HEALTH

The End Of The Pap Smear: What You Need To Know

It's a complex topic, but let's lay down the facts.

01/03/2017 12:36 PM AEDT | Updated 01/03/2017 3:54 PM AEDT
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The new program will offer women a HPV test every five years from 25.

You've probably heard that soon women will no longer require a Pap smear test every two years. Instead they will be screened for Human Papillomavirus (HPV) every five years, from age 25 as part of the Australian government's renewed cervical cancer screening scheme.

The Pap smear test detects pre-cancerous cellular changes and has served women over 25 extremely well since its inception in 1991.

However, the change is based on new evidence that shows a HPV screening will not only improve early detection and reach more women who had previously fallen through the cracks, but reduce the overall rate of cervical cancer cases and deaths by 20 percent. You can read about how the new test will work here.

A recent online campaign persuading the Turnbull government to scrap the change has caused concern. It claims that screening women later is dangerous and runs the risk of missing those rare cervical cancers not caused by HPV.

Medical experts have collectively refuted the claims, saying the change will not put young women at greater risk of contracting cervical cancer. They also explain the rare cases of cervical cancer that won't be detected by this test weren't detected by pap smears either.

Ahead, Megan Smith, program manager, Cervix/HPV and Breast Group at Cancer Council NSW explains what we need to know about the new scheme.

So, screening women before 25 has not been effective?

Smith explains since the introduction of Pap smears more than 20 years ago, they have not been effective in preventing the incidence of cervical cancer in this younger age group, despite many women undergoing pre-cancerous treatments.

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'It is very important that all women -- vaccinated or not -- do start screening when they turn 25 and receive their invitation.'

"Rates had not changed at all in young women aged 25 and younger and that was in huge contrast to the older women, where squamous cell carcinoma (SCC) and overall cervical cancer rates have declined dramatically, almost halving since its inception," Smith said.

This could be due to the fact that many HPV strains that cause infection of the genital tract in younger women are short-lived and do not go on to develop into cancer.

"It's very common for women under 25 to become infected with HPV soon after they become sexually active, but your immune system usually fights it off and importantly because of the successful uptake of HPV vaccine, even those infections are becoming much less common than they used to be," Smith said.

But wait, isn't something better than nothing?

"What is clear from the evidence is that screening younger women has not been effective in preventing cervical cancer and because of this, there is room for improvement," Smith said.

Smith explains the new scheme takes into account the anxiety an abnormal result can cause in young women, the dangers of carrying out (sometimes unnecessary) pre-cancerous surgeries and what effect these surgeries have on future pregnancies.

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The new scheme takes into account the dangers of carrying out (sometimes unnecessary) pre-cancerous surgeries.

"Given we know the impact surgery of the cervix has on future pregnancies, we need to weigh up the dangers and what we know is that pregnancy is a lot more common than cervical cancer."

The key thing to remember is that screening is meant to prevent cancer, and it is clear that it has not been doing that in younger women, Smith explains.

OK, but what about those rare cases of cervical cancer, not caused by HPV?

"Firstly, it's important to note that well over 90 percent of cervical cancers are caused by HPV," Smith said.

For those rare cases that are not caused by HPV, Smith explains they were also being missed by the Pap smear test.

On average, there are 1.3 cases of cervical cancer each year per 100,000 women aged 20-24 (with less than one death per year on average), versus 6.7 cases per 100,000 women aged 25-49.

"Women who have cancer at that young age would typically have symptoms and that is typically how it would be picked up. They would see a doctor and they would get the tests," Smith said.

On average, there are 1.3 cases of cervical cancer each year per 100,000 women aged 20-24 (with less than one death per year on average), versus 6.7 cases per 100,000 women aged 25-49.

Experts agree women of any age should see their doctor if they have symptoms suggestive of cervical cancer or pre-cancer such as abnormal vaginal bleeding and bleeding after sex.

What next?

It is important that women aged between 18 and 69 years, who have ever been sexually active continue to participate in the current two yearly Pap test program, until the changes come into effect on December 1.

From that date, women aged 25 years or over who have not yet started cervical screening will receive an invitation to have the new cervical screening test.

Women of any age who have symptoms (including pain or bleeding) should see their doctor immediately.

An invitation will be sent to attend for screening

The National Cervical Screening Register will send an invitation to women to let them know they are due for their test and also remind women if they become overdue for their regular test.

Women already participating the program will be invited to screen within three months of the date when they would have been due for their two yearly Pap test.

Source: cancerscreening.gov.au


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