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.