The National Cervical Screening Program
Overview of the Cervical Screening Test
Cervical cancer can be prevented through screening. Most cervical cancers occur in people who have never screened or do not screen regularly. Having a regular Cervical Screening Test is the best way to protect against cervical cancer.
The Cervical Screening Test detects infection with human papillomavirus (HPV), the virus that causes abnormal changes in the cells of the cervix, which if left untreated may eventually lead to cervical cancer.
If oncogenic HPV is detected, partial genotyping is used to categorise into two groups – oncogenic HPV types 16/18, or other oncogenic HPV types not 16/18 (as a pooled result).
Reflex liquid-based cytology (LBC) is applied to all HPV-positive samples to triage women into one of three risk levels and to inform clinical management.
Most women will receive a result of negative, which means they do not have oncogenic HPV, are classed as ‘Low risk’ and are advised to screen again in five years.
The National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding were developed to support the renewed National Cervical Screening Program (NCSP).
Self-collection of samples
Anyone who is eligible for cervical screening should be offered the choice of either a self-collected vaginal sample or a clinician-collected sample from the cervix. A self-collected sample is taken from the vagina (not the cervix) and is tested for the presence of HPV. Recent evidence shows a Cervical Screening Test using a self-collected vaginal sample is as accurate in detecting HPV as a clinician-collected sample taken from the cervix during a speculum examination.
Cervical screening on a self-collected vaginal sample needs to be ordered and overseen by a healthcare provider who can also ensure timely clinician-collected testing if required as part of follow-up assessment.
During the consultation, provide the patient with an information sheet and an instruction sheet. These and other resources are available from the National Cervical Screening Program.
People who may have difficulty (or are not confident) collecting a vaginal sample themselves, may be assisted to do so by the healthcare provider, or the healthcare provider may collect the sample on their behalf using a self-collection swab without using a speculum.
If HPV not 16/18 is detected in the self-collected sample, then the patient will need to return for a clinician-collected cervical sample for Liquid Based Cytology (LBC) to determine if they are at Intermediate risk or Higher risk. This is expected to affect around 6% of all people attending for routine screening.
The cervical screening management pathway is the same irrespective of how the sample was taken. See Cervical Screening Test – self-collected vaginal sample A quick reference guide for healthcare providers for further information.
It is the responsibility of the supervising healthcare provider to facilitate patient access to, and return of, self-collection swabs, request tests from laboratories, and communicate results and any follow-up requirements to patients.
See also the following section in chapter 6 of the Guidelines.
Results of the Cervical Screening Test
Based on the result of the HPV test and reflex LBC, healthcare providers will be provided with a risk rating and a recommendation for management, outlined below.
Return to screen in five years - Low risk result
A low risk result means that HPV was not detected. Patients with a low risk result will be invited to screen again in five years. Patients cannot be told they have ‘no risk’ because they may subsequently acquire a HPV infection, or have a latent infection that becomes active and cell changes may develop over time.
It is safe for a patient with no HPV detected to wait five years before their next Cervical Screening Test. The average time taken for a persistent HPV infection to cause cervical abnormalities and progress to cancer is usually 10 to 15 years. The Cervical Screening Test has a high negative predictive value, and patients who have no HPV detected are at low risk of developing significant cervical abnormalities.
Unsatisfactory result
Occasionally the Cervical Screening Test may be unsatisfactory and the laboratory may request another test be performed. It is important that another sample is collected within six to 12 weeks.
Repeat the HPV test in 12 months - Intermediate risk results
This result means that HPV not 16/18 was detected. Reflex liquid-based cytology (LBC) conducted on the sample showed either low-grade squamous intraepithelial lesion (LSIL) or possible LSIL (pLSIL), or was negative for abnormalities. Patients will be invited to return for a repeat HPV test in 12 months, to check that HPV has cleared their system.
This result is not associated with high-grade cell changes that require treatment.
At the 12-month repeat HPV test, possible results are:
- HPV not detected; the patient can safely return to five-yearly screening.
- HPV detected not 16/18 and reflex LBC was either high-grade squamous intraepithelial lesion (HSIL) or possible HSIL (pHSIL), cancer or a glandular abnormality, the patient will be referred for colposcopic assessment.
- HPV detected not 16/18 and reflex LBC was negative for abnormalities or was low-grade squamous intraepithelial lesion (LSIL) or possible LSIL (pLSIL), a second follow-up HPV test* in a further 12 months is recommended (i.e. 24 months after the initial screen). If HPV detection persists at the second follow-up test, it is recommended that women are referred for colposcopy, regardless of the result of reflex LBC.
Women who may be at higher risk of harbouring a high-grade abnormality should be referred to colposcopy if HPV is detected at 12 months, regardless of the result of reflex cytology. This includes the following groups:
- Women two or more years overdue for screening at the time of the initial screen.
- Women who identify as being of Aboriginal or Torres Strait Islander descent.
- Women aged 50 years or older.
* An update to the pathway was made in on 1 February 2021, see Guidelines for details including evidence for the update.
Refer to specialist - Higher risk
There are two outcomes that result in a higher risk result:
- HPV detected – not 16/18 – and reflex LBC found high-grade squamous intraepithelial lesions (HSIL) or possible HSIL. Colposcopic assessment is required.
- HPV type 16/18 detected. As these HPV types are more likely to progress to cervical cancer than other HPV types, colposcopic assessment is required.
The Guidelines summarise the cervical screening pathway (clinician-collected or self-collected)
For more information about the management of oncogenic HPV test results, refer to Chapter 6 of the Guidelines.
Women under 25
Under the National Cervical Screening Program, routine cervical screening is not recommended for women under 25 years. Some women under 25 will have had previous screening and may present with an expectation to continue.
Medicare does not fund routine Cervical Screening Tests for women under 25.
Any tests submitted to pathology laboratories will need to be privately funded, or with the consent of the referring practitioner, will not be processed.
For information about women who experience sexual activity at a very young age, see the relevant section below ‘Screening women who experienced early sexual intercourse or sexual abuse’.
Screening women with specific needs
Screening after hysterectomy
Refer to the Guidelines:
- Chapter 13 of the Guidelines (Screening after total hysterectomy)
Screening in pregnancy
View more information about cervical screening during pregnancy >
Screening women who have experienced early sexual intercourse or sexual abuse
The following information is taken from the Guidelines.
Human papillomavirus (HPV) infection often occurs shortly after first sexual activity. Women who experience first sexual activity at an early age and are subsequently infected with oncogenic HPV may have a higher risk of cancer over time if these infections persist.
For women who experienced first sexual activity at a young age (<14 years), and who had not received the HPV vaccine before becoming sexually active, a single HPV test between the ages of 20 and 24 may be considered on an individual basis.
Consider that some women who engaged in early sexual activity may have or be in an abusive situation. Consider referral to specialist sexual assault counselling services as appropriate.
- Chapter 15 of the Guidelines (Screening in women who experienced early sexual intercourse or victims of sexual abuse)
- Chapter 19 of the Guidelines (Psychosocial care)
- NSW Sexual assault services
Screening in immune-deficient women
See the following section in the Guidelines.
- Chapter 16 of the Guidelines (Screening in immune-deficient women)
Screening in DES-exposed women
See the following section in the Guidelines.
- Chapter 17 of the Guidelines (Screening in DES-exposed women)
National Cancer Screening Register
The National Cancer Screening Register (NCSR) is a secure and confidential database of women’s Cervical Screening Test results. The NCSR supports the National Cervical Screening Program by:
- Inviting women to commence screening when they turn 25.
- Reminding women when they are due or overdue for cervical screening.
- Providing women’s cervical screening history to laboratories, which in combination with current results, will inform clinical management.
- Providing a ‘safety net’ for women who have positive HPV test results and who have not attended for further testing, by prompting them to have follow-up tests or treatment.
Healthcare professionals should ask all women whether they identify as Aboriginal or Torres Strait Islander, and this should be recorded on the pathology request form in accordance with ABS classification and standards. This information can then be recorded in the NCSR.
Contacting the NCSR
- Healthcare providers can contact the NCSR on 1800 627 701 if you need to query a result or access a woman’s cervical screening test history.
- The NCSR can also be accessed online through the Healthcare Provider Portal or through integrated clinical software.
Guidelines and training
The National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding were developed and published by Cancer Council Australia, in accordance with National Health and Medical Research Council (NHMRC) recommended processes.
The Guidelines are available on a web-based wiki platform, allowing feedback and regular updating as new evidence emerges.
Cervical cancer education modules were developed to support the Guidelines, for GPs, nurses, sexual health physicians and gynaecologists. Separate modules are available for professionals providing primary colposcopy.
On-line training is available as part of a Cancer Screening Education for General Practitioners course.
Family Planning NSW offer a range of education and training courses about cervical screening – contact their education team for details.
