QUICK REFERENCE: MANAGEMENT OF SELF-COLLECTED HPV TEST RESULTS SUMMARY OF GUIDELINE RECOMMENDATIONS
ONCOGENIC HPV NOT DETECTED
ONCOGENIC HPV DETECTED
Participants who do not have oncogenic HPV detected should be told their risk of developing cervical cancer is low
A small number of participants will have oncogenic HPV detected. These participants should be contacted by the practice to arrange a follow up visit
• These participants will be invited by the National Cancer Screening Register to re-screen in 5 years. • Add a recall for a Cervical Screening Test in 5 years.
HPV 16/18
UNSATISFACTORY (INVALID) RESULTS Unsatisfactory results will occasionally occur for self-collected samples • • • • • •
Currently unsatisfactory (invalid) rates are approximately 2.5% of all vaginal HPV self-collected samples received. This rate is similar to the unsatisfactory rates for liquid based cytology (LBC) test results. The most common reason for an unsatisfactory result is that insufficient cellular material is contained in the self-collected sample. For participants returning to repeat self-collection after a previous unsatisfactory result, consider sensitively exploring other concerns that the participant may have around performing the test which may have prevented them from taking the test appropriately. Check with the participant that they understand how to take the sample and are comfortable to do so. A visual guide for participants is available at https:// www.vcs.org.au/pathology/for-women/resources/ Alternatively, the participant may choose to accept a clinician-collected sample at this time. The self-collected vaginal HPV test may be inhibited by the presence of blood; in these circumstances it will be an unsatisfactory result and re-collection will be required. While it may be preferable to defer self-collection until after menstruation, consideration should be given to whether the participant is likely to return at a later time to complete the self-collected test.
www.vcs.org.au/pathology
• Participants with oncogenic HPV (16/18) detected should be referred for colposcopy. This should not be delayed. The cervical sample for LBC will be obtained by the colposcopist. HPV (not 16/18) • • • • •
For participants with oncogenic HPV (not 16/18) detected, collect a sample from the cervix for reflex LBC. Explain to the participant that the LBC result will guide further management. If the LBC test result is negative, possible Low-grade Squamous Intraepithelial Lesion (pLSIL) or LSIL, the participant should be recalled in 12 months for a repeat HPV test. Participants who decline a clinician collected sample at their 12 month follow up HPV test will be eligible for a second self-collected sample. If the LBC test result is possible High-grade Squamous Intraepithelial Lesion (pHSIL), HSIL or any glandular abnormality, refer for colposcopy preferably within 8 weeks. Participants screened under the self-collection pathway are excluded from new recommendations introduced on 1 February 2021 for intermediate risk HPV results (not 16/18). Referral to colposcopy continues to be recommended for all participants with self-collected samples at intermediate risk who test positive for HPV (any type) at 12 months after an initial positive test.
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QUICK REFERENCE: MANAGEMENT OF SELF-COLLECTED HPV TEST RESULTS SUMMARY OF GUIDELINE RECOMMENDATIONS
* Cancer Council Australia Cervical Cancer Screening Working Party. Clinical pathway: Cervical screening pathway for self collection. National Cervical Screening Program: Guidelines for the management of screen detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. CCA 2016. Accessible from http://wiki.cancer.org.au/australia/ Guidelines:Cervical_cancer/Screening
www.vcs.org.au/pathology