Following a comprehensive review of the current evidence for cervical screening, MSAC has recommended for both HPV vaccinated and unvaccinated women that:
- an HPV test should be undertaken every five years
- cervical screening should commence at 25 years of age
- women should have an exit test between 70 and 74 years of age
- women with symptoms (including pain or bleeding) can have a cervical test at any age.
One HPV test every five years can save more lives and women would need fewer tests than in the current two-yearly Pap test program.
HPV vaccinated women will still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.
Further information on the MSAC recommendation is available on the MSAC website.
What the recommendations mean
The HPV test
- A HPV test detects HPV, the virus that can cause pre-cancerous abnormalities. The Pap smear detects abnormal cell changes. The HPV test is more effective as it can detect the virus that causes the abnormal cell changes.
- The procedure for collecting the sample for HPV testing is the same as the procedure for having a Pap smear. A doctor or nurse would still take a small sample of cells from the woman’s cervix to send away to a laboratory to be examined.
- If HPV is found (HPV positive), further testing (cytology) would automatically be done on the same sample to check if any abnormal cells are present (like the Pap test), with no need to go back for a second test.
- If a woman doesn’t have the virus (HPV negative), she would be invited to rescreen in five years.
Women younger than 25 years of ageThe recommendation to commence cervical screening at 25 years of age is based on evidence that shows:
- cervical cancer in young women is rare
- screening women younger than 25 has not changed the number of cases of cervical cancer or deaths from cervical cancer in this age group
- investigating and treating common cervical abnormalities in young women that would usually resolve spontaneously can increase the risk of pregnancy complications later in life
- HPV vaccination has already been shown to reduce cervical abnormalities among women younger than 25 and will continue to reduce the risk of cervical abnormalities in this age group.
Women over 69 years of age
- Women between 70 and 74 who have had a regular screening test would be recommended to have an exit HPV test before leaving the cervical screening program.
- Women older than 69 who have never been screened or have not had regular screening tests should have an HPV test if they request screening.
Rare cervical cancer types
- There is no effective population screening test for rare neuroendocrine cervical cancers.
- Neither the current Pap test nor the new Cervical Screening Test (primary HPV test) effectively detects rare neuroendocrine cervical cancers.
Evidence and economics reportsThe MSAC has provided advice on the safety, effectiveness and cost effectiveness of a new cervical screening process for the National Cervical Screening Program.
The MSAC recommendations build upon the world’s first national school-based HPV vaccination program by recommending the establishment of one of the world’s first national cervical screening programs, using a primary HPV test, to prevent cervical cancer. They also provide an opportunity to further reduce incidence and mortality from cervical cancer.
The Assessment Reports considered by MSAC are to be read with the two statements dated 13 June 2014 and 26 June 2014.
Statement 13 June 2014
Statement 26 June 2014
The MSAC public summary documentation including the recommendations is available on the MSAC website.