Great news for women who hate Pap smears…
I have been at the business end of enough pap smears to know that no woman turns up for their second-yearly cervical cancer screening appointment for fun. From the embarrassment of baring your bottom half to the discomfort of the examination itself, as much as we may all dread the experience, it is generally over in a couple of minutes and is infinitely less horrible than having cervical cancer. Since the introduction of national cervical screening in 1991, the number of cases of cervical cancer diagnosed, and the number of women who have died of cervical cancer, has HALVED. That is a huge amount of pain, suffering and heartache that has been prevented by a couple of minutes of minor discomfort per test.
It has been a long time coming, but as of December 1st this year, the current second-yearly cervical screening test will be replaced by five-yearly HPV testing. But what will that involve exactly, and how will the changeover work? And why do you still need screening if you’ve had the ‘cervical cancer vaccine’?
Currently, the process of screening for cervical cancer involves insertion of a speculum (the plastic duck-bill shaped tool) to allow visualisation of the cervix and collection of cells with a small plastic brush or wooden spatula. The cells are then either put onto a slide or into a liquid medium, and sent to a lab. The samples are then stained and viewed under a microscope where pre-cancerous changes can be detected. This allows women to be treated when changes in the cervix have not yet progressed to become cancer, but are at risk of doing so, therefore preventing cancer before it actually occurs.
Once December rolls around, the process at the GP will be basically the same for women presenting for screening. It will still involve a speculum insertion and use of a small plastic brush to collect cells from the cervix, but the tests done in the lab will be completely different. Instead of looking for pre-cancerous changes, the new tests will be detecting the human papilloma virus (HPV), which is the cause of 99.7% of all cases of cervical cancer, and is the virus at which the cervical cancer vaccine (which is actually an HPV vaccine) is directed. This test is more accurate than the current testing which means you will only need to have screening once every five years!
HPV is a very common virus, spread by genital skin to skin contact, and most people will contract it at some time in their lives and be none the wiser. It is usually harmless and most of the time your body clears the infection without causing you any symptoms at all. BUT, when it isn’t cleared, there is a risk that the infection will cause pre-cancerous changes to cells in the cervix and then progress into cervical cancer. So detecting this process at the stage of initial HPV infection means that changes in the cervix can be found earlier, and potentially treated earlier, with the aim that less woman actually end up developing cervical cancer at all.
“But I’ve had the HPV vaccine! Surely that will do the trick?!” I hear you say… well there are actually 100 different types of HPV, and the vaccine only protects against type 16 and 18 which are high risk types that cause 70% of all cervical cancers. One of the HPV vaccines that is available in Australia also protects against two other HPV types which cause genital warts. Bonus! Moral of the story is, whether or not you’ve been vaccinated, you will still need ongoing screening to detect the pesky HPV infections not covered by the vaccine and ensure any abnormalities can be picked up early.
Another change beginning in December is that the age of first testing will be pushed back from 18 to 25 years old, or once a woman becomes sexually active, whichever is later. The evidence shows that screening hasn’t changed the number of cases of cervical cancer in women under 25, or the number of deaths from cervical cancers in this age group, despite halving the overall number of cervical cancer deaths in the 26 years since national screening started. In young women under 25, there is also a higher risk of ‘over-treating’, where abnormalities are treated even though they might not actually be problematic. Treatment of cervical abnormalities can include removal of tissue and laser to the cervix, which later increases the risk of pregnancy complications like cervical incompetence and premature delivery. The widespread vaccination of both girls and boys has reduced spread of virus within the community, so young women and all the immunised generations that follow will be at lower risk to begin with. So it’s a balancing of risks and benefits, and in this case the evidence points towards 25 years of age as the time where HPV testing should begin.
In the changeover period, women will be invited to attend screening two years from their last test, and then every 5 years after that. As the new test is more accurate than previously, it is safe to have a longer interval between screening. If you are due for a pap smear before December 1st, continue as normal and have the current test when it is due, then your next one in another two years time will be the new HPV test.
When all these changes were announced, there was mass panic amongst some women who were concerned that the new testing was merely an exercise in cost savings and would put women at risk with longer time between testing. However, since more information has become available and the concerns regarding risks and efficacy of the new tests have been addressed, the vast majority of women, as well as doctors and the public health sector are welcoming the changes. Not only will it bring more accurate testing but it means the number of speculums a woman will have to encounter in her lifetime has more than halved.
Despite all of the above, if you have any abnormal bleeding, pain, discharge or other worrying symptoms, do not wait for your next test to come up, see your GP straight away.
Do you have questions or concerns about the changes? Leave a comment below, I’d love to hear your thoughts!