Requesting screening and follow-up under the renewed National Cervical Screening Program
From 1 December 2017, a new Cervical Screening Test every five years will replace the existing two yearly Pap test. People will be due for their first Cervical Screening Test when they would have been due for their next Pap test.
Healthcare providers will still perform a vaginal speculum examination and take a cervical sample, but the sample medium is liquid-based and will be tested for the presence of HPV. If HPV is detected the laboratory will automatically conduct a cytology test. This means that there will be a change to the way pathology for cervical and vaginal samples is requested and processed.
The current Pap test will no longer be covered under the Medicare Benefits Schedule (MBS), which means that if you write ‘Pap test’ or ‘smear’ on the pathology request form, your patient may be charged.
Speaker: A/Prof Lyndal Anderson, Senior Staff Specialist & Gynaecological Pathologist, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney.
New items, new clinical pathways, new clinical management guidelines
From the 1st of December we will be increasing the MBS item numbers from four to seven.
This is to reflect the different pathways patients will now take through the National Cervical Screening program in line with new management guidelines.
The reason we have had to increase to seven MBS item numbers is because the same material can be used for screening or diagnosis and it has a very different pathway in the laboratory depending on the patient’s previous history.
This sounds more complicated but it really just reflects a diversity of patients that come to our service and a better understanding of who they are and what their needs will be in this new system.
Pathology laboratories will assign the item number based on the clinical information provided on the request form
To help us choose the most appropriate MBS item number from the seven, we really need quite a comprehensive history, particularly if the patient has been immunocompromised, if they have had previous surgery such as hysterectomy, or if they’ve had symptoms such as spotting, PV bleeding or any sort of pain, and that information helps us decide in the laboratory what sort of pathway that material will take.
Other information that will be relevant is when the patient was last screened for example, has there been any previous abnormality even if it was some time ago, and what are the symptoms present in your patient, if any.
The more information you put on the pathology request form will ensure that the correct test is conducted on your patient’s sample.
A table containing key information, including what to write on a pathology request form has been developed to support both providers and pathologists
Most providers should have received a package in the mail from the Chief Medical Officer. Included in this package was a poster-sized copy of a table titled ‘Pathology Test Guide for Cervical and Vaginal Testing’ mail along with a guide for Healthcare providers summarising the key changes associated with the renewal of the Program. At the back of this guide is a handy fold-out version of the table for your reference.
How to transition patients
Patients aged 25 to 74 years of age should be offered the new Cervical Screening Test when they are next due for their Pap test, which is usually two years after their last negative test.
Patients who are undergoing clinical management for a previous abnormal result of treatment should be offered the new test when they are due for clinical follow-up.
It is important to note, symptomatic patients can be tested at any age.
The renewed Program will be supported by a new National Cancer Screening Register that will send invitations and reminder letters on behalf of the National Cervical Screening Program.
Writing 'Not for register' on the pathology form will no longer be an accepted way for a patient to 'opt out' of the Register
There’s going to be change in the way that patients opt out of the register. No longer can you use the information on the pathology form to opt patient out. It must come from the patients themselves, through a healthcare provider or a patient representative to the 1800 number directly (National Cancer Screening Register 1800 627 701).
Importantly, if people do change their mind patients can opt back into the Register on that same number
Speak with your pathology provide to clarify the clinical information they require
We recognise that gathering all this information in a very short potentially emotionally charged time is very difficult, so we will be happy to have conversations with general practitioners and womens’ health providers in the early phases in order to gather this complete, comprehensive list of clinical data.