MEDICUS FEBRUARY 2016

A BIG CHANGE IS COMING: AN UPDATE ON THE NATIONAL CERVICAL SCREENING PROGRAM C L I N I C A L E D G E

Professor Ian Hammond Chair, Steering Committee for the Renewal Implementation Project National Cervical Screening Program Department of Health Australia

I n May 2017, the National Cervical Screening Program (NCSP) will undergo a major change that will affect GPs and their female patients. The two-yearly Pap test will be replaced by a five-yearly Human Papilloma Virus (HPV) test for women aged 25-74. An HPV test every five years is more effective, just as safe and is expected to result in a further 15-22 per cent reduction in incidence and mortality from cervical cancer in Australian women. In April 2014, the Australian Medical Services Advisory Committee (MSAC) made several recommendations for the NCSP, that are detailed elsewhere (cancerscreening.gov. au) including five-yearly cervical screening using a primary HPV test with partial genotyping and reflex liquid-based cytology; self collection of an HPV sample for under or never screened women; invitations and reminders to be sent to women aged 25-69 yrs with exit testing up to 74 years of age. The Australian Government will also be establishing a National Cancer Screening Register (NCSR) that will support both the new NCSP and the National Bowel Cancer Screening Program. The register will be operational by 1 May 2017 when the new cervical screening items will be listed on the Medicare Benefits Schedule (MBS). WHAT DOES THIS MEAN FOR THE GENERAL PRACTITIONER? • Women will be invited by the NCSR to start screening at age 25 years. • Women, both HPV vaccinated and unvaccinated should be screened.

suggestive of cervical cancer or cancer precursors can have an HPV test at any age.

• The cervical screening test will involve the collection of a liquid-based sample from the cervix and a request that an HPV test be performed. • If the specimen is HPV positive, the laboratory will automatically perform a liquid-based cytology on the initial specimen. • The laboratory report to the GP will state HPV status, the result of reflex cytology where indicated, the level of risk and a single recommendation for action. • The GP and/or the NCSR should identify women who are under screened (overdue for screening by two or more years) or never screened and encourage them to have a cervical screening test. If the woman declines a speculum examination, she should be offered the opportunity to take a self-collected vaginal sample that can be sent to the laboratory for HPV testing. • For women who are already participating in the NCSP or who are having a test of cure following treatment for high grade abnormalities, there will be clear guidelines for GPs regarding the timing of their next test and these will be disseminated in the lead up to the change to primary HPV testing in May 2017. WHAT IS HAPPENING TO SUPPORT THESE CHANGES? • The Steering Committee for the Renewal Implementation Project is a sub-committee of the Australian Standing Committee on Screening, and has oversight of this complex and innovative change to the

• Women who have symptoms, signs or sexual history

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