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.
In December 2017, the 2 year Pap test was replaced by the Cervical Screening Test (CST) every 5 years from the age of 25 to 74
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.
You Can Now Collect Your Own Sample!
Not keen on a speculum examination? It's ok... we get it. But please don't let that stop you from caring for your health. Although clinician collected samples are our preferred 'gold standard' (because we often find issues other than HPV while doing the CST), you can now collect your own sample!
Provided your last test was clear or you haven't had a test previously, and as long as you don't have any symptoms, we can now offer you a 'self-collection' option either in the clinic, or at home via telehealth.
It's really easy to do - if you can insert a tampon, you can collect your own CST sample with a simple cotton swab. And it's just as reliable as a clinician collected sample for detecting HPV.
But you still need to meet with your GP in order to receive the testing kit.
Do I need to have an IUD insertion with sedation or can I be awake?The choice is yours. If you have intravenous sedation, you will have a brief, light anaesthetic and have no recollection of the procedure. You will need someone to drive you home, as you can’t drive on the day of a sedation anaesthetic. Commonly, those who have an IUD insertion (or removal) with sedation are women who: Are nervous or tense about being examined or having cervical screening tests Are only recently or never sexually active Have had surgery to their cervix, such as a LLETZ procedure Have ONLY had elective Caesarean section deliveries (without labouring) Are approaching menopause Want an IUD removed, but the threads cannot be seen in the cervix If you DO opt for sedation, then you should: NOT eat any food during the 6 hours prior to your appointment Drink only water between 6 and 2 hours before your appointment Have nothing pass your lips in the 2 hours immediately before your appointment (this means no food or dring and includes smoking, lollies and chewing gum) An awake IUD insertion procedure takes about 5-10 minutes and there may be some discomfort. We advise that you take some simple pain relief (the same as what you would normally take for period pain) about 30 mins before the procedure. Awake IUD insertion can also be performed using local anaesthetic and/ or a Penthrox inhaler (green whistle). Please note that for women who have NEVER been sexually active, we do not offer IUD insertion as an awake procedure ( must be booked under IV sedation) The doctor who performs your insertion procedure will discuss what kind of anaesthesia might be necessary.
What do I need to bring with me?2 or 3 sanitary pads (light flow only) Some photo identification- a driver’s licence or passport Your Medicare card Warm, comfortable clothes and nothing that is too restrictive around the tummy A snack, or some food or drink for AFTER the procedure If you are travelling from more than 100km away, you should schedule yourself a telehealth consultation with one of our doctors prior to travelling, to ensure that you are suitable for an IUD procedure with us. We do not want to disappoint !
Are there any reasons why a woman can’t have an IUD inserted?If you have a history of breast cancer, we will need a letter from your oncologist and/or breast surgeon to say that you are clear to have a Mirena (hormonal) IUD. If you have a history of uterine fistula or complex surgery to your uterus, an IUD may not be suitable (a previous Caesarean Section is fine). Large fibroids, unusual layout such as bicornuate uterus or any other problem which can distort the inside of your uterus (womb) might make the use of an IUD difficult. We will discuss your options with the report from a formal pelvic ultrasound. If you know you have an unusual uterus, please make an appointment to discuss your options PRIOR to booking in for your procedure. (We dont want you to waste your time by accepting your booking and then us not being able to help you) A pregnancy must be excluded before using an IUD, and that is why we like you to come in for an IUD insertion within 7 days of the start of your menstrual period. In that way, we know that you are not likely to be pregnant. However, if you do not get regular periods, you can still have an IUD inserted but the timing needs to be discussed with one of our doctors or nurses.
Do I need a pelvic ultrasound before my IUD insertion?If you are over 40 years old and you have heavy periods, we need you to have a formal pelvic ultrasound scan to make sure that there are no underlying problems. If needed, we can refer you for a bulk-billed pelvic ultrasound scan. Women in their forties who have heavy periods are likely to need to have a Pipelle endometrial biopsy, and there is an additional charge for this procedure (Medicare rebates apply). If you have had a termination of pregnancy (medical or surgical), and you haven’t yet had a period after the procedure and you wish to have an IUD inserted, you should have a pelvic ultrasound performed. Please send us the report prior to booking in for your IUD insertion. We can provide you with a request form which will be “bulk billed for Medicare card holders.
What if I want my IUD removed or replaced?Removal of an IUD is usually quite straightforward, and can be done in the consulting rooms by a doctor who has experience at removing an IUD. If the IUD strings are not able to be found in the cervix, and you want to have your IUD removed, we need an ultrasound scan before we attempt to remove the IUD to ensure that the device is still in the uterus (womb). Please dont have unprotected sex for one week prior to the IUD removal or replacement, as sperm can hang around and its possible you could get pregnant once the IUD is removed, even from sperm which have been in the body for a few days.
Why should I use a condom for the week before my IUD removal or replacement?Please do not have condomless sex one week prior to the replacement OR removal of an IUD (as sperm can hang around, and this can result in an unintended pregnancy).
Do I need to have a GP consultation before having my IUD inserted?You do need to have a consultation prior to having your IUD inserted, which can be done with your own doctor, or one of our doctors or clinical nurse specialists. This pre-insertion consultation is important, as the timing of insertion, the type of device and anaesthetic options all need to be discussed. If you dont want to come into the clinic, you can have a consultation with one of our Telehealth doctors. Please make a booking at clinic66online.com.au
Frequently Asked Questions about Cervical Screening & Self Collection
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 people with a cervix.
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.
And you now have the choice to take your own sample if you are eligible. Click here to find out more >
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 other infections, (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.
Colposcopy Q&A's with Dr Lynne Wray, Sexual Health Physician and diagnostic colposcopist
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.
The HPV vaccine is safe and effective with very few contraindications and is an inexpensive and effective way to protect against cancer!
The cost of the course of 3 doses of HPV vaccine (for those not eligible for the free vaccine) is relatively low (about $450 for the full course of 3 injections),
Last updated on 11/09/2023