January 22nd – 28th is Cervical Cancer Awareness Week, which we are observing with a two part series detailing:
– The basics of cervical cancer screening and HPV testing
– Navigating colposcopies, cervical intraepithelial neoplasia (CIN) changes and their significance
What is cervical cancer?
Cervical cancer is a type of cancer that starts in the cervix, the lower part (or ‘neck’) of the uterus. Thanks to a robust screening program, the incidence in Australia is lower than in most another countries: it has been estimated that Australia may even become the first country to eradicate cervical cancer, by as soon as 2035. Unfortunately, approximately 800 women are diagnosed with cervical cancer every year, the majority of whom haven’t undertaken the screening suggested by national guidelines.
The importance of screening and human papillomavirus (HPV)
The aim of a screening program is to:
– Identify people who are at higher risk of developing a serious condition in future
– Identify people within the early stages of the disease (or process of cellular change), so that something can be done to stop the process in its tracks
Screening for cervical cancer in Australia used to involve having a ‘Pap smear’ every two years. This was a test where a sample of cells is taken from the cervix, and observed under a microscope to see if there are abnormal cells present showing pre-cancerous changes.
In the past three decades, it has become clear that all cases of cervical cancer are caused by human papillomavirus (HPV). HPV is a common, sexually-transmitted virus that can lead to changes in the cells of the cervix, which can eventually lead to cervical cancer. There are about 50 strains of HPV that can cause such pre-cancerous changes, with the two highest-risk strains being HPV-16 and HPV-18.
Most sexually active people will contract a strain of HPV at some point, but our immune systems are generally strong enough to fight and clear the virus (just like we would clear the virus causing the common cold). However, if it takes our bodies a little longer to clear the virus, or we are immunosuppressed, and the HPV virus remains persistent for more than five years, the risk of changes to the cells can increase over time.
Since 2017, the screening program has changed to account for this causal link (between prolonged HPV positivity and the risk of future cervical cancer). We now screen for the presence of the relevant (cancer-causing) HPV strains on the cervix. If your cervical screening test result is negative for all HPV strains, you will require a repeat test in 5 years’ time. If your cervical screening test result is positive for an HPV strain, the laboratory will perform a traditional ‘Pap smear’ (called ‘liquid-based cytology), which looks at the cervical cells under a microscope, and analyses them for signs of cellular changes. Depending on the results of this cytology testing, you may need to see a gynaecologist for further investigations. (This will be discussed in more detail in Part 2 of this blog series.)
Since 2023, HPV tests can now be performed at home, with a self-collection swab. The presence of the relevant virus strains can be detected on this swab, and this can be done without visualising the cervix. If the test returns positive for the HPV strain then you will need to see your GP to perform a cervical screening test by visualising the cervix (with a speculum) to confirm the result.
HPV vaccination
Following the revolutionary discovery that virtually all cervical cancer is linked to HPV, a vaccination against HPV strains 16 and 18 was developed by some Australian scientists from the University of Queensland (Professor Ian Frazer and Professor Jian Zhou). Australia was the first country to introduce free HPV vaccination into the National Immunisation schedule: to girls aged 12-13yo in 2007, and to boys aged 12-13yo in 2013. Now both men and women up to 25yo can be vaccinated for free.
Cervical screening tests: when to start
The Australian guidelines recommend that people with a cervix commence cervical screening at 25yo, regardless of whether or not they have been sexually active before. This marks a shift from the previous practice of starting Pap smears at 18yo. Starting cervical cancer screening at 25yo strikes a balance between the importance of detecting precancerous changes promptly, and the high likelihood of (completely innocent) transient HPV infections in young people.
For women aged 25 – 74yo, HPV testing is recommended every five years. This testing is less frequent than the old Pap tests, but is actually a more accurate and evidence-based screening approach.
Conclusion: empowerment through knowledge
Knowledge is power, and when it comes to cervical health, being informed is the first step in taking charge of your wellbeing. Regular cervical screening tests, understanding the significance of HPV, and breaking the stigma associated with it, are integral parts of the journey toward elimingating cervical cancer altogether.
Remember: you have the tools to protect yourself! Stay informed, prioritise your health, and embrace the empowerment that comes with making informed choices about your cervical health.
Together, we can continue to make strides in the fight against cervical cancer!
Frequently asked questions about cervical cancer screening
I’ve never had penetrative sex. Do I still need to start doing cervical screening tests from 25yo?
The human papilloma virus can also be passed on by intimate genital skin-to-skin contact, irrespective of whether penetrative sex occurred, so it is still important to screen for HPV. The recommendation is still to commence screening at 25 years of age.
My cervical screening test five yars ago was negative (no HPV was found); my most recent test was positive. Did my new partner give me HPV?
HPV can remain dormant in the cells for a long time (10 – 20 years) before a positive screening test result. A positive result does not necessarily mean this HPV strain has been given to you by a new partner, nor that they have been unfaithful.
HPV has been found on my cervical screening test. Does my partner need to be notified? Or tested / treated?
It is up to you whether you wish to tell your partner of your HPV positive result, but there is no mandatory notification requirement. Your partner does not need to be tested, and there is no treatment for the virus. In the majority of cases, the virus leaves the body naturally. You do not need to stop having sex.
Does cervical cancer run in families, like ovarian and breast cancer can?
Given the causal link with the HPV infection, we now know that cervical cancer does not run in families, however how our bodies rid themselves of the virus may be influenced by our genes. There is currently research being undertaken in this area. If you have family members who have been diagnosed with cervical cancer, the recommendation would be to adhere to the screening program, by ensuring that you have regular cervical screening tests as per the national guidelines.
I didn’t receive my HPV vaccinations as a teenager. I’ve just had HPV found on my cervical screening test. Is there any point in paying to receive my HPV vaccinations now?
The answer to this varies on a case-by-case basis, and depends on a number of factors. The product information for Gardasil9 (the 9vHPV vaccine) states that the vaccine is indicated for all people up to the age of 45. ATAGI (the Australian Technical Advisory Group on Immunisation) recommends men who have sex with men, and immunocompromised people of any age can also receive the vaccine.
Therefore, if you are immunocompromised or at risk of further exposure to HPV (ie. high likelihood of multiple future sexual partners), then it would be worthwhile considering receiving the vaccine. While this won’t protect you against the strain you are already infected with, if you are negative for the important high risk HPV-16 and HPV-18 strains, it will protect you against those, and reduce your risk of cervical cellular change as a result of a new infection.