Guidelines for preventive activities in general practice

Reproductive and women’s health

Cervical cancer

      1. Cervical cancer

Cancer | Cervical cancer

Screening age bar

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 70-74 75-79 ≥80

In 2021, cervical cancer was estimated to be the 13th most commonly diagnosed cancer recorded among females, with 913 new cases of cervical cancer diagnosed in Australia.1 Aboriginal and Torres Strait Islander women have a higher incidence of cervical cancer. 

Under-screened women remain the most likely to develop cervical cancer. The main burden of cervical cancer is in developing countries without screening programs or human papillomavirus (HPV) vaccination. 

The introduction of HPV vaccination in Australia has been instrumental in reducing HPV infection and has placed Australia on track to reach the elimination of cervical cancer targets of 90:70:90 (vaccination: 90% of girls fully vaccinated with the HPV vaccine by age 15 years; screening: 70% of women screened using a high-performance test by age 35 years, and again by age 45 years; treatment: 90% of women identified with cervical disease receive treatment) by 2030.2 GPs play an important role in achieving these targets by providing vaccination and encouraging participation in the cervical cancer screening program to ensure early detection. Population level targets are beyond the scope of the Red Book, which focuses on recommendations that can be implemented in practice.

Screening

Recommendation Grade How often References
Cervical screening is not recommended in women under the age of 25 years. Screening not recommended (strong) N/A 3
Evidence does not support screening for women aged less than 25, even when they have experienced early sexual activity. However, for those who experience their first sexual activity at a young age (<14 years) and who had not received the HPV vaccine before sexual debut, a single HPV test between 20 and 24 years of age could be considered on an individual basis but is not required. Practice point N/A 3
Women and people with a cervix who have ever had sexual contact aged between 25-74 years of age and are eligible for screening should have a HPV screening test for cervical cancer. This can be on a self-collected vaginal sample or on a clinician-collected sample. Recommended (strong) Every five years. 3
Women with a negative oncogenic HPV screen between the ages of 70–74 no longer require ongoing routine screening. Practice point N/A 3
Women who are 75 years or older who have never had a cervical screening test or have not had one in the previous five years, may request a test and can be screened. The sample can be clinician-collected or self-collected, according to the woman’s choice. Practice point N/A 3

Preventive activities and advice

Recommendations Grade How often References
Administer one dose of the 9vHPV vaccine in immunocompetent adolescents and young adults from nine years of age and ensure catch up vaccination up to 26 years. For more information, refer to the Australian immunisation handbook. Recommended (strong) From age 9 to 26 years 4
Administering the HPV vaccine in adults aged ≥26 years is generally not recommended.
However, some adults may benefit from HPV vaccination. When deciding whether to vaccinate adults, consider:
  • the likelihood of previous exposure to HPV
  • the future risks of HPV exposure.
Generally not recommended N/A 4
  • A short course of topical oestrogen therapy could be considered in postmenopausal women, people experiencing vaginal dryness, or trans men, prior to collecting the sample – for example, daily for at least 2 weeks, ceasing 1–2 days prior to the appointment. The reason for this should be explained (to reduce discomfort from the speculum and to improve the diagnostic accuracy of any associated liquid-based cytology [LBC]).3
  • When deciding whether to choose self-collection or clinician collection, people must be given clear information by the supervising healthcare professional about the likelihood that HPV may be detected and, if so, what follow-up will be required. If a person chooses self-collection, the healthcare professional should provide information about how to collect the sample and how they will receive the test results.3
  • Cervical screening on a self-collected vaginal sample needs to be ordered and overseen by a healthcare professional.* For details of self-collection, refer to the section on self-collected vaginal samples in the National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding.3
  • When follow-up HPV testing is required after an initial positive oncogenic HPV test result, the sample may be self-collected or collected by a clinician. The woman’s healthcare professional should advise the woman of the follow-up that will be recommended if HPV is detected and explain that a clinician-collected sample allows for reflex LBC to be performed on the same sample. This potentially avoids the need for an additional visit to collect a cervical sample for LBC. HPV testing is not repeated on the clinician-collected sample in this circumstance.3
  • Among those attending for a routine screening test, approximately 2% have HPV16/18 detected and approximately 6% have HPV (not 16/18) detected, although the latter varies by age.3

*Only doctors and nurse practitioners can sign the pathology request for tests under current Medicare Benefits Schedule (MBS) rules.

Screening in pregnancy5 

  • Routine antenatal and postpartum care should include a review of the woman’s cervical screening history. Women who are due or overdue for screening should be screened.
  • A woman can be safely screened at any time during pregnancy, provided that the correct sampling equipment is used. An endocervical brush should not be inserted into the cervical canal because of the risk of associated bleeding, which may distress women.
  • All women who are due for cervical screening during pregnancy may be offered the option of self-collection of a vaginal swab for HPV testing, after counselling by a healthcare professional about the small risk of bleeding. Women testing positive for HPV (not 16/18) on a self-collected sample should be advised to return so that a cervical sample for LBC can be collected by the healthcare provider.
  • For other specific populations, refer to the National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding.
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Related documents

  Lifecycle-chart.pdf (PDF 0.12 MB)

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