types of cancer, growth is uncontrolled and the immune system may find it impossible to kill the cell. If the body detects the infected cells, sometimes the immune system can get rid of the infected cells, but sometimes the infection persists.

If high risk HPV causes a persistent infection of the cervix, high grade changes such as CIN3 (cervical intraepithelial neoplasia) may develop over a number of years.

There is an HPV test for women, taken from the cervix which looks for the virus but it is not available to men. HPV testing is not included in a screen for sexually transmitted infections. Men don't have pap tests because they don't have a cervix.

New cervical cancer screening using HPV detection

In May 2017, there will be changes in the cervical cancer screening programme in Australia. These changes are planned because new technologies have developed to help us understand the cervical cancer better and it's causes. Since the introduction of the HPV vaccination programme, the number of women who screen positive for pre cancerous cells has reduced. So the new screening is based on a more reliable test for women who are less likely to have abnormalities.

Instead of having a Pap test every 2 years, women will be invited to have an HPV test every 5 years. The process for collecting HPV samples is the same as having a Pap test i.e. a doctor or nurse will collect a small sample of cells from around the cervix. The age group will change slightly, so that women between the ages of 25-74 will be invited to have the HPV test every 5 years. Our doctors and nurses are very happy to answer any questions you may have about Pap tests, the current screening programme and also the proposed changes to the cervical screening programme.

It is important to continue to have screening with a Pap test until the new cervical screening programme is introduced in December 2017.

HPV Vaccination helps prevent cancer

Australia has led the way with a national vaccination campaign aimed to prevent infection with Human Papilloma Virus (HPV) , which is helping reduce the number of abnormal pap smears (see below). However, all women still need to have cervical cancer screening, even if they have had the HPV vaccination, because the vaccine doesn't provide protection against the effects of all types of HPV that can potentially cause cancer.

What if I test positive in the screening test?

If a woman has an abnormal pap smear in the current screening programme, or later with the new screening programme, and HPV and abnormal cells are detected, it may be necessary to take a closer look at her cervix to get more information. This might involve a colposcopy. Colposcopy involves a speculum insertion into the vagina like the Pap test examination and a high powered binocular microscope (colposcope) is used to examine the vulva, vagina or cervix in a woman. Colposcopy may involve using acetic acid and iodine washes, and using coloured filters to properly examine the tissues under high powered magnification. It may be necessary to take a biopsy, in order to provide information about abnormal looking cells. For instance, if HPV has been found and abnormal cells indicate pre-cancerous or cancerous change, then a biopsy taken at colposcopy will help the gynaecologist decide what, if any treatment is required.

Colposcopy can be performed on pregnant women and women who have an IUD. Tell your gynaecologist if you think you might be pregnant, or if you have an IUD.

IMPORTANT; make sure your colposcopy doctor is credentialed to perform colposcopy, otherwise the doctor is not properly qualified to do the procedure.

Who needs to have HPV vaccination and why?

Anyone who has sexual contact can get infected with HPV. Often people get it soon after having sex for the first time. The more sexual partners a person has, the more chance they have of being infected with a number of different types of HPV. However, people who have only had one partner, people who haven't had sex for a long time, and people who use condoms can still be infected with HPV. There are usually no symptoms from the HPV infection. Sometimes people may develop warty skin lesions if they have contracted subtypes 6 or 11, but people can be infected with HPV and never know it.

HPV vaccination can protect an individual from being infected with some of the most common types of HPV that can cause genital warts and cancer. Therefore, it is best given to young males and females before they become sexually active. In Australia, the HPV vaccination is available free to all girls and boys of 12-13 years of age. The HPV vaccination will therefore prevent the spread of HPV and reduce risk of developing cancer. The HPV vaccination used in the national HPV vaccination programme in Australia consists of the quadrivalent vaccine; i.e. subtypes 6,11,16 and 18 are included in the vaccine and is highly effective at preventing HPV 6,11,16 and 18 related infection. Parents of the child need to sign a consent form and the vaccination is given in schools. Pregnant females and anyone with an allergy to the vaccine or yeast should not be given. It can also be offered to older men and women. Doctors and nurses at Clinic 66 are very happy to answer any questions that you may have about the HPV vaccine.

There are potential benefits from vaccinating people who have already become sexually active, as they may not yet have been exposed to the types of HPV which cause harm and maybe at risk of future exposure to HPV. HPV vaccination does not however, provide any protection or treatment against the subtype of HPV used in the vaccine, if the person has already been infected with it.

Here at Clinic 66, we vaccinate any man or woman who wants to be protected, and they can buy their own vaccine. The course of 3 doses of vaccine is relatively low (about $450 for the full course of 3 injections), making it an inexpensive and effective way to protect against cancer! However, even if you only have one dose of vaccine, you will get some protection against HPV.

Treatment options after a colposcopy; What happens next?

If abnormal cells are discovered on the cervix, further investigation required. This may include colposcopy and possibly biopsy which will enable the gynaecologist to gather more information regarding the abnormal cells, and will dictate what type of treatment should be given.

Treatments which are recommended for abnormal cervical cells include the following:

  1. No treatment (for minor abnormalities). A check screen for cervical cancer may be offered sooner than usual.
  2. LLETZ procedure (Large Loop Excision of Transformation Zone). This takes about 20 minutes and involves a wire loop removing the area which contains the abnormal cells.
  3. Cone biopsy. This is when abnormal cells are higher up inside the canal of the cervix.
  4. Laser treatment.
  5. Hysterectomy. This is the last option, and is for women who have already developed cancer of the cervix.

After these treatments, it will probably be necessary to repeat the colposcopy and check to ensure that the abnormal cells have been successfully removed.

Colposcopy is performed at Clinic 66 by our in-house gynaecologist, and can be performed under IV sedation for women who do not wish to be awake for the procedure.

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