I need to get a cervical cancer screening. What can I expect? Can I do it myself? And what happened to the pap smear results?

Cervical screening in Australia Changed over the past seven years. The test has changed, and women (and people with cervical cancer) now have much more choice and control. Here’s why – and what to expect if you’re aged 25 to 74 and you have to pass the test.

When and why did the test change?

In 2017, Australia became one of the first two countries to exploit human papillomavirus (HPV) testing instead of Pap tests.

HPV is the cause of virtually all types of cervical cancer, so testing for the virus is a very good indicator of a person’s current and future risk of developing the disease.

This solution contrasts with the older technology of Pap smear testing, which involved examining cells every two years for changes resulting from HPV infection.

The screening change was supported by a very huge group international AND Australian Data indicate that basic HPV testing is more exact than cytology.

Women and people with cervixes who have no HPV detected by a test have a very low risk of developing cervical cancer in the next five years or more. This was the basis for extending the screening interval when HPV screening was introduced.

Australia now recommends five years of HPV screening starting at age 25 until age 74 for those eligible, regardless of whether they have been vaccinated against HPV. Many other countries are following suit by moving to HPV screening.

All established screening tests – which are performed on people without any symptoms – are associated with health benefits, but also with some harms. These can include psychological and clinical consequences of receiving a “positive” screening result, which need to be investigated further.

However, recently the World Health Organization (WHO) evidence review found:

• HPV is a more effective screening test than a Pap smear or any other method
• significantly reduces the incidence and mortality of cervical cancer
• it is a method of examining the cervix, which has best balance benefits to harm.

As a result, WHO now clearly recommends HPV screening as the best method.

Now you can collect your own sample

One of the main benefits of switching to HPV screening is that it opens the door for people who may collect your own sample (which was impossible with a Pap smear). If the HPV virus is present, it can be detected in the vagina without having to take a sample directly from the cervix.

In 2022, Australia became one of first countries worldwide to introduce a universal self-sample option as part of the main national screening programme. This means that people eligible for screening, under the supervision of their primary care physician, can now choose to collect their own vaginal sample, in privacy, using a uncomplicated swab.

By the end of 2023 27% of people we decided to take the test this way, but this trend is growing and will probably continue to grow, information campaign is scheduled to start next month.

So what happens when I take the test?

You will receive an invitation from National Cancer Screening Registry to take part in your first test when you turn 25. If you are older, you will receive reminders when it is time for your next test. You will be invited to see your GP or health service for a test.

You should be asked whether you would prefer to have the test performed by a physician or if you would prefer to collect the sample in person.

There is no right or wrong way. The accuracy of the tests has been shown be equivalent for samples taken by a physician or by yourself. It is a matter of choice.

If your doctor does the test, they will perform a pelvic exam with a speculum inserted into your vagina. This allows the doctor or nurse to view your cervix and take a sample.

If you are interested in the possibility of personal collection, please check when making an appointment whether the office offers this option.

If you choose to collect yourself, you can do so in privacy. You will be given a swab (which looks like a COVID test swab with a longer shaft) and given instructions on how to insert and rotate the swab into your vagina to collect a sample. It only takes a few minutes.

What does it mean if my test detects HPV?

If the test detects HPV, it means you have an HPV infection. These are very common and do not, in and of themselves, mean you have cancer or even precancerous conditions (which involve changes in the cells of the cervix that, over time, make it more likely to develop into cancer).

However, it does mean that you are at greater risk of developing a pre-cancerous condition or developing it in the future and that you will benefit from further check-ups or diagnostic tests. Your doctor or nurse to guide you on next steps in line with national guidelines.

If a diagnostic test is needed, it will involve a procedure called a colposcopy, during which a gynaecologist or other specially trained healthcare professional will carefully examine your cervix and may also take a petite sample to examine the cells in detail.

If you have a precancerous condition, you can be treated quickly and easily, usually without having to go to the hospital. The treatment involves ablation, or removal of a petite area of ​​the cervix. This treatment will drastically reduce your risk of developing cervical cancer.

What does this mean for cervical cancer rates?

Cervical HPV screening is a very effective method of preventing cervical cancer. Due to HPV screening in Australia, combined with HPV vaccination in younger people, Australia is expected achieve such a low cervical cancer rate by 2035 that the disease can be considered eliminated.

Last year the government launched National Cervical Cancer Elimination Strategy which presents key recommendations for eliminating cervical cancer and making it equitable for all groups of women and people with a cervix.

One of the best ways to protect yourself is to get a cervical screening test as soon as you are eligible, whether or not you have been vaccinated against HPV.

This article was co-authored by Marion Saville, pathologist and executive director of the Australian Centre for Cervical Cancer Prevention.