Cervical cancer can affect anyone with a cervix

Cervical cancer screening – what you need to know

In December 2017, the National Cervical Screening Program changed, and now provides a Human Papillomavirus (HPV) test for women aged 25-74 every 5 years. Although the program can offer the chance to prevent cervical cancer, or catch it much earlier, it’s estimated that in 2018 only 54% of eligible women1 participated in screening.

What are the symptoms of cervical cancer?

Firstly, please do not wait until you have symptoms to get tested. Early detection is one of the most important factors in being able to successfully prevent or treat cervical cancer.

Secondly, if you have symptoms, please see your doctor, even if you recently had a cervical screening test. There could be a number of causes for any symptoms, so it is vital you see a doctor to investigate.

Cervical cancer often has no symptoms, particularly in the early stages, which is one reason the screening program was developed. However, see your doctor if you experience any of these:

  • Any abnormal bleeding from the vagina, including; bleeding between periods, bleeding after menopause, having a period that lasts longer or is heavier than usual, or bleeding after sex
  • Pain during sex
  • Unusual discharge from your vagina

It is rare for cervical cancer to become advanced before being detected however, advanced cervical cancer can cause additional symptoms such as:

  • Extreme tiredness
  • Leg pain or swelling
  • Lower back pain

The reason the program has changed is that the new test looks for the Human Papilloma Virus (HPV), because a persistent HPV infection can cause changes in the cells of the cervix that can lead to cancer. So this test provides an earlier warning that someone is at risk of cancer.

HPV is usually found without symptoms, it is very common and affects most women in their lifetime. About 80% of women have HPV at some stage but the body’s immune system is able to tackle it in the majority of cases; 95% of cases clear up without treatment2.

What does the cervical screening test involve?

The sample is collected in the same way as the previous ‘pap smear’ test. A doctor inserts a device called a speculum into the vagina which opens up the neck of the womb (the cervix) so they can perform a short visual examination and take a sample.

This is done using a cervical sampler, a device like a tiny broom that the doctor gently sweeps over the cervix to gather some cells for testing. The sampler is then rinsed in a jar of fluid which is sent to a pathology laboratory for testing. The procedure takes a few minutes and may be uncomfortable but should not cause a lot of pain.

There is also a self-collection option available for those aged over 30 who have never been screened or who are overdue for screening by 2 years or more. The sample has to be collected in a healthcare setting such as a doctor’s practice or clinic. This is done privately by the patient inserting a swab, which is like a long cotton tip, into the vagina themselves after receiving some direction from the health practitioner. Self-collection is not recommended for anyone who is pregnant, symptomatic, or has a past history of cervical cancer or abnormal screening results.

When do I need to be tested?

If you have never had a pap smear or cervical screening test and you are aged 25 or over, talk to your doctor or local clinic about testing.

This new type of test was introduced in December 2017 and women now only need to be tested every 5 years. So, if you had a cervical screening test since December 2017 you don’t need to be tested again for 5 years from the date of that test.

If your last test was before December 2017, or if you can’t remember when it was, make an appointment to see your doctor for a test.

What happens if my cervical screening test is positive? Does that mean I have cancer?

A positive cervical screening test is not a cancer diagnosis. It means you have one of the higher risk types of the HPV virus.

What do the test results mean?

If the test is negative for HPV you will be informed, and you just need to return for testing in 5 years’ time.

A positive result means HPV was found in your cervix. When the laboratory detects HPV, they automatically do some further examination of your sample called cytology, and this gives your doctor more information to discuss with you what the next steps might be.

Depending on what the pathology report says, your doctor may recommend increased monitoring, for example, coming back for another HPV test in several months, to see if your body has been able to clear the virus on its own. You might also be referred for a colposcopy, where a doctor uses a device called a colposcope that magnifies the cervix for a detailed examination. The doctor may also take a biopsy during examination which will be sent to a pathology laboratory for analysis. The pathologist will see if any changes are present in the tissue which are cancerous or likely to become cancer (a pre-cancerous condition).

What happens if I don’t get tested?

Like any pathology test, cervical screening is optional, but if you choose not to be tested there is no way to know if you have HPV, a pre-cancerous condition of the cervix, or cervical cancer. HPV is very common, up to 90% of people will be infected with at least 1 genital type of HPV in their lives3. Women who avoid screening need to be aware of the risks; in Australia up to 90% of cervical cancers occur in women who have not been appropriately screened.4

Screening provides the opportunity to catch any problems early, and if lesions are discovered in the cervix, when they are detected early they can be more easily removed.

I have had the HPV vaccine, do I still need a cervical screening test?

Yes.

There are more than 100 types of HPV, with 15 strains known to be associated with cancer5. The most recent vaccine which is currently given in schools protects against 9 strains of the virus; 7 of these can cause cancer, and 2 are linked to genital warts.

Earlier versions of the vaccine only protected against 2 of the high-risk strains of HPV associated with cancer. This is the version of the vaccine that most vaccinated women now in their 20s and 30s have had, this means screening is still very important for all women, even those who have been vaccinated.

Cervical screening test data from 2018 revealed6 that rates of any cancer-causing HPV were highest in women in the youngest age group of 25–29 years. Prevalence of the highest risk HPV types 16 and 18 peaked in the 30–34 age group.

There are other risk factors for cervical cancer such as being a smoker, but HPV infection is the biggest risk factor, the virus is present in more than 90% of cervical cancer cases.7

A recent study showed high rates of participation in both the HPV vaccination program, and cervical cancer screening offers the chance to eliminate cervical cancer as a public health problem in Australia by 2035.8

References
1. https://www.aihw.gov.au/reports/cancer-screening/national-cervical-screening-monitoring-2019/contents/summary 
2. https://www.thewomens.org.au/health-information/womens-cancers-pre-cancers/cervical-cancer
3. https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/human-papillomavirus-hpv
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832287/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118362/
6. https://www.mja.com.au/journal/2019/211/3/routine-cervical-screening-primary-hpv-testing-early-findings-renewed-national
7. https://www.mja.com.au/journal/2020/importance-human-papillomavirus-vaccination-and-screening-highlighted-0
8. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2818%2930183-X/fulltext

 

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