NATIONAL CERVICAL SCREENING PROGRAM GUIDELINES
THE RENEWED NATIONAL CERVICAL SCREENING PROGRAM: Quick Reference Guide CERVICAL SCREENING PATHWAY QUICK REFERENCE GUIDE CERVICAL SCREENING PATHWAY
CERVICAL SCREENING PATHWAY For queries about clinical guidelines and management of patients please contact the VCS Liaison Physician Team. Tel: (03) 9250 0309 or email: LiaisonTeam@vcs.org.au
Oncogenic HPV test with partial genotyping HPV detected (not 16/18)
HPV not detected
HPV detected (16/18)
Routine 5-yearly screening Unsatisfactory LBC
Negative
Retest for LBC only in 6 –12 weeks
pLSIL/LSIL
Repeat HPV test in 12 months
Retest HPV in 6 –12 weeks
Any LBC result or unsatisfactory
LBC pHSIL or worse*
Refer for colposcopic assessment
HPV detected (16/18)
HPV detected (not 16/18)
HPV not detected
Unsatisfactory HPV test
Unsatisfactory HPV test
Retest HPV in 6 –12 weeks
Routine 5-yearly screening Unsatisfactory LBC
Retest for LBC only in 6 –12 weeks
LBC negative/pLSIL/ LSIL
Repeat HPV test in 12 months
Direct referral to coloscopy is recommended for: • women 50+ years • Aboriginal and/or Torres Strait Islander women • women overdue for screening by at least 2 years
Any LBC result or unsatisfactory
LBC pHSIL or worse*
LEGEND Primary test
Test result Recommendation
Woman’s risk of developing cervical cancer precursors Low Intermediate Higher
HPV not detected Cancer Council Australia Cervical Cancer Screening Working Party. Clinical pathway: Cervical screening pathway. 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. Updated Dec 2020.
www.vcs.org.au/pathology
HPV detected any
Refer for colposcopic assessment
Routine 5-yearly screening
*Includes pHSIL, HSIL, cancer or glandular abnormality.
Suggested citation: Cancer Council Australia Cervical Cancer Screening Working Party. Clinical pathway: Cervical screening pathway. National Cervical Screening Program: Guidelines for the management of screen CCA 2016. Accessible from http://wiki.cancer.org.au/australia/Guidelines:Cervical_cancer/Screening.
Updated Dec 2020.
DES: diethylstilboestrol LSIL: low-grade squamous intraepithelial lesion HSIL: high-grade squamous intraepithelial lesion pLSIL: possible low-grade squamous intraepithelial lesion pHSIL: possible high-grade squamous intraepithelial lesion
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NATIONAL CERVICAL SCREENING PROGRAM GUIDELINES
THE RENEWED NATIONAL CERVICAL SCREENING PROGRAM: Quick Reference Guide CERVICAL SCREENING PATHWAY QUICK REFERENCE GUIDE
COMMENCEMENT OF CERVICAL SCREENING
SELF-COLLECTION PATHWAY
SELF-COLLECTION ELIGIBILITY CRITERIA
All people with a cervix who have ever been sexually active should commence cervical screening at 25 years of age.
The NCSP Self-Collection Policy provides an alternative screening process for asymptomatic patients who are underscreened or neverscreened. The vast majority of cervical cancer in Australia occurs in these groups.
• Participant must be 30 years of age or older
CEASING CERVICAL SCREENING Participants can be discharged from the NCSP if they are aged 70–74 years and have a screening test at which oncogenic HPV is not detected. Patients who are 75 years or older who have never had a cervical screening test, or have not had one in the previous five years, may request a test and can be screened.
DIAGNOSTIC CO-TESTING Any person at any age with signs or symptoms suggestive of cervical cancer (unexplained persistent, unusual or abnormal bleeding) should have diagnostic cytology and HPV testing (co-testing) and appropriate referral.
Arbyn et al, Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses BMJ 2018; 363 :k4823 Saville et al, Analytical performance of HPV assays on vaginal self-collected vs practitioner-collected cervical samples: the SCoPE study, Journal of Clinical Virology (2020), doi: https://doi.org/10.1016/j.jcv.2020.104375
www.vcs.org.au/pathology
Patients may decline to have a practitioner-collected cervical screening test for a range of reasons, including fear, discomfort, cultural reasons, trauma and lack of access to a suitable cervical screening provider. Self-collection is a highly acceptable test and it is as sensitive as practitioner-collected samples for the detection of CIN2+/AIS and HPV (Arbyn et al, BMJ, 2018). A recent study has also demonstrated that self-collected swabs are no less sensitive for the detection of HPV than practitioner-collected cervical specimens (Saville et al, JCV, 2020). Patients should be advised that if their result is positive for any type of HPV they will be recommended to return for further examination.
• Participant must be 2 or more years overdue for screening • Participant must have declined a speculum examination • Participant must not have symptoms suggestive of cervical cancer (this requires a co-test)
FURTHER INFORMATION For queries about clinical guidelines and management of patients please contact the VCS Liaison Physician Team. Tel: (03) 9250 0309 or email: LiaisonTeam@vcs.org.au The clinical guidelines are available at http://wiki.cancer.org.au/australia/Guidelines:Cervical_ cancer/Screening NCSP policies and resources are available at https://www.health.gov.au/initiatives-and-programs/ national-cervical-screening-program