Renewal of the National Cervical Screening Program FAQs

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, as just as safe as, screening with a Pap smear every two years

Read more about the Renewal changes.

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.

Why has the screening interval changed to 5 years?

New 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 NCSP.

The NCSP 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.

Women who are undergoing follow-up and/or treatment should transition to the renewed program as outlined in the 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.

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 and cervical cancer

What is human papillomavirus (HPV)?

The human papillomavirus (HPV) is a common infection in females and males.

Most people will have HPV at some time in their lives and never know it. The majority of HPV infections clear up by themselves without causing any problems. Because the virus can be inactive in a person’s cells for months or years, for many people it is not possible to determine when and from whom HPV was contracted.

There are more than 100 different types of HPV that can affect different parts of the body. Genital HPV is spread during sexual contact. HPV types 16 and 18 are the types most commonly associated with cervical cancer and cause about 70% of cervical cancer cases.

Genital HPV infections can cause cervical cell abnormalities. If the virus persists, these cell abnormalities can progress and this may lead to cervical cancer. The time from HPV acquisition to cervical cancer is generally 10-15 years. Cervical screening enables detection of HPV and any cervical cell abnormalities it may cause. This facilitates monitoring and timely treatment when needed, to prevent cervical cancer.

It is important to remember that most women who have HPV clear the virus and do not go on to develop cervical cancer.

What is the relationship between human papillomavirus (HPV) and cervical cancer?

Persistent infection over many years with one or more oncogenic types of HPV is the main cause of cervical cancer. HPV types 16 and 18 cause around 70% of cervical cancer cases. Nearly all cervical cancers are caused by HPV infection.

Do women still need to screen if they have received the HPV vaccine?

Yes. The HPV vaccine protects against HPV types 16 and 18 but does not protect against all types of HPV infection that can cause cervical cancer, so HPV vaccinated women still require regular cervical screening.

Does the Cervical Screening Test replace the HPV vaccination program?

No. Eligible girls (and boys) should still be vaccinated to reduce transmission of HPV and help to protect the whole community against cervical cancer, as well as other HPV-related cancers such as throat and anal cancers.

Cervical cancer prevention is best achieved through maximising participation in both approaches – HPV vaccination and regular cervical screening.

Produced by

WA Cervical Cancer Prevention Program