It is now known conclusively that Human Papillomavirus (HPV) is a necessary cause of Cervical cancer. There are about 40 types of HPV virus that can infect the lower genital tract and of these 15 are thought to be cancer causing. Types 16 and 18 are the more serious types. It is estimated that 80% of people will become infected at some time but the majority will clear naturally.  Women who are unable to clear the infection are at risk of developing cervical cancer.
From 1st December 2017 the Cervical Screening Program will change significantly.
The current PAP test will be replaced by a viral screening test. This new test, which still requires a vaginal examination, is looking for the presence of​ HPV.  It will more accurately identify women who are at higher risk of developing Cervical cancer.
 
The other change is the frequency of testing. After the initial HPV screen, testing will be done 5 yearly commencing from aged 25yrs (unless there are special circumstances – see below) and ceasing at aged 75yrs. Medicare will cover the cost of routine screening. It won’t cover the cost if the screening is more frequent unless there are Special Circumstances as detailed below.
 
Vaccination against HPV is provided with Gardasil to all school aged children through The National Immunisation Program – first introduced in 2007.  This has already resulted in a significant reduction in HPV infection in the Community and it is expected to see a significant reduction in the incidence of Cervical Cancer in coming years.
Who needs to have a Cervical smear?
​All women who have ever been sexually active need to have a regular Pap smear, even if:
  • you are well and have no symptoms
  • you have received the HPV vaccine 
  • you are pregnant
  • you have only had one sexual partner
  • same sex attracted/lesbian women
  • you no longer have periods
  • you are no longer sexually active
Special Circumstances
  • Anyone with symptoms – abnormal bleeding/pain – is eligible for testing at any age and should see a doctor for further assessment.
  • Hysterectomy – if you have had a hysterectomy for benign (non cancerous) reasons you no longer need to have Cervical screening
                                         – if you have had a hysterectomy for malignant (cancerous) reasons then ongoing screening will be needed
  • Previous abnormal smears – Anyone currently undergoing follow up for a previously abnormal smear is eligible for repeat testing at the recommended interval (usually one year after the last test)
  • Diethylstilboestrol (DES) exposure – will require annual testing- lifelong
  • Adenocarcinoma in situ (AIS) – will require annual testing lifelong
  • Woman under the age of 25yrs who have a history of early onset sexual activity (<14yrs) or unwanted sexual activity (rape).
  • Immuno-suppressed women – i.e HIV +ve women, Solid organ transplant recipients or those on immunosuppressive medication may require more frequent testing – 3 yearly – discuss with your treating doctor
Interpretation of Results
The pathology report will advise either:
  1. Low risk : No HPV is present.  Cervical screening will be repeated in 5 years. 
  2. Intermediate risk: The sample comes back positive for HPV but NOT types 16 or 18. Cytology will then be performed on the same sample.  If this is normal or shows low grade disease Cervical screening will be repeated in 1 year. 
  3. High risk: The sample tests positive for Type 16 or 18 or high grade cytology changes are detected - you will be referred for colposcopy.  
  4. Unsatisfactory – needs repeating in 6-12 wks.  This may occur if an inadequate sample is taken or if blood or inflammatory cells contaminate the specimen.

​All women who have been treated for high risk changes will require two negative
HPV tests (test of cure) at 1 yr intervals before returning to standard 5 yearly screening.
For more information on Pap Smears, please visit:  ​SA Health