A brief history of cervical cancer screening
Australia is fortunate to have some of the lowest numbers of cervical cancer (and related deaths) in the world. This is largely due to our cervical screening program.
The original test or ‘Pap Smear’ involved a swab from the cervix that was then smeared onto a microscope slide and examined. A Greek doctor, Georgios Papanicolaou, made the discovery in the 1920’s that abnormal cells of the cervix could be seen this way.
In the 1960’s, this test became available in Australia. However, it was only in 1991 when the National Cervical Screening Program started that the screening became commonplace and the incidence of cervical cancer steadily reduced.
The screening was again changed in December 2017 to the current ‘Cervical Screening Test’.
Why are ‘Pap smears’ now called ‘cervical screening tests’?
Since the test technology changed in 2017, we use a brush to collect cells from the cervix or genital tract, and place it in a liquid. This is called the ‘Cervical Screening Test’ or CST, which has replaced the previous ‘Pap Smear’ process. From this liquid sample, we can test for Human Papillomavirus. If needed, we can also test for abnormal (pre-cancerous) cervical cells.
What is HPV?
We now know that almost all cervical cancer is caused by the Human Papillomavirus, or HPV. HPV is a very common virus, that usually doesn’t have any symptoms. I often describe it as similar to the common cold, but for your genital tract: it doesn’t require treatment, and often goes away by itself. About 80 – 90% of people that have ever had sex will come into contact with HPV, but will usually clear the virus. However, there are some types of HPV, that if it stays in the cervix or genital tract and isn’t cleared, it can lead to abnormal cells that can become cancer.
HPV is often present for years before abnormal cells develop: this is why we now do the Cervical Screening Test – to detect HPV, and detect any cell changes, before they become cancer.
Why does cervical screening only need to be done every five years now, instead of every two?
The new Cervical Screening Test is more effective than the Pap Smear – it’s estimated it will further reduce cervical cancer rates by at least 20%. As we now test for HPV, we are screening for cervical changes one step earlier, and it is safe to screen every 5 years. We also know that the time between being infected with HPV and the infection possibly leading to cervical cancer is very long (at least 10 years). Screening will identify you as low, intermediate or high risk. If you are in the low risk group (HPV negative), it is safe to have the screening performed only every 5 years.
For certain groups of people who are immunocompromised (for example with HIV or on immunosuppressant medication), it is recommended you have screening every 3 years.
Why does cervical cancer screening only start at 25 years old now?
As mentioned above, HPV is very common (80 – 90% of sexually active people will come into contact with HPV). This is more common in your teens and early 20’s, as many people first become sexually active. The virus usually clears and goes away on its own. Cervical cancer is also very rare in this age group. By starting the screening at 25 years old, it means that we avoid unnecessary tests and treatment.
However, if you are under 25yo and have previously had an abnormal result, or have any worrying symptoms (like abnormal bleeding or bleeding after sex), it’s important you see your doctor to discuss this, and see if you need a CST.
When do I need to start cervical cancer screening?
Anyone who has a cervix should be screened if they are between the age of 25 – 75yo and have ever had sexual contact.
How does self-collected cervical screening tests work?
Self collection became an option in 2022 and is available for if you are due or overdue for your CST. You still need to see a healthcare provider to discuss the test, and will then be given a swab and instructions. The doctor does not need to examine you or use a speculum. You will be given a private place to collect the sample.
The self collected CST involves using a long cotton swab that is inserted a few centimetres into the vagina, and rotated for 10 – 30 seconds. This swab is sent to the lab to be tested for HPV.
What if I’ve never had penetrative (penis-in-vagina) sex?
HPV is spread through intimate skin-to-skin contact : this involves skin of the vulva, vagina, cervix, penis or anus, and even the mouth or throat. So even if you haven’t had penetrative sex, you can still come into contact with HPV. That’s why the current screening recommendations are for anyone who has had any sexual contact.
What do the results mean?
The results of your CST will show whether HPV has been detected on your cervix.
If HPV was NOT detected (or “negative”), it means you do not have HPV and will be due your next test in 5 years.
If HPV is detected, it is usually broken down by the type of HPV (16 or 18; or “other” / non-16 / -18). They will then also test the cells on the cervix to see if there is any abnormality.
If you have HPV non-16 / -18 and the cells on the cervix are normal, then you will have another test in 12 months.
If you have HPV type 16, type 18 or the cells are abnormal, then you will be referred to a gynaecologist to have a ‘colposcopy’. This is done in the clinic, where we have a closer look at your cervix and can do a small biopsy if needed. Our gynaecologists at Maven Centre provide this service.
HPV vaccinations and the future of cervical cancer screening
All children aged 12 – 13yo are offered the HPV vaccine for free as part of the National Immunisation Program; this is usually done in school. The vaccine is also available for anyone age 12 – 25yo if they missed out. Although this vaccine doesn’t cover all types of HPV that can cause cervical cancer, it does protect against the more common types.
As more people are vaccinated against HPV and with our current cervical screening program, including the option for self-collection, it is estimated that cervical cancer will become even more rare, and may even be eliminated from Australia by 2035
Conclusion
Cervical screening in Australia has evolved a lot over the past 50 years! It now involves the five yearly Cervical Screening Test (CST) looking for human papillomavirus (HPV). Cervical cancer is easily preventable with regular screening, as any early changes detected on the cervix can be monitored and treated. At Maven Centre, we can further discuss the CST, perform it, or advise you about self-collection, and offer further testing or treatment as required.
