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Cervical cancer screening

Medical Services Advisory Committee recommendations for HPV testing

GUIDELINE UPDATES - This guideline was last updated 8/15/2018

UPCOMING GUIDELINES - This guideline was updated and comes into practice on 7/1/2022Download PDF

In 2014 the Medical Services Advisory Committee (MSAC) recommended that the National Cervical Screening Program (NCSP) adopt human papillomavirus (HPV) testing for cervical screening at 5-yearly intervals.[1]

After considering the strength of the available evidence in relation to the safety, clinical and cost-effectiveness of a cervical screening pathway for the NCSP, MSAC supported public funding for the following:[1]

  • five-yearly cervical screening using a primary HPV test with partial HPV genotyping and reflex liquid-based cytology (LBC) triage, for HPV vaccinated and unvaccinated women aged 25–69 years, with exit testing of women up to age 74 years
  • self-collection of an HPV sample for an under-screened or never-screened woman, facilitated by a medical practitioner, nurse practitioner or other healthcare professional on behalf of a medical practitioner who also offers mainstream cervical screening
  • a system of invitations and reminders to be sent to women aged 25–69 years, and exit communications to be sent to women aged 70–74 years of age, to ensure the effectiveness of the program
  • de-listing of the existing cervical screening test MBS items over a 6- to 12-month transition period.

See MSAC outcomes. Application No. 1276 – Renewal of the National Cervical Screening Program.

The renewed NCSP applies to both HPV-vaccinated and unvaccinated women. It involves a primary screening test for HPV with partial genotyping (to distinguish HPV types 16 and 18 from other oncogenic types) and reflex LBC testing for all women with a positive oncogenic HPV test result:

  • Women who have a positive oncogenic HPV (16/18) test result are referred immediately to colposcopy, with reflex LBC results available to inform the colposcopy examination.
  • For women with a positive oncogenic HPV (not 16/18) test result, LBC is used as a triage to determine whether they are referred for colposcopy, or for repeat HPV testing in 12 months.

MSAC advised that this screening strategy was safer, more effective and more cost-effective than the pre-renewal NCSP,[1] which is based on 2-yearly screening using conventional cytology (the Pap test) in sexually active women between the ages of 18–20 and 69 years.

The MSAC recommendation was based on systematic review of evidence and a comprehensive modelled evaluation.[2][3][1] The modelling for HPV primary screening with partial genotyping for HPV 16/18 indicated an expected reduction in cancer incidence and mortality of over 20% (if women were screened until age 70 years).[3] Subsequent modelling, taking into account post-colposcopy management as recommended in these guidelines, has predicted that a 31–36% reduction in incidence and mortality may be achievable in unvaccinated cohorts and a 24–29% reduction may be achievable in cohorts offered vaccination (see Appendix A. Modelled evaluation of the predicted benefits, harms and cost-effectiveness of the renewed National Cervical Screening Program (NCSP) in conjunction with these guideline recommendations).

These recommendations were accepted by the Australian Government in May 2015. A revised NCSP policy has been developed based on these recommendations and has been endorsed by the Standing Committee on Screening.

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NCSP policy summary
Five-yearly cervical screening using a primary HPV test:

  • partial HPV genotyping and LBC triage
  • in HPV-vaccinated and unvaccinated women aged 25–69 years
  • exit testing of women up to age 74 years.

Source: National Cervical Screening Policy (2016)

References

  1. Medical Services Advisory Committee. MSAC Outcomes. Application No. 1276 – Renewal of the National Cervical Screening Program. [homepage on the internet] Canberra: Australian Government Department of Health; 2014 [updated 2015 Apr]. Available from: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/FD36D6990FFAA639CA25799200058940/$File/1276%20-%20Final%20MSAC%20PSD%20-%20NCSP%20Renewal.pdf.
  2. Medical Services Advisory Committee. National Cervical Screening Program renewal: executive summary. Report November 2013.MSAC application no. 1276. Assessment report. Canberra: Australian Government Department of Health; 2014 Available from: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/E6A211A6FFC29E2CCA257CED007FB678/$File/Executive%20Summary%20notated%2013.6.14.pdf.
  3. Medical Services Advisory Committee. National Cervical Screening Program renewal: effectiveness modelling and economic evaluation in the Australian setting. Report November 2013. MSAC application 1276. Canberra: Australian Government Department of Health; 2014 Available from: http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/E6A211A6FFC29E2CCA257CED007FB678/$File/Renewal%20Economic%20Evaluation.pdf.

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