Cervical cancer screening

The goal of cancer screening is to detect cancer or pre-cancerous changes at an early stage. The benefits of early detection include increased survival, increased treatment options and improved quality of life.1

Australia currently has three national, population-wide screening programs for the early detection of cancer:2

Population-wide testing for all early signs of various cancers  can lead to overdiagnosis, which may cause more harm than benefit.3 However, these programs have demonstrated an acceptable benefit in detecting cancer without a significant cost of overdiagnosis.2
Read more about which tests make a difference to patient outcomes.

Cervical cancer screening — the Pap test

A large body of evidence supports the effectiveness of cervical cancer screening in reducing mortality. The incidence of cervical cancer has fallen in many populations since the introduction of population-wide screening programs.4,5

The risk of developing cervical cancer is 3–10 times greater in women who have not been screened. Around 85% of women who develop cervical cancer have either not had a Pap test or have been inadequately screened in the past 10 years.1

Screening for cervical cancer using the Pap test is recommended every 2 years in women who have had sexual intercourse and have an intact cervix, starting at age 18–20 years.

Pap tests may stop at age 70 years for women who have had two normal Pap tests within the last 5 years. Women aged over 70 who have never had a Pap test, or those who request it, should be screened.1

These guidelines are currently under review and the ages and frequency of testing may be subject to change. See the Australian Government website on cancer screening for more information about this review.

The RACGP recommend the use of invitations and educational materials as a means to encourage women to participate in the screening program.

Table 1. Tests used to detect cervical cancer
Test
Technique
Pap test1

A sample of the ectocervix using an extended tip spatula, then the endocervix using a cytobrush can be used in all age groups.

The cytobrush is not recommended in pregnancy.
In postmenopausal women the transformation zone tends to be higher in the endocervical canal.

The cervical cells should be placed onto a glass slide and fixed within 5 seconds. A smear that is technically unsatisfactory should not be repeated before 6 weeks

HPV testing1 Not recommended as a primary screening tool for cervical cancer
Liquid-based cytology1 Can be used as an additional test to the conventional smear technique but should not be used as a substitute

References

  1. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice (The Red Book) 8th Edition. Melbourne: RACGP, 2012. http://www.racgp.org.au/your-practice/guidelines/redbook/ (accessed 11 February 2013).
  2. Australian Institute of Health and Welfare. Cancer in Australia an overview 2012. 2012. http://www.aihw.gov.au/publication-detail/?id=60129542359 (accessed 4 March 2013).
  3. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010;102:605–13.[FullText]
  4. Eddy DM. Screening for cervical cancer. Ann Intern Med 1990;113:214–26.[PubMed]
  5. Laara E, Day NE, Hakama M. Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes. Lancet 1987;1:1247–9.[PubMed]