In December 2018 the screening test for cervical cancer in Australia changed. This means that tests start later and happen less often. Many people are concerned this will mean that more women will develop cervical cancer and that it will be caught later, but actually these changes mean that the test will be able to find those women who are at higher risk and avoid doing additional tests for those who are not.
The test itself
Unfortunately, the process involved in having a pap smear (or cervical screening test as they are now called) has not changed but at the end of the day what’s a few minutes discomfort for peace of mind? What has changed is what tests are performed on the sample once it gets to the laboratory. Previously they used to look at the cells from the cervix for any changes which might, if untreated, lead to cervical cancer. The vast majority of cervical cancers are caused by the human papilloma virus (HPV) and this is what they now test for first. The good news is that if there is no HPV found you don’t need another test for 5 years. This is safe because it takes between 5-10 years for HPV to start causing any changes in the cells and then another 5-10 years to cause cancer.
What is HPV?
The name HPV covers a group of over 200 viruses of which more than 40 can be spread through sexual contact. It is thought that about 70% of people will come into contact with HPV during their lifetime and in the vast majority of cases it will clear naturally. As well as causing cervical cancer HPV has also been found to cause some cases of anal, throat, vulval and penile cancer.
What happens if I do have HPV?
The HPV test performed for cervical screening can be broken down into two groups.
The strains of HPV which are most strongly associated with cervical cancer are 16 & 18. If you test positive for these it will be recommended that you get referred for further testing with a colposcopy.
There is another group of HPV strains which are much less likely to cause cancer although they can still do so. If you test positive for one of these, the lab will then look at the cells from your cervix from the already taken sample: if these look normal they will suggest that you have the HPV test repeated in one year, if they are showing changes they will suggest that you also get referred on.
What is a colposcopy?
If your result suggests that you need further testing done your GP will refer you to see a gynaecologist where they are likely to perform a colposcopy. During a colposcopy the doctor will insert a speculum (like with the first test), but they will then have a detailed look at your cervix through a special microscope(colposcope) and apply a stain which shows up any abnormal cells. Sometimes a biopsy of these cells will be taken for further examination.
Why are they no longer testing women under 25?
The new screening test only covers women aged 25 and over: many people have questioned whether this is safe. HPV infection is common in young women and usually clears naturally. Treating these women has not been found to help reduce the incidence of cervical cancer but can cause anxiety about their health and complications due to treatment.
What about the HPV vaccine?
The HPV vaccine was first introduced in Australia in 2007 and initially just included girls; it was widened in 2013 to also include boys. The current HPV vaccine protects against 9 strains of HPV, the two most strongly associated with cancers (16 & 18) but other strains causing genital warts. It is best to have the vaccine before people start being sexually active and being exposed to the viruses. Some specialists believe that cervical cancer will be very rare in 20 years’ time due to the success of the vaccine.
I hope that this has given you a bit more information about the reasons behind the changes to the cervical screening test and has helped reassure you that these changes are safe. Despite this if you have any symptoms that you are concerned about you should always discuss them with your doctor. It may be that your symptoms are normal, or you could need other tests performing to find and treat the cause.
I am happy to see you at either clinic to perform the cervical screening test and many patients have commented on how quick and painless they found it when I performed it. You only need to book a single appointment and you don’t need to say what the appointment if you don’t want to.