National Cervical Screening Program

Australia has one of the lowest rates of cervical cancer in the world, largely as a result of the success, over the last 25 years, of the National Cervical Screening Program. The program is now changing, based on Medical Services Advisory Committee recommendations and the latest available evidence on the development and prevention of cervical cancer.

A new Cervical Screening Test which looks for the human papillomavirus (HPV) will replace the Pap test and a new cervical screening pathway will be introduced.

This series of six modules, developed by the Commonwealth Department of Health in conjunction with NPS MedicineWise and clinical experts, provides training for healthcare providers who conduct Cervical Screening Tests and follow-up management for women aged 25–74.

The modules are intended to enhance, reinforce and increase knowledge about the changes to the Cervical Screening Test, including the introduction of the human papillomavirus (HPV) test, 5-yearly screening intervals, and how to manage screening test results in accordance with the new clinical guidelines.

Cervical cancer – module 1

Provides an opportunity for you to enhance and reinforce your knowledge of cervical anatomy, the aetiology of cervical cancer, strategies for prevention of cervical cancer in Australia, and the burden of this disease in the Australian context. Read the learning outcomes for module 1.

Changes to the National Cervical Screening Program – module 2

Outlines the changes to be implemented when the National Cervical Screening Program (NCSP) is renewed. These include changes to the primary screening test, the screening interval, target age range for screening, new policies and guidelines, and the establishment of a National Cancer Screening Register. Read the learning outcomes for module 2.

Communicating the importance of cervical screening – module 3

Focuses on communicating the importance of cervical screening to all women and particularly to under-screened and never-screened women. The module includes strategies to overcome barriers to cervical screening for specific populations, including Aboriginal and Torres Strait Islander women, women from culturally and linguistically diverse (CALD) backgrounds, women with disabilities, women who identify as lesbian, bisexual or are same-sex attracted and (where relevant) transgender men, women who have experienced sexual trauma, women of low socioeconomic status, older women, and those who are HPV-vaccinated. Read the learning outcomes for module 3.

Screening in practice – module 4

Reinforces your knowledge of changes to the NCSP and information on what these changes mean in practice. Areas covered in the module include ways to improve patient psychological and physical comfort during cervical screening, components of a quality cervical sample, how to locate the transformation zone through various age stages, how to take a quality cervical sample and how to transition women to the renewed NCSP based on cervical screening history. Read the learning outcomes for module 4.

Understanding the cervical screening clinical pathway – module 5

Provides an overview of the cervical screening clinical pathways under the renewed NCSP. Includes recommendations for managing patients who are asymptomatic, those who present with abnormal vaginal bleeding, women who have self-collected a vaginal sample, and cases where a cervical abnormality has been visualised during the speculum examination. Read the learning outcomes for module 5.

Communicating test results and patient management – module 6

Provides an opportunity for healthcare providers to reinforce their knowledge about communicating test results and patient management under the renewed NCSP. This module provides participants with effective communication techniques that will help patients understand their cervical screening test results. Includes approaches to explaining HPV-detected results to a patient and identifies ways to minimise medico-legal risks related to screening. Read the learning outcomes for module 6.

After completing the modules, you should be able to: 

Module 1

• Describe the anatomical features of the female pelvis and cervix that are relevant to cervical screening.
  
• Describe the link between human papillomavirus (HPV), cervical cell abnormalities and the development of cervical cancer, understanding that progression or regression can occur.
  
• Identify the strategy for primary prevention of cervical cancer in Australia.
  
• Explain the importance of the secondary prevention strategy and the role of population-based screening for prevention of cervical cancer in Australia.
  
• Apply the National Cervical Screening Program: Guidelines for the Management of Screen-Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines) to assist with the management of symptomatic women aged 25–74.
  

Module 2

• Explain the rationale behind the decision to replace Pap tests with human papillomavirus (HPV) testing with partial genotyping, and liquid-based cytology triage.
  
• Describe the rationale behind five-yearly screening intervals in the renewed National Cervical Screening Program (NCSP).
  
• Explain why the age to start cervical screening has been raised to 25 years for the renewed NCSP.
  
• Identify the role of the National Cancer Screening Register (NCSR).
  
• Apply the policies of the NCSP and the supporting clinical management guidelines.
  
• Apply the National Cervical Screening Program: Guidelines for the Management of Screen-Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines) to assist with the management of symptomatic women aged 25–74.
  

Module 3

• Identify effective communication techniques to convey the importance of cervical screening to women.
  
• Describe the importance of personal attitudes, values and open and non-judgemental communication when discussing cervical screening with women.
  
• Identify strategies or approaches to increase participation to the specific populations of under-screened and never-screened women.
  
• Describe approaches that help to deliver cervical screening in a culturally sensitive manner.
  
• Identify approaches to increase participation in cervical screening in Aboriginal and Torres Strait Islander women.
  
• Apply the National Cervical Screening Program: Guidelines for the Management of Screen-Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines) to assist with the management of symptomatic women aged 25–74.
  

Module 4

• List the ways you can improve patient psychological and physical comfort during cervical screening.
  
• Identify the components of a quality cervical sample.
  
• Describe how the location of the transformation zone can vary with age and menopausal status.
  
• Describe how to take a quality cervical sample.
  
• Determine how to transition women to the renewed NCSP based on cervical screening history.
  
• Apply the National Cervical Screening Program: Guidelines for the Management of Screen-Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines) to assist with the management of symptomatic women aged 25–74.
  

Module 5

• Apply the National Cervical Screening Program: Guidelines for the Management of Screen-Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines) to assist with the management of symptomatic women aged 25–74.
  
• Identify the role of colposcopy and treatment options for those with cervical abnormalities.
  
• Identify management for women with an abnormality detected on visual examination of the cervix.
  
• Identify the range of pathology test results that may be reported following a cervical screening test.
  

Module 6

• List effective communication techniques that will assist patients in understanding their cervical screening test results.
  
• Identify approaches that assist with explaining to a patient that HPV was detected in their cervical sample.
  
• Demonstrate knowledge of medico-legal issues relating to screening.
  
• Identify approaches to minimise and manage medico-legal risks relating to screening.
  
• Apply the National Cervical Screening Program: Guidelines for the Management of Screen-Detected Abnormalities, Screening in Specific Populations and Investigation of Abnormal Vaginal Bleeding (2016 Guidelines) to assist with the management of symptomatic women aged 25–74.