For Healthcare providers

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

Page last updated: 20 June 2018 (this page is generated automatically and reflects updates to other content within the website)

Download a copy of the Colposcopy and Treatment Form for the National Cervical Screening Program. You can also order pads of the Colposcopy & Treatment Forms from the Publications and Resources section of this website at no cost to you.
Why has the program changed?
What do the changes mean for Healthcare providers?
How can I get across the changes?
Ordering the new Cervical Screening Test
Symptomatic women / when to order a test
The new screening pathway
The National Cancer Screening Register Rules 2017
More Information for Healthcare providers

Why has the program changed?

Australia’s National Cervical Screening Program (NCSP) was revised on 1 December 2017 based on recommendations by the Medical Services Advisory Committee (MSAC). The National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding (2016 Guidelines) have been updated to reflect the recommendations.

The new Cervical Screening Test has replaced the Pap test. The Cervical Screening Test detects infection with human papillomavirus (HPV).

MSAC also advised that:

  • a 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 unusual or persistent vaginal bleeding (post-coital, unexplained inter-menstrual or any post-menopausal), discharge (offensive and/or blood stained) or deep persistent dyspareunia ) can have a cervical test at any age.
Nearly all cervical cancers are caused by 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 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 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

The Pap test is no longer 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 and may result in the patient being charged incorrectly for a test.

From 1 December healthcare providers should not write Pap test or smear on the pathology request form, otherwise their patient will be charged. To assist with completing the pathology request please refer to the Pathology test guide for Cervical and Vaginal testing.

How can I get across the changes?

How do I transition my patients under the age of 25 from the Pap test program to the new program?

Women under 25 years of age who have previously had a Pap test and are not currently under clinical management for a cervical abnormality are due either:

  • when they turn 25 years of age
  • after they turn 25 years of age, once it has been two years since their last Pap test
  • All women including those under 25 years of age who are currently under clinical management for a cervical abnormality should continue to be managed according to the recommendations on transitioning individuals in the 2016 Guidelines at: https://wiki.cancer.org.au/australia/Clinical_question:Transition_to_the_renewed_National_Cervical_Screening_Program
  • Women aged 25 years or older who are currently under clinical management for a cervical abnormality should be managed according to the recommendations on transitioning individuals in the 2016 Guidelines on the Cancer Council website.

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 need to fill in pathology request forms differently, under the renewed program.

It is critical that you provide the pathology laboratory with the correct patient details, clinical presentation and any previous cervical screening history.

This ensures that the pathology laboratory conducts the right test(s), makes the correct clinical recommendations and selects the correct MBS item.

If this information is not provided, patients may be charged 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 Pathology Test Guide for Cervical and Vaginal Testing.

If you are unsure of your patient’s test history, you can call a member of the Contact Centre team on 1800 627 701 or visit the National Cancer Screening Register website.

Symptomatic women / when to order a co-test

Women with signs or symptoms suggestive of cervical cancer are tested and managed on a different clinical pathway from those who are asymptomatic. Women at any age with symptoms suggestive of cervical cancer require diagnostic testing (co-test and usually a gynaecological assessment) and not ‘cervical screening’.

A co-test is where the laboratory performs both the HPV test and the liquid-based cytology (LBC) test at the same time and on the same specimen. This means that the LBC test is performed irrespective of the HPV test result.

The following signs or symptoms can be suggestive of cervical cancer and require further investigation:

Abnormal vaginal bleeding is the most common symptom of cervical cancer and is covered in detail in the 2016 Guidelines. Briefly
  • Pre-menopausal women at any age with unexplained inter-menstrual bleeding require initial investigation with a co-test (HPV and LBC) and referral for gynaecological assessment.
  • Pre-menopausal women at any age with a single episode of post-coital bleeding should be investigated with a co-test
    • if the cervix is clinically normal and the co-test is negative, then she should be advised that no further investigation is necessary
    • but if the post-coital bleeding recurs or is persistent, she should be referred for gynaecological assessment and colposcopy
  • Post-menopausal women with any episode of vaginal bleeding (including post-coital) should be investigated with a co-test and referred for gynaecological assessment.
The following circumstances do not require co- testing or referral for colposcopy
  • Breakthrough or irregular bleeding due to hormonal contraception
  • Contact bleeding at time of obtaining the cervical sample
  • Heavy regular periods (menorrhagia)
Vaginal discharge and/or deep dyspareunia, in the absence of bleeding, may rarely be the initial presentation of cervical cancer:
  • Vaginal discharge and/or deep dyspareunia are commonly due to benign gynaecological conditions and should be investigated appropriately and if necessary referred for gynaecological assessment. A routine Cervical Screening Test (CST), if indicated, is appropriate for these women.
  • Unexplained persistent unusual vaginal discharge, especially if offensive and blood stained, may be associated with a cervical cancer and should be investigated by clinical examination of the cervix and a co-test (HPV and LBC).
    • If the co-test is abnormal she should be referred for colposcopy.
    • Even if the co-test is negative (no HPV detected and LBC normal), referral for gynaecological assessment should be considered.
  • The investigation of unexplained persistent deep dyspareunia (in the absence of bleeding or discharge) should include a CST (if due) and referral for gynaecological assessment should be considered.
Summary: symptomatic women and co-testing
  • Women at any age with abnormal vaginal bleeding (post coital, unexplained inter-menstrual or any post-menopausal bleeding) should have a co-test, and usually will be referred for a gynaecological assessment.
  • Any woman with an unexplained persistent unusual vaginal discharge (especially if offensive and/or blood stained) should be investigated with a co-test, and subsequent referral for gynaecological assessment.
  • Any woman with unexplained persistent deep dyspareunia, should have a CST, and subsequent referral for gynaecological assessment.
Persistence of any unexplained gynaecological symptoms should always warrant further investigation and referral as appropriate.

When requesting co-test for symptomatic women, write Co-test, symptomatic and clearly describe the symptoms on the Pathology Request Form.

For symptomatic women consider referral for gynaecological assessment and further investigation to exclude genital tract malignancy.

The Pathology Test Guide for Cervical and Vaginal Testing 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. The Pathology Test Guide for Cervical and Vaginal Testing can be found under the Publications and Resources page

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 National Cancer Screening Register 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.

Colposcopists and pathology practitioners are required to notify prescribed cervical screening information to the CMO through the National Cancer Screening Register (the Register).

The Rules 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

Toolkit for engaging under-screened and never screened women

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.

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