Cervical cancer screening
20. Transition to the renewed National Cervical Screening Program
Clinical question
GUIDELINE UPDATES - This guideline was last updated 7/1/2022
Background
This chapter describes the management for women who participated in cervical screening before the introduction of the renewed National Cervical Screening Program (NCSP) on 1 December 2017, when the Pap test was replaced by primary screening using human papillomavirus (HPV) testing, with reflex liquid-based cytology (LBC) for women with a positive oncogenic HPV (any type) test result.
Among women attending for their first test since the renewal of the NCSP there will be women who have had a previous screen detected abnormality and who are currently undergoing investigation, treatment or follow-up for:
- abnormal Pap test result
- histologically confirmed high-grade squamous intraepithelial lesion (HSIL) (cervical intraepithelial neoplasia grades 2 to 3 (CIN2/3))
- histologically confirmed adenocarcinoma in situ (AIS).
Women who have participated in the pre-renewal NCSP and have not had any previous abnormality, or who have returned to routine screening after a Test of Cure, are recommended to attend for their first HPV test 2 years after their most recent Pap test or at age 25, whichever is later.
Recommendations
Flowchart 20.1. Transitioning to the renewed National Cervical Screening Program
| Practice point |
REC20.1: HPV test has replaced the Pap test Conventional Pap tests are no longer used. Reflex LBC is performed on any clinician-collected sample with a positive oncogenic HPV (any type) test result. Co-testing (HPV and LBC) should be performed only as recommended in these guidelines, in the follow-up of screen-detected abnormalities or the investigation of abnormal vaginal bleeding. |
| Practice point |
REC20.2: HPV testing for women in follow-up after pLSIL/LSIL
|
| Practice point |
| REC20.3: Colposcopic management of a prior screen-detected abnormality should continue Women who have been referred for colposcopic assessment following any cytological abnormality in the pre-renewal NCSP should continue their colposcopic management according to these guidelines. |
| Practice point |
REC20.4: Prior treatment and Test of Cure Women should have an annual co-test (HPV and LBC) performed at 12 months after treatment, and annually thereafter, until both tests are negative on two consecutive occasions, when they can return to routine 5-yearly screening. A co-test cannot be performed on a self-collected sample. |
| Practice point |
REC20.5: Prior treatment for AIS † Until sufficient data become available that may support a policy decision that cessation of testing is appropriate. |
Author(s):
- Professor Deborah Bateson – Co-author
- Dr Vivienne Milch – Co-author
- Dr Marsali Newman – Co-author
- Ms Kirsteen Fleming – Co-author
- Professor Karen Canfell — Co-author
- Dr Lara Roeske — Contributor
- Professor Marion Saville — Co-author
- Cancer Council Australia Cervical Cancer Screening Guidelines Working Party — Co-author
See also:
Chapter 10. Management of histologically confirmed high-grade squamous abnormalities
Chapter 11. Management of glandular abnormalities
WEBSITE UPDATES - This website was last updated 7/1/2022
