Goodbye Pap Smear; Hello New Cervical Screening Test

 

A new test is now being used in Australia’s cervical cancer screening program, replacing the old pap smear. What do the changes mean for you?

The short answer is that having the test feels pretty much the same when you’re lying there with your legs apart but you only need to do it every five years instead of every two. The main difference between the old Pap smear and the new cervical screening test is how it is processed in the laboratory – the new test is looking for signs of high-risk human papilloma virus (HPV) infection, which we now know can lead to cancer if untreated.

Let’s take a step back at this point to ask why we screen for cervical cancer and how targeting HPV can help. But first, let’s learn about the cervix. Though you can’t see or feel it, it’s an important part of your reproductive system.

Where’s My Cervix?

Your cervix is inside your body at the top of your vagina. It’s a little passageway that connects your vagina to your uterus (womb). During your period, it lets the blood flow out of your uterus and down through your vagina. During sex, it lets sperm travel through to your womb. Your cervix closes during pregnancy then softens, opens and stretches (dilates) during birth.

Why Screen for Cervical Cancer?

Symptoms of cervical cancer include heavier periods, bleeding between periods or after menopause, or bleeding after sex. There may also be pain during sex or an unusual vaginal discharge.

Cervical cancer can be prevented if its early signs are detected soon enough. That’s usually before you notice any symptoms. You won’t know that any change has happened in your cervix unless you go for cervical screening.

Australia has had a national screening program for cervical cancer since 1991. Many women have benefitted from screening, which has enabled them to identify and treat any early cell changes in the cervix. This deliberate, regular checking of women’s cervixes has cut the death rate from cervical cancer in half.

What Is the Link Between HPV and Cervical Cancer?

We now know that a persistent infection with certain high-risk strains of the human papilloma virus (HPV) causes most cases of cervical cancer.

HPV is a common sexually transmitted infection that can affect both men and women. It’s passed on through intimate skin contact (e.g. when your genitals touch your partner’s genitals). You can still get HPV even if you use a condom because it doesn’t cover all the genital skin.

There are many types of HPV. Most don’t give you cancer. Low-risk HPV types can cause genital warts. As with other viruses, your immune system usually fights off HPV, clearing the virus within 6-12 months.

Your body finds it harder to fight off high-risk HPV types though. That persistent, lingering infection can cause abnormal cells to grow on the cervix. If they’re not found and treated, they can progress to cervical cancer over the next ten years or so. Two high-risk types of HPV known as HPV16 and HPV18 cause about 70% of all cervical cancers.

What’s Different About the Cervical Screening Test?

Now that we understand the role of HPV in causing cervical cancer, Australia’s screening program has changed. Instead of trying to find early cell changes in the cervix, it’s now testing for signs of HPV infection.

From 1991-2017, Australian women aged 18-70 were offered a free Pap smear test every two years. Now, Australian women over 25 will be offered a free cervical screening test every five years.

Why Is Cervical Screening Done Less Often?

You can have the new test less often (every five years instead of every two) because it’s more reliable. We know HPV causes most cervical cancer and we know it usually takes at least 10 years to do so. That means we can test you more accurately and less often. That’s good news all round.

Who Should Be Screened?

If you’re a woman aged 18-74 and have ever been sexually active, you should be screened for cervical cancer. If you’ve already had a pap smear, then you should have the new test about two years after your last pap smear. If you’ve never been tested before, then have the test around your 25th birthday.

If you’ve had the HPV vaccine, you should still have the cervical screening test. The vaccine protects you against some types of HPV but not all. And no vaccine is ever 100% effective.

If you’re a lesbian, then you should still have the cervical screening test. That’s because the HPV virus isn’t spread by bodily fluids such as sperm but by intimate skin-to-skin contact, meaning women can catch it from other women.

How Is Cervical Screening Done?

From your point of view, there’s no real difference between the pap smear and the new cervical screening test. The test may feel uncomfortable but shouldn’t be painful.

When you come for your appointment, your GP or gynaecologist will ask you to remove your clothing below the waist, then lie down on an examination bed with your knees bent. Your doctor will usually give you a towel or sheet to cover yourself with for a bit of privacy.

Your doctor then stands at the foot of the bed. They’ll put an instrument called a speculum into your vagina to hold it open so they can see your cervix. Then they’ll push a little brush through the speculum and up towards your cervix. They’ll rub the brush around a bit to collect some cells from your cervix. Then they’ll put it in a sterile tube and send it to the lab to be tested.

It’s here, in the lab, that the difference between the two tests becomes clear. With a pap smear, a scientist looked at your sample of cervical cells under a microscope, trying to spot any abnormal cells that needed further investigation. The new test is done by a machine that detects HPV in your cells.

What Happens Next?

You will be grouped into a certain risk category depending on your test results.

If you’re low risk, it means no HPV was found. You’ll be recalled for another screening test in 5 years’ time.

If you’re at intermediate risk, it means some high-risk HPV types have been found but not the really dangerous HPV16 or 18. You’ll be asked to have another test in a year to see if your body has got rid of the virus.

If you’re at high risk, it means your test showed that you have HPV16 or 18 and/or significant cell changes on your cervix. This does not mean you have cancer; it means you’re at high risk of developing cancer. You’ll be referred to a specialist for further tests and treatment.

Cervical Cancer Screening at Elm Rd.

Elm Rd.’s mission is to improve the health of the local community and we encourage all eligible patients to come for cervical screening. It’s the most effective way of protecting yourself against cervical cancer.

Our GPs are well-trained in doing cervical cancer screening tests and will do their best to make you feel at ease. Please tell us how you’re feeling, particularly if this is your first test.

So, don’t put off your cervical cancer screening test any longer. See it as a positive step in maintaining your health. Please book an appointment today. Feel free to request a female doctor when you book your appointment if that makes you feel more comfortable.