Cervical screening

Overview

• The cervical screening test (CST) is the only Medicare funded routine test and is available to women aged 25 years and over.
• From July 1, 2022, all women presenting for routine screening became eligible for self-collection. SNP is fully validated to carry out self-collected HPV testing on site using the red topped FLOQSwabs®.
• See below for details on “collecting the right sample”; either clinician-collected or self-collected.
• Request forms must specify whether the test is clinician-collected or self-collected, the requested test PLUS the reason for testing. Supporting clinical history is essential.

A risk-based approach

The CST uses an HPV DNA test to detect the presence of oncogenic HPV types known to be associated with a higher risk of developing significant cervical abnormalities. The HPV test is more sensitive than cytology, so it can be performed less frequently.

Numerous studies in Australia and overseas have shown that the sensitivity in detection of HPV in self-collected vaginal samples is equivalent to a clinician-collected sample however reflex LBC cytology cannot be performed on self-collected specimens. Women presenting with symptoms, for co-test of cure or other special circumstances must have a clinician collected sample.

• Asymptomatic women who test negative for oncogenic HPV^* are at low risk of developing cervical cancer and only need to be screened every 5 years.
• Asymptomatic women who test positive for oncogenic HPV^* will need to return for a clinician collected specimen for liquid-based cytology (LBC) testing. Those positive for high risk HPV 16/18 will be referred for colposcopy and the specimen can be collected at that time. Those positive for HPV non (16/18) will be recommended to return to their original referring practitioner for the LBC collection.
• Symptomatic women and those with a history of high-grade cervical pathology will have both an HPV^* and LBC test (Co-test) performed, regardless of their HPV^* result.
• Approximately 10% of self-collected samples will be positive for HPV. These women need to return for a clinician collected specimen to be used for LBC cytology triage. The 2% of women positive for HPV 16 or 18 will be recommended for immediate colposcopy and cytology sample will be taken at that time. The 8% of women positive for non 16/18 HPV will need to return to their local health provider for a clinician-collected cervical sample.
• Women with special circumstances identified by the program may be offered more frequent screening or a single screening test prior to age 25.
• Custody of the self-collect specimen:  The latest NCSP Clinical Practice guidelines state ”patients attending an in-person consultation should be encouraged to collect a sample while still at the clinic, however collection of the sample may occur in any setting the health care professional ordering the test considers appropriate including telehealth consultation”.  The healthcare professional is responsible for custody of the specimen. Women must return Self-collected samples to their health care professional for collection by SNP. CST results are delivered to the requesting healthcare professional who is then responsible for informing patients of the results and any required follow-up.

^* Oncogenic HPV types reported are HPV 16, HPV 18 and HPV (not 16/18). HPV (not 16/18) variants tested: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.

Patient eligibility for CST/HPV self-collections

 If a self-collection is performed outside of current National Cervical Screening Program (NCSP) guidelines, no Medicare rebate is available, and an account will be issued to the patient. Prior to offering self-collections, check your patients’ eligibility via the National Cancer Screening Register. Visit ncsr.gov.au and search for ‘NCSR portal’. 

Eligible patients

• All people with a cervix between the ages 25 to 74, and who have ever been sexually active.
• Asymptomatic patients who are starting or coming in for their five-yearly routine screening.

Ineligible patients

• Patients who have recorded negative HPV test results within the past five years.
• Patients who require a co-test for one of the following five groups, including patients:
  - with symptoms suggestive of cervical cancer
  - who are undergoing test of cure after treatment for a high-grade squamous intraepithelial lesion (HSIL)
  - who have been treated for a glandular abnormality, including adenocarcinoma in situ (AIS)
  - who have been exposed to diethylstilboestrol (DES) in utero
  - who have had a total hysterectomy with a history of HSIL.

CST resources

A wide range of resources are available for download using the links below.