Cervical cancer
| Age | 0 - 9 | 10 - 14 | 15 - 19 | 20 - 24 | 25 - 29 | 30 - 34 | 35 - 39 | 40 - 44 | 45 - 49 | 50 - 54 | 55 - 59 | 60 - 64 | 65 - 69 | 70 - 79 | >80 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 17 | X | X | X | X | X | X | X | X | X | X |
Pap test screening is recommended every 2 years for women who have ever had sex and have an intact cervix starting from 18–20 years of age (or up to 2 years after first having sexual intercourse, whichever is later).
Australia has the lowest mortality rate and the second lowest incidence of cervical cancer in the world. The success of the Cervical Screening Program is dependent upon recruitment of women. Eighty-five percent of women in Australia who develop cervical cancer have either not had a Pap test or have been inadequately screened in the past 10 years. Women over the age of 50 years still represent an under-screened group. The introduction of the HPV vaccine as part of the National Immunisation Program (NIP) in 2007 aims to reduce the future incidence of cervical cancer, but it is not a substitute for a continuing screening program.
| Who is at higher risk? | What should be done? | How often? | Level of evidence and references |
|---|---|---|---|
Average risk
|
Pap test |
Women who have ever had sex and still have an intact cervix should undergo Pap test screening Routine screening with Pap tests should be carried out every 2 years for women who have no symptoms or history suggestive of cervical pathology. All women who have ever been sexually active should start having Pap tests at 18–20 years of age, or 1–2 years after first having sexual intercourse, whichever is later Pap tests may cease at the age of 70 years for women who have had two normal Pap smears within the past 5 years. Women over 70 years of age who have never had a Pap test, or who request a Pap test, should be screened Women with female sex partners are also at risk of developing cervical cancer and should be screened as above |
|
| HPV vaccination | For maximum effect the vaccination should be given before the onset of
sexual activity. It has no modifying effect on already acquired HPV
infections. It is available as part of the NIP for girls in year 7 |
49,379 | |
Increased risk
|
Pap test |
It is important to ensure patients always receive their test results Low grade squamous intraepithelial lesions (LSIL) Women aged 30 years or over with a Pap test report of LSIL, without a history of negative smears in the preceding 2–3 years, should be offered either colposcopy or a repeat Pap test at 6 months High grade squamous intraepithelial lesion (HSIL)
Glandular abnormality or adenocarcinoma
If the woman is symptomatic or has a clinically abnormal cervix, referral for colposcopy is recommended |
V B 380 |
| Test | Technique | References |
|---|---|---|
| Pap test | A sample of the ectocervix using an extended tip spatula, then the endocervix using a cytobrush provides the best method of sampling and can be used in all age groups of women. (The cytobrush is not recommended for use during pregnancy.) The cervical broom can be used on its own in premenopausal women if it is possible to sample from both sides of the transformation zone. In postmenopausal women the transformation zone tends to be higher in the endocervical canal. The cervical cells should be placed onto a glass slide and fixed with spray within 5 seconds. If the smear is reported as technically unsatisfactory, it should not be repeated before 6 weeks. In postmenopausal women with atrophic changes it may be necessary to use vaginal oestrogen for 14–21 days before the test. (See Chapter 15 Screening tests of unproven benefit regarding evidence related to bimanual vaginal examination) | 381 |
| HPV testing | As a primary screening tool In triage of LSIL
In follow up of HSIL
|
|
| Liquid based cytology | Liquid based cytology can be used as an additional test to the conventional smear but not as a substitute. Its addition may be useful when repeating an unsatisfactory test. It should be added if requested by the woman | 387,388 |
Strategy
Methods of encouraging women to undergo cervical screening include: invitations, reminders, education, message framing, counselling, risk factor assessment, procedures and economic interventions. Evidence supports the use of invitations, and to a lesser extent, educational materials. It is likely other methods are advantageous, but the evidence is not as strong. Further research is required.389
Methods of encouraging women to undergo cervical screening include: invitations, reminders, education, message framing, counselling, risk factor assessment, procedures and economic interventions. Evidence supports the use of invitations, and to a lesser extent, educational materials. It is likely other methods are advantageous, but the evidence is not as strong. Further research is required.389
© The Royal Australian College of General Practitioners
Printed from www.racgp.org.au/redbook