Cervical cancer

Human papillomavirus vaccination (B)

For maximal effect, the vaccination should be given prior to the onset of sexual activity. It has no modifying effect on already acquired human papillomavirus (HPV) infections. It is available as part of the National Immunisation Program Schedule for girls and boys in year 7.^81,82 HPV-vaccinated women still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.

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 the recruitment of women: 85% of women in Australia who develop cervical cancer have either not had a Papanicolaou (Pap) test or been inadequately screened in the past 10 years. Women aged >50 years are still under-screened.⁸³

Australia’s National Cervical Cancer Screening Program will change from December 2017 (the change was originally planned for May 2017 but a delay was announced in February 2017). As of that date, women aged 25–74 years, both HPV vaccinated and unvaccinated, will be invited to undertake an HPV test every five years.⁸⁴ Women of any age who have symptoms (including pain or bleeding) should have appropriate clinical assessment, which may include a cervical cytology test and an HPV test. Women between 70 and 74 years of age who have had a regular screening test will be recommended to have an exit HPV test before leaving the cervical screening program.

A comparison between the current program and the one starting in December 2017 is given in Box A. In the interim, the National Cervical Cancer Screening program continues to recommend Pap test screening every two years for women who have ever had sex and have an intact cervix, commencing from 18–20 years of age (or up to two years after first having sexual intercourse, whichever is later).⁸⁵

Box A

Comparison of the key aspects of the current national cervical screening program with that commencing from May 2017

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Table 9.5.1

Cervical cancer: Identifying risk

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Table 9.5.2

Tests to detect cervical cancer risk

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The following resources provide helpful advice:

• Recommended screening tests and the visual appearance of the cervix
• HPV: A guide for practitioners

Screening pelvic examinations for the detection of pathology in asymptomatic, non-pregnant, adult women is not recommended because there is no evidence of benefit.⁹⁸ Also refer to Chapter 15. Screening tests of unproven benefit.

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.⁹⁷