The Cervical Screening Test (the Pap test replacement*) and management pathway is based on the risk of developing cervical cancer, determined by the test results.
The Cervical Screening Test detects infection with human papillomavirus (HPV)
Partial genotyping is used to classify the type of HPV into one of two groups:
- Oncogenic HPV type 16 and/or 18; or
- Oncogenic HPV type (not 16 or 18).
When HPV is detected, the pathology laboratory will conduct reflex liquid-based cytology on the same sample to determine if any cervical cell abnormalities are present. This assists in determining the patient’s risk rating and triaging for colposcopy.
The pathology report will include the combined result as a risk category and the recommended management. There are three risk categories:
- low risk – Return to screen in five years
- intermediate risk – Repeat the test in 12 months
- higher risk – Refer to specialist
It’s important to make it clear to your patient if she needs to repeat her test in 12 months or be referred to a specialist, it does not mean that she has cervical cancer. She may not even require further treatment to prevent cervical cancer.
You’ll need to clearly explain what her result means, and what the next steps will be.
Proposed cervical screening pathway:
This chart outlines the proposed cervical screening pathway following the changes to the National Cervical Screening Program:
Communicating test results
As a Cervical Screening Test provider, you will have your own system in place for informing patients of their result. While many providers deliver low-risk test results over the phone, a follow-up appointment is highly recommended for communicating intermediate or higher risk results.
This will make it easier to discuss the results in detail with your patient, as well as allowing you to monitor how they respond to the news.
Naturally, some women will be upset when they are told their cervical screening results show she has HPV. The way you communicate the news plays a significant part in how your patient reacts.
- Clearly explain what her result means
- Reassure her that an intermediate or higher risk result does not mean she has cervical cancer
- Provide a detailed explanation of the next steps
- Encourage her to ask questions or raise any concerns she may have
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 10-15 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.
Occasionally the Cervical Screening Test may be unsatisfactory, possibly not containing enough ectocervical and endocervical cells, and the laboratory may request another test be performed.
It is important that another sample is collected within 6-12 weeks.
Repeat the HPV test in 12 months - Intermediate results
This result means that HPV – but not type 16 and/or 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, there are two possible results:
- HPV not detected; the patient can safely return to five-yearly screening
- HPV detected (any type) and reflex LBC performed. Regardless of the LBC result, the patient will be referred for colposcopic assessment.
Refer to specialist - Higher risk
There are two outcomes that result in a higher risk result:
- HPV detected – not types 16 and/or 18 – and reflex LBC found high-grade squamous intraepithelial lesions (HSIL) or possible HSIL. Colposcopic assessment is required.
- HPV types 16 and/or 18 detected. As these HPV types are more likely to progress to cervical cancer than other HPV types, colposcopic assessment is required.
NCSP Resource Directory
The NCSP’s Resource Directory includes the following free resources, about cervical screening results:
- Understanding the National Cervical Screening Program Management pathway: A guide for healthcare providers
- A Guide to understanding your Cervical Screening Test results
Delivering a cervical cancer diagnosis
A Cervical Screening Test looks for HPV. If HPV is found, the laboratory test will automatically look at the cervical cells from the same sample and, in very rare cases, cervical cancer will be detected. If this is the case, your patient will need additional emotional and psychological support. As her health provider, your involvement will be of great importance to your patient.
For additional support, you can refer your patient to Cancer Council NSW and encourage her to call the Cancer Council NSW helpline on 13 11 20.
The Cancer Council’s book, Understanding Cervical Cancer (PDF), may help with explaining the diagnosis to your patient.
If you are unable to contact your patient
If you can’t contact a patient to deliver her Cervical Screening Test results, you can contact the National Cancer Screening Register (NCSR) on 1800 627 701.
The NCSR may be able to advise whether your patient has updated their contact details.
Are your details in our Cervical Screening Test Provider Directory?
The National Health Service Directory search tool can help women find a Cervical Screening Test provider. If you’d like to be listed as a cervical screening provider, please register yourself or your practice.
*In December 2017, the cervical screening test replaced the Pap test as the method of screening women to prevent cervical cancer in Australia.
- Discover how cervical screening has changed.