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Cervical cancer screening

20. Transition to the renewed National Cervical Screening Program

Clinical question

GUIDELINE UPDATES - This guideline was last updated 8/16/2018

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

Author(s):

Background

At the transition of the renewed National Cervical Screening Program (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).

This chapter describes how these women should be transitioned to the renewed program after 1 December 2017, when the Pap test will be 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.

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, will be transitioned in accordance with NCSP transition policy.

Recommendations

Flowchart 20.1. Transition to the renewed National Cervical Screening Program

Practice point
REC20.1: HPV test replaces the Pap test

All Pap tests are replaced by HPV testing.

Conventional Pap tests are no longer used.

Reflex LBC will be performed on any sample with a positive oncogenic HPV (any type) test result.

Co-testing (HPV and LBC) to 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
Women who are in follow-up for pLSIL/LSIL cytology in the previous program (pre-renewal NCSP) should have a HPV test at their next scheduled follow-up appointment.

  • Women with a positive oncogenic HPV (any type) test result should be referred for colposcopic assessment informed by reflex LBC.
  • If oncogenic HPV is not detected, the woman can return to 5-yearly screening.
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 who have been treated for HSIL (CIN2/3) in the pre-renewal NCSP and are undergoing, or have not yet commenced Test of Cure, should start or continue Test of Cure in accordance with these guidelines.

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.
Practice point
REC20.5: Prior treatment for AIS
Women who have been treated for AIS in the pre-renewal NCSP, and are undergoing or have not yet commenced surveillance, should have annual co-testing (HPV and LBC) indefinitely.†

†Until sufficient data become available that may support a policy decision that cessation of testing is appropriate.

See also:

Chapter 10. Management of histologically confirmed high-grade squamous abnormalities

Chapter 11. Management of glandular abnormalities

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