For Healthcare providers

Information for healthcare providers about their role in the National Cervical Screening Program

Page last updated: 21 November 2017 (this page is generated automatically and reflects updates to other content within the website)

Download a copy of the Colposcopy and Treatment Form, to assist with your preparations for the commencement of the renewal of the National Cervical Screening Program on 1 December 2017.
Why is the program changing?
What do the changes mean for Healthcare providers?
How can I get across the changes?
Ordering the new Cervical Screening Test
The new screening pathway
The National Cancer Screening Register Rules 2017
More Information for Healthcare providers

Why is the program changing?

Australia is establishing a new cervical screening process based on recommendations by Australia’s independent Medical Services Advisory Committee (MSAC).

From 1 December 2017, a new Cervical Screening Test should replace the existing Pap test. MSAC recommended that the new screening test will be conducted every five years instead of every two for people aged 25 to 74 years.

MSAC also advised that

  • an HPV test with partial genotyping should be undertaken every five years
  • cervical screening should commence at 25 years of age
  • people should have an exit test between 70 and 74 years of age
  • people with symptoms (including pain or bleeding) can have a cervical test at any age
Nearly all cervical cancers are caused by the human papillomavirus (HPV). Cervical cancer is a rare outcome of persistent infection with oncogenic HPV types. The time from HPV infection to cervical cancer is usually 10 to 15 years. Cervical screening should focus on detecting early stage HPV, in particular types 16 and 18 that have been associated with 70% to 80% of the cases in Australia. Evidence suggests that screening for HPV every five years is more effective than, and just as safe as, screening with a Pap test every two years.

Because Australia has an effective national vaccine program, the prevalence of HPV in young people 18-24 is very low.

If you require further information on the program please call 13 15 56.

What do the changes mean for Healthcare providers?

Patient reminder and recall systems

Healthcare providers will need to update their practice patient reminder and recall systems in line with the new pathways and screening intervals.

Changes to the Cervical Screening Test

Healthcare providers will still perform an examination using a vaginal speculum and take a sample, but the sample medium is liquid-based and will be tested for the presence of HPV. For the participant, if they have ever had a Pap test before, the way the test is done will look and feel the same.

For your patients that may have refused to screen, an alternate method of collection is available but patients must meet the eligibility criteria; be over 30 years of age and be overdue for their screening test by two years or more.

Please visit the Publications and resources section of this website to download further information.

Changes to MBS items

From 1 December 2017 the Pap test will no longer be covered under the Medicare Benefits Scheme (MBS) and will be replaced with the new Cervical and Vaginal Testing and accompanying MBS item numbers. Healthcare providers will need to know the differences between the MBS items and provide as much information on the pathology request form as possible. This will avoid the wrong pathology test being performed on the sample or the patient being charged incorrectly for a test.

From 1 December 2017 if healthcare providers write ‘Pap test’ or ‘smear’ on the pathology request form, their patient will be charged.

How can I get across the changes?

Information pack for Healthcare providers

An information pack has been sent to Healthcare providers. It contains the essential information about the changes to the National Cervical Screening Program and materials which you can use to explain the changes to your patients.

Additional information packs can be ordered from the Publications and resources section of this website.

Online training modules

Online training modules to help you understand the new test and Clinical Pathways are available on the NPS MedicineWise website. This training will be recognised as continuing professional development hours with RACGP, ACRRM, ACN, ACM and APNA.

Training covers information about the changes to cervical screening, including:

  • The difference between the new Cervical Screening Test and the Pap test
  • New results categories and clinical pathways
  • Managing people transitioning to the new clinical pathway who have test results and are under clinical management
  • Practical advice and videos to help you engage with patients from culturally and linguistically diverse communities and patients with an intellectual disability
The training was developed by the Department of Health and NPS MedicineWise.

See the online training modules.

Ordering the new Cervical Screening Test

You will need to fill in pathology request forms differently, under the renewal. Getting this information correct is critical for pathology laboratories to conduct the right tests, match to the correct clinical recommendations and select the appropriate MBS item.

You will need to provide the patient’s presentation and testing history on the pathology request form to correctly order the new Cervical Screening Test.

If this information is not provided, patients may be charged incorrectly for the test, or have to return for a repeat examination.

You can find out how to correctly order the new Cervical Screening Test using the in the Pathology Test Guide for Cervical and Vaginal Testing.

This table lists the new MBS items for the Cervical and Vaginal Testing and the types of information that healthcare providers will need to include when ordering pathologist reports:

Pathology Test Guide for Cervical and Vaginal Testing



Patient presents as

Context*

Age

Sample type

Test type

What to write on the pathology request form

Asymptomatic

NCSP routine five yearly screening

  • Only 1 of this MBS item is claimable in a 57-month period

≥ 24yrs & 9mths

Cervical

HPV test

Cervical Screening Test (CST)

Screening under-and never-screened patients

  • ≥30 years of age and
  • At least 2 years overdue or never-screened and
  • Declines cervical sampling
  • Only 1 of this MBS item is claimable in a 7-year (84mth) period

≥ 30yrs

Vaginal

HPV test

HPV test, self-collected

Screening under-and never-screened patients

  • Following a self collect test result of HPV not 16/18 detected (intermediate risk)

Cervical

Standalone LBC

LBC

Asymptomatic

Screening in specific populations

  • Immune-deficient
  • Early sexual debut, prior to 14 years and not vaccinated prior to sexual debut (only one claimable between 20 to 24 years of age)

Any age

Cervical

HPV test

 

  • HPV test, Immune deficient
  • HPV test, Early debut HPV

Follow up test claimable after previous positive screening test (12 month repeat)

  • Follow up HPV test

Follow up or post treatment for clinical management

  • Following treatment of HSIL (also called “test of cure”)
  • Following treatment of AIS
  • DES exposed in utero

Co-test (HPV & LBC)

 

  • “Co-test” or “HPV & LBC”, Test of Cure
  • “Co-test” or “HPV & LBC” Post-treatment
  • “Co-test” or “HPV & LBC”, DES

Symptomatic

For investigation of symptoms e.g. abnormal bleeding

“Co-test” or “HPV & LBC”, Symptomatic

Patient presents as

Context*

Age

Sample type

Test type

What to write on the pathology request form

HPV test after total hysterectomy

  • No evidence of cervical pathology on hysterectomy specimen and the patient screening history not available

Any age

Vaginal vault

HPV test

Vaginal vault HPV

  • Unexpected LSIL or HSIL identified in hysterectomy specimen;
  • Hysterectomy for treatment of HSIL in the presence of benign gynaecological disease; or
  • Following histologically-confirmed HSIL without previous Test of Cure and no cervical pathology in hysterectomy specimen.

Co-test (HPV & LBC)

Vaginal vault “Co-test” or “HPV & LBC”

Follow up self-collect HPV test (clinical management)

  • Only claimable within 21 months following the detection of oncogenic HPV (any type) on a self-collected screening test

≥ 30yrs

Vaginal

HPV test

Self-collect HPV follow up test

Cervical

Standalone LBC

LBC

Repeat test following an unsatisfactory test

Following an unsatisfactory test

  • Only claimable when preceded by another cervical or vaginal MBS Item

Any age

Cervical

HPV test

HPV test, previous result unsatisfactory

Vaginal

HPV test

HPV test, previous result unsatisfactory

Cervical

LBC

LBC, previous result unsatisfactory

The new screening pathway

The new Cervical Screening Test and pathway is a risk-based approach to the management of HPV and cervical cancer, as recommended by the Medical Services Advisory Committee (MSAC). Patients are managed according to their risk of developing significant cervical abnormalities within the next 5 years, which is determined by their Cervical Screening Test result.

The new Cervical Screening Test is more accurate than cytology alone (i.e. Pap tests) as it detects the presence of HPV and the potential for progression to high-grade lesions earlier, thus preventing more cervical cancers. Screening using HPV testing has the potential to improve detection of adenocarcinoma and its precursors.

For clinician collected specimens, reflex LBC can be performed on the same cervical specimen (without requiring an additional request) and the pathology lab will issue the HPV test result, LBC test result and overall screening risk rating as a combined report. Self collection of a vaginal sample can only be tested for HPV. A new pathology request will be required for the clinician collected specimen for reflex LBC testing only. The pathology lab will then issue a combined report with the initial self-collect HPV test, LBC test result and overall screening risk rating as a combined report.

If any glandular abnormalities are detected on a screening test, healthcare providers should follow up according to the 2016 Guidelines.

There are four result categories:

  • Return to screen in five years
  • Repeat the HPV test in 12 months
  • Refer to a specialist
  • Unsatisfactory sample (HPV or LBC) retest within 6-12 weeks

Return to screen in five years

This result means oncogenic HPV was not detected. Patients with this result will be invited to screen again in five years.
These patients are at low risk of developing cervical cancer and can safely return for a Cervical Screening Test in five years.

We cannot assure patients that they are at ‘no risk’ because they may subsequently acquire an HPV infection or have a latent infection that becomes active.

Repeat the HPV test in 12 months

This result means an HPV infection was detected. It is not associated with high-grade cell changes that require treatment.

A reflex LBC conducted on the same sample showed that the patient has negative or possible low-grade squamous intraepithelial lesion (LSIL), or LSIL abnormal cervical cells.

These patients will be invited to return for a repeat HPV test in 12 months. This is to check if the body has cleared the HPV infection.

Refer to a specialist

This result means the patient has received one of two possible results:

  • HPV is detected, but not types 16 or 18
    A reflex LBC will be conducted on the same sample. If possible high-grade squamous intraepithelial lesion (HSIL) or HSIL on cytology has been detected, the patient should be recommended to a specialist to have a colposcopic assessment because they are at a higher risk of cervical cancer. A colposcopy will determine if a biopsy is needed and treatment is required.
  • HPV types 16 or 18 have been detected
    HPV types 16 and 18 are associated with approximately 70% of cervical cancers. These HPV types are more likely to progress to cervical cancer than other oncogenic HPV types. Regardless of the reflex LBC test result, the patient should be recommended to have a colposcopic assessment because they are at a higher risk of cervical cancer. The LBC will inform the colposcopic assessment.

Unsatisfactory sample (HPV or LBC) retest within 6-12 weeks

This result means the sample collected was unsatisfactory. If the HPV test was unsatisfactory, the patient should return with 6-12 weeks for a repeat HPV test. If the LBC test was unsatisfactory, the patient should return with 6-12 weeks for a repeat LBC test.

The four pathways are shown in the diagram below.

This image shows the 4 pathways for collected Cervical  Screening tests and sent to pathology laboratories. The 4 pathways are: Pathway 1 – HPV not detected, Pathway 2 - HPV not 16/18 detected, Pathway 3 – HPV 16/18 detected, Pathway 4 – Unsatisfactory HP

The National Cancer Screening Rules 2017

The Rules prescribe the requirement for mandatory notification to the Commonwealth Chief Medical Officer (CMO) under section 13 of the National Cancer Screening Register Act 2016 (the NCSR Act), including who is required to notify, the mandatory data sets and the timeframe for notification.

From 1 December 2017, colposcopists and pathology practitioners will be required to notify prescribed cervical screening information to the CMO through the Register.

The Rules will support notification of individuals’ screening test results, results of follow-up procedures, diagnosis (or clearance) of cancer and other relevant screening information to the Register and enable monitoring of NCSP program quality, safety and effectiveness.

More information on the Rules is provided below:

More Information for Healthcare providers

Healthcare provider information pack

If you are a Healthcare provider and have not received an information resource pack, you can order resources from the Publications and resources section of our website.

Healthcare provider and waiting room materials

If your practice has TONIC managing the content within your waiting room, TONIC will display information on your digital screens, supply and manage the content in your brochure stands and, in some practices, will include translated brochures. You will still need to order the booklet- A Guide to Understanding your Cervical Screening Test results and the Self-collect resources: Self-collect factsheet and Self-collect instruction sheet.

If your practice does not have TONIC managing your waiting room, you can order posters, brochures, booklets, factsheets and instruction sheets by visiting Publications and Resources. There will be no cost to you or your practice.

The Clinical Guidelines for the National Cervical Screening Program

Health providers should regularly check for updates in the 2016 National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. The latest version is available on the Cancer Wiki platform

These new guidelines are available for training and reference purposes only, and do not guide clinical practice until 1 December 2017.