In Australia cervical cytology remains a cost effective test for reducing incidence and mortality of cervical cancer by the detection and subsequent treatment of its precursors. General practitioner have a great role in recruitment of women who has never been screened or under screened.
Renewal of the National Cervical Screening Program:
2017 cervical screening program changes from every 2 years pap smear for women aged 18-69 to a 5 yearly Human Papilloma Virus (HPV) test for women aged 25-74 years.Screening will be for oncogenic virus rather than cytology.
The new test is more sensitive and less frequent with high negative predictive value.
there will be 2 different types of testing
1. Cervical screening test (CST) to detect for oncogenic Viruses type16,18 and other High Risk Viruses.
2. Co Test which will detect both the oncogenic Virus +LBC , also this test will be used for test of cure.
women are divided in to 3 groups
1. Low Risk / woman with Negative CST and those will be reminded to repeat the test in 5 years.
2. Intermediate Risk / women with positive Other High Risk Viruses (non 16/18 HPV) with LBC showing Low Grade or Possible Low Grade Squamous Intra epithelial Lesion(LGSIL, PLGSIL) would be invited to do a cotest in a year , if negative for the Virus then to be referred to 5 yearly screening program.
3. High Risk groups / are three sub groups who needs to be referred for a Colposcopy
a. All positive HPV 16/18 needs colposcopy what ever the results of LBC
b. All positive (HPV non 16/18) with LBC showing High or possible high grade squamous intra epithelial Lesion (HGSIL, PHGSIL) also persistent HPV infection for a year + LGSIL or PLGSIL
c. All Adeno Carcinoma Insitue AIS
Women with HPV 16 & 18 positive with Liquid base Cytology (LBC) showing invasive squamous cell carcinoma or glandular lesion should be referred to Gynaecology Oncology ideally in 2 weeks.
Women who have had a total hysterectomy with no evidence of cervical pathology, have previously been successfully treated for histologically confirmed High Grade Squamous Intraepithelial Lesion (HSIL) and have completed Test of Cure, do not require further follow-up. These women should be considered as having the same risk for vaginal neoplasia as the general population who have never had histologically confirmed HSIL and have a total hysterectomy.
Conservative Management Followup.
Diathermy of the cervix.
Large LOOP Excision of Transformation Zone (LLETZ) or Cone biopsy,usually used for Glandular Lesion.
Find out more about cervical screening test at cancerscreening.gov.au/cervical or call 131556