Cervical screening ( cancer prevention) & HPV
Human Papillomavirus (HPV) screening & Vaccination
Most cancer of the cervix is preventable. Australia has one of the lowest rates of cancer of the cervix in the world. The incidence has been reduced by 50% since the Pap test screening programme was introduced in 1991.
Now more than 80% of cancer of the cervix is diagnosed in women who have never had screening or overdue for screening.
Screening aims to detect the human papillomavirus (HPV) infection and cell changes on the cervix well before the development of cervical cancer.
Changes to the National Cervical Screening Program (NCSP)
In December 2017, the National Cervical Screening Programme (NCSP) changed and aims to reduce the incidence of cancer by a further 30%.
The reasons for the change in the NCSP include:
increased knowledge about HPV and cervical cancer
better detection using modern technology (HPV testing and liquid based cytology) and
the introduction of the HPV Vaccination Program in 2007, aimed at preventing some types of HPV infection which cause 75% of cancer of the cervix.
The Pap test has been replaced by a Cervical Screening Test (CST)
It is now only necessary to have the new CST every 5 years from the age of 25+
Does the HPV virus cause cancer?
You can get HPV by having direct genital skin contact with an infected person. Sexually transmitted HPV can occur with vaginal, oral, anal sex or genital to genital skin contact without penetrative sex.
Genital HPV infection is often transient, causes no symptoms and resolves spontaneously.
Some types of HPV may cause simple genital warts (condylomata). Genital warts are usually caused by low risk HPV types most commonly HPV types 6 and 11.
More than 99% of cancer of the cervix is due to high risk or oncogenic HPV.
There are about 14 high risk (or oncogenic) types of HPV. This means they can be associated with cancer of the cervix. Oncogenic HPV types 16 and 18 cause about 75 % of cancer.
If high risk (oncogenic) HPV causes a persistent infection of the cervix, cell changes such as CIN3 (cervical intraepithelial neoplasia) and even possibly cancer can occur. These changes usually occur slowly over many years.
Persistent infection with high risk HPV can also be associated with other cancers such as vulvar, vagina, cervix, anus, penis, mouth and throat cancers.
There are over 100 types of human papillomavirus (HPV) and around 40 can infect the genital region via sexual contact. HPV infection is very common -80 % of men and women who have ever been sexually active have been exposed to HPV.
What are the changes to the NCSP?
The Pap test has been replaced by a Cervical Screening Test (CST). The CST looks for the presence of HPV. This new CST is an improved, more sensitive test than the previous Pap test
Though you will be charged a consultation fee, your cervical screening pathology cost will be bulk billed to Medicare (see "Important Notice" below).
If you don’t have Medicare cover, we can still do cervical cancer screening for you, but there may be a small cost for the lab tests. These are usually covered by private health insurance.
The CST is an HPV test and if HPV positive, the sample is checked automatically for cell changes. This test is only available for women.
There is no HPV test for males. HPV testing is not included in a screen for sexually transmitted infections.
It is now only necessary to have the new CST every 5 years, which is safer and more protective than having a Pap test every 2 years.
Women will be invited to have a screening test from the age of 25 and have their last screening test between 70 and 74 years of age.
The experience of having a Cervical Screening Test (CST) is the same as the Pap test which involves a pelvic examination with a speculum insertion in the vagina to view the cervix and a sample taken. This examination should not be painful or uncomfortable, and all our doctors or practice nurses are experienced in conducting this examination and taking a CST.
There may be an option for self-collection for an HPV test for certain eligible women who are under screened or never screened within a clinic setting. Self testing home collection tests are not recommended and are not part of the National Cervical Screening Program.
IMPORTANT NOTICE REGARDING MEDICARE REBATE:
Medicare eligibility rules for Cervical Screening Tests changed in Dec 2017.
Some women may not be eligible for a Medicare rebatable cervical screening test if they fall outside of the screening age range (25Y - 74Y) or present sooner for a re-test than recommended. This may result in a pathology bill being received from the pathology provider.
Clinic 66 is not responsible for checking eligibility for Medicare rebates for cervical screening, please check your eligibility with Medicare.
Is it safe to wait until 25 for the first Cervical Screening Test?
It is safe to have a first Cervical Screening Test at the age of 25 years because:
Cervical cancer is very rare in young women
The cervical screening program has not been shown to make a difference to the detection of cervical cancers in this age group
We now know that HPV infection and cervical abnormalities are common in young sexually active women. These abnormalities in young women usually clear without treatment.
Young women are protected by the HPV vaccine which includes 2 types of HPV that potentially cause 75 % of cancer of the cervix.
However, you may be eligible to have a cervical screening test if you are younger than 25 years old and have:
experienced first sexual activity before 14 years of age or
have an illness or are on medication affecting your immune system.
Remember if you are a woman aged younger or older than age 25 years old, it is important to report to your doctor any abnormal vaginal bleeding ( eg bleeding after intercourse). This may be a sign of an abnormality on the cervix.
What if my Cervical Screening Test is Positive!?
If HPV is found on your screening test, further action will be taken.
This may mean having a repeat test at a shorter interval, or it may be that a colposcopy is required to provide more information.
Our doctors and nurses are very happy to answer any questions you may have about your results, cervical screening tests and how the programme has changed.
If you have an abnormal test, and HPV and/or abnormal cells are detected, it may be necessary to take a closer look at your cervix to get more information. This might involve a colposcopy.
Colposcopy involves a speculum insertion into the vagina (like the CST examination) and a high powered binocular microscope (colposcope) is used to examine the vulva, vagina or cervix.
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.
By screening and closely observing and/or treating, the transition of abnormal cells to cancer cells is stopped, and cancer does not develop.
Note: It is very easy to screen for infection, (such as chlamydia) at the same time as a Cervical Screening Test is performed.
Treatment options after a colposcopy ~ what happens next?
If abnormal cells are discovered on the cervix, further investigation maybe 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 options which are recommended for abnormal cervical cells include the following:
No treatment (for minor abnormalities). A check screen for cervical abnormalities may be offered sooner than usual.
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.
Cone biopsy. This is when abnormal cells are higher up inside the canal of the cervix.
Hysterectomy. This is the last option, and is for women who have already developed cancer of the cervix.
After any of these treatments, it is recommended to follow up to ensure that the abnormal cells have been successfully removed.
Colposcopy is delivered by our in-house, accredited colposcopists (gynaecologists and sexual health physician), and can be performed with sedation (inhaled or intravenous) if you prefer .
HPV Vaccination helps prevent cancer
In 2007, Australia led the way with a National HPV Vaccination Programme aimed to prevent infection with 4 types of Human Papilloma Virus (HPV). It aims to reduce HPV infection and the number of abnormal cervical screening tests as well as genital warts.
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 all types of HPV that can potentially cause cancer.
In 2018, a new HPV vaccine was introduced in Australia. It is capable of vaccinating against 9 types of HPV and aims to reduce the incidence of cancer of the cervix by 93%.
The new HPV vaccine protecting against 9 types of HPV, is now used in the school based HPV immunisation programme. It will also be available to other men and women.
Who needs to have HPV vaccination and why?
There are usually no symptoms from the HPV infection. Sometimes people may develop warty skin lesions if they have contracted sub-types 6 or 11, but people can be infected with HPV and never know it.
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.
HPV vaccination can protect you from being infected with some of the most common types of HPV that can cause genital warts and cancer.
The HPV vaccine 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 and young people up to 19 years old who missed the school based HPV vaccination. Please ask us if you have any questions about the HPV vaccination.
There are also 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. Unfortunately, HPV vaccination does not provide any protection or treatment against the sub-type of HPV used in the vaccine, if the person has already been infected with it.