You may have already heard that as of May next year, Australian 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 government's renewed cervical cancer screening scheme.
Questions around whether screening later is cause for concern, as well as what the actual evaluation will look (and feel) like are naturally being raised. Here, we break down the ins and outs of what you need to know.
Why a HPV test?
Most cervical cancers are caused by HPV infections and in the last five years, experts agree that a HPV test is in fact far more accurate in detecting these pre-cancerous changes, at a much earlier stage, compared to a Pap smear test.
"A Pap smear test is really looking for abnormal changes in the cells but the HPV test can detect the virus which causes these abnormal changes," Megan Smith, Program Manager, Cervix/HPV and Breast Group at Cancer Council NSW told The Huffington Post Australia.
Why scrap the Pap smear test?
A Pap smear requires a certain amount of expertise, whereby a specialist looks down a microscope and examine cells but in future this will only happen for the women who test positive for HPV.
Why? Because women who don't have HPV are at very low risk of cervical cancer for quite some time (10, sometimes 20 years).
"For the women who are HPV positive what will then automatically happen in the lab is effectively a Pap smear," Smith said.
"It's really allowing the specialists to look down those microscopes and focus on the women who really need their attention," Smith said.
While it may seem like the new program is doing less, Smith said research has shown that we could expect rates of cervical cancer to fall by 30 percent as a result of this change.
"For the majority of women who don't have HPV, they'll be able to relax and go away for five years, but also feel reassured that going away for five years after a negative HPV test is actually safer than waiting for two years after a negative Pap smear test," Smith said.
Yes, waiting until 25 is safe
A new study from Cancer Council NSW supports the move, confirming that starting the screening later at age 25, rather than the ages of 18 and 20, is safe and necessary for a number of reasons including the low rate of cervical cancer in young women to begin with.
Smith said the study looked at the incidence of cervical cancer in Australia since the introduction of the current scheme in 1991, and it did not appear to have been effective in preventing cervical cancer in this age group.
"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.
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.
Basically, the study showed younger women weren't getting any benefit from the current screening scheme. In fact, you would have never even known there was a screening program in Australia for women aged 25 and under.
"On top of that, there is a concern that we might be treating young women in ways that could have adverse effects on their pregnancies later in life."
"You have to balance that up, if we're not actually doing any good for young women, are these risks for their future pregnancies worth it?" Smith said.
The role of the HPV vaccine
"The HPV vaccination -- introduced in 2007 -- protects against the two most dangerous forms of HPV which cause the majority of cervical cancers," Smith said.
In the last ten years Australia's HPV vaccination program -- which is administered in schools -- has been very effective in reducing these infections in young women compared to earlier generations.
"This means that for women younger than 25, the vaccine has been shown to reduce cervical abnormalities and will continue to reduce their risk," Smith said.
But what if you received treatment when you were under 25?
Smith said it's important to make the distinction between a cervical cancer diagnosis and pre-cancerous treatment.
"It's possible that some young women, not all of them, but some are confusing treatment they might have had for a pre-cancerous change, with treatment for cervical cancer," Smith said.
Smith said it's important to highlight the fact the best prevention for cervical cancer in women under 25 is HPV vaccination, and most women under 25 have been vaccinated.
From the woman's point of view, the evaluation will be no different rather, the change will take place in the lab.
Smith said it is true the current pap smear test does miss women who could then potentially go on to develop cancer -- and the HPV test may also miss some women -- but the important thing is that the HPV test will miss far fewer women, than the Pap test is already missing.
What will the new HPV test look like?
"From the woman's point of view, the evaluation will be no different rather, the change will take place in the lab," Smith said.
The major change will be that you only need to have the test every five years, and that you'll receive explicit invitations to attend for screening, the first one close to their 25th birthday.
"It is very important that all women -- vaccinated or not -- do start screening when they turn 25 and receive their invitation," Smith said.
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