Renewal of the National Cervical Screening Program FAQs

From 1 December 2017 the National Cervical Screening Program (NCSP) changed. These changes are the outcome of the Renewal, a rigorous assessment of the evidence and economics of potential screening pathways, tests and intervals.

The Renewal aims to ensure that all women in Australia, HPV vaccinated and unvaccinated, continue to have access to a cervical screening program that is acceptable, effective, efficient and based on current evidence.

Why has cervical screening in Australia changed?

  • an increased understanding of the natural history of cervical cancer
  • new technology and evidence available on screening intervals and screening in different age groups
  • evidence that screening for human papillomavirus (HPV) (with reflex cytology when indicated) every five years is more effective than, and just as safe as, screening with a Pap smear every two years

For more information about cervical screening in Australia visit the National Cervical Screening Program (NCSP) (external site).

Changes to cervical screening

What are the changes?

When the renewed National Cervical Screening Program (NCSP) was introduced on 1 December 2017:

  • a five-yearly Cervical Screening Test replaced the two-yearly Pap smear. The Cervical Screening Test looks for the presence of human papillomavirus (HPV) with partial genotyping, if HPV is found, a reflex liquid based cytology (LBC) test is performed on the same sample to check for any abnormal cervical cells
  • the screening age range changed to women aged 25 to 74 years
  • a risk based approach to cervical screening was adopted, with women receiving a result based on their risk of developing significant cervical abnormalities in the following five years
  • new Medicare Benefits Schedule items became available with MBS items for the Pap smear no longer available.

A self-collection option is available for women 30 years of age or over, who are under-screened (two or more years overdue for screening) or never screened and have declined invitations and reminders for screening with a provider collected cervical sample.

Learn more about the clinical management of cervical screening.

Why has the screening interval changed to 5 years?

Evidence about cervical screening has found that screening for human papillomavirus (HPV) (with reflex liquid based cytology when indicated) every five years is more effective than, and just as safe as, screening with a Pap smear every two years. Because of this more effective test, women only need to screen every five years, regardless of whether or not they have had the HPV vaccination.

The Cervical Screening Test detects HPV infection, which is the first step in developing cervical cancer. HPV infections can cause abnormal cervical cell changes. When HPV is persistent, these cell changes may progress to cervical cancer. However, this usually takes a long time, often up to 10 to 15 years. While the Pap smear can detect abnormal cervical cell changes, the Cervical Screening Test can detect HPV infection and if present, assess the cervical cells for any abnormalities. HPV testing along with reflex cytology testing (when indicated) has been demonstrated to be a more effective means of cervical screening than cytology (i.e. Pap smear) alone.

Due to the high sensitivity of HPV testing, the screening interval can be safely increased to five years. Screening every five years can detect persistent HPV infections and any abnormal cervical cell changes it may cause. These enable monitoring, further investigations, and when needed, treatment. This avoids detecting HPV infections that are likely to go away on their own within one to two years.

Why has the screening age changed to starting at 25 years of age?

In the renewed Program women are invited to screen from 25 years of age. This change is because evidence shows that:

  • cervical cancer in young women is rare (in both HPV vaccinated and unvaccinated women)
  • despite screening women younger than 25 years of age for over 20 years there has been no change to the incidence of cervical cancer or rates of death from cervical cancer in this age group
  • investigating and treating common cervical abnormalities in young women that would usually resolve by themselves can increase the risk of pregnancy complications later in life
  • delaying screening until the age of 25 has been demonstrated to be safe (and has been safely implemented in other countries)
  • HPV vaccination has already been shown to reduce cervical abnormalities among women younger than 25 years of age and, in contrast to screening, is ultimately expected to reduce cervical cancer in this age group.

How are women invited to screen?

Women aged 25 years or over who have not yet started cervical screening will receive an invitation to have the Cervical Screening Test from the National Cancer Screening Register (NCSR) (external site).

The NCSR will send an invitation to women to let them know when they are due for their Cervical Screening Test and also remind women if they become overdue for their regular test or any recommended follow-up.

When should women stop cervical screening?

Women between 70 and 74 years of age are invited to have a Cervical Screening Test. If the HPV test result is negative the woman can then safely exit the NCSP.

Women aged 75 years and older who have never been screened or not had regular screening tests should have a Cervical Screening Test if they request screening.

How do women transition to the renewed Program?

Most women will be due for their first Cervical Screening Test two years after their last negative Pap smear. Anyone aged 25 to 74 years who has not had a Cervical Screening Test since their last Pap smear is now overdue.

Women who are undergoing follow-up and/or treatment should transition to the renewed Program as outlined in the NCSP Guidelines for the Management of Screen Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines) (external site). This includes women aged less than 25 years who were screened and had an abnormality detected in the Pap smear program.

For information on how to access your patient’s cervical screening record, call the National Cancer Screening Register (NCSR) on 1800 627 701 or refer to the Healthcare Provider Portal User Guide (external site)

Are changes to the NCSP a cost-cutting measure by the government?

No. The changes have been made because of new evidence about cervical screening which has demonstrated that screening for HPV (with reflex cytology when indicated) every five years is more effective than, and just as safe as, screening with a Pap smear every two years. The changes to the Program are anticipated to result in a further reduction in cervical cancer incidence and mortality of up to 30 per cent.

Cervical Screening Test

What is the Cervical Screening Test?

The Cervical Screening Test detects human papillomavirus (HPV) infection, with partial oncogenic HPV genotyping. If HPV is detected, the laboratory will automatically conduct cytology testing on the same sample.

The procedure for collecting the sample for a Cervical Screening Test is the same as the procedure for performing a Pap smear, except the Cervical Screening Test sample medium will be liquid based cytology. A small sample of cells from a woman’s cervix will still be taken. The sample will be sent to a pathology laboratory for examination and the laboratory will make a recommendation based upon the HPV result and, if indicated, the cytology findings.

While the Pap smear detected abnormal cervical cell changes, the Cervical Screening Test detects the HPV infection that can cause the abnormal cell changes, prior to the potential development of cancer.

Persistent HPV infections can cause abnormal cervical cell changes that may lead to cervical cancer. However, this usually takes a long time, often up to 10-15 years.

Human papillomavirus (HPV)

There are many types of HPV infections and most are cleared naturally by the body’s immune system within one to two years without causing problems.

HPV is a very common infection that is spread by genital skin-to-skin contact during sexual activity. HPV is so common that many people have it at some point in their lives and never know it as there are usually no symptoms.

In some cases, an HPV infection that is not cleared by the body can cause abnormal cervical cell changes. If left undetected and/or untreated, these changes can develop into cervical cancer. It usually takes more than 10 to 15 years for a persistent HPV infection to develop into cervical cancer.

Access the HealthyWA website (external website) for more information on HPV.

The HPV vaccine (external website) can protect against some types of cancer-causing HPV, including types 16 and 18. Since the HPV vaccine does not protect against all types of HPV known to cause cervical cancer, HPV vaccinated women still need to have regular cervical screening.   

Produced by

WA Cervical Cancer Prevention Program