“Cervical cancer should be almost entirely preventable” – Professor Ian Frazer AC, co-inventor of the HPV vaccine.
Thanks to vaccination and screening, cervical cancer is one of the most preventable cancers. Vaccination prevents infection with the most common cancer-causing strains of HPV, the virus responsible for almost all cases of cervical cancer. Cervical screening is a test that detects changes to the cells of the cervix, often caused by prolonged HPV infection, and allows abnormalities to be treated before becoming cancerous. Regular cervical screening is the number one way to prevent cervical cancer.
As of 2017, the 2-yearly Pap test will be changing to a 5-yearly HPV test, a measure expected to prevent an additional 140 cervical cancer cases each year. You can read about the changes that will occur here.
There are two cervical cancer vaccines Gardasil® and Cervarix® which guard against about 70% of the HPV infections that can cause cervical cancer as well as other cancers in men and women. In Australia, only the Gardasil® vaccine is offered.
Both vaccines will prevent up to 70% of cervical cancers as well as some other less common genital cancers in women, including vaginal and vulval. The vaccine also helps protect men against penile cancer and anal cancer as well as genital warts in both men and women.
It also guards against head and neck cancers in both men and women. It is for this reason that since 2013, Australia now vaccinates both girls and boys. The vaccine is most effective if given before the start of sexual activity. It’s currently free for girls and boys in Year 7 as part of the school-based National Immunisation Program. In 2013 and 2014 only, the vaccine will also be free for boys in Year 9 as part of a national catch-up initiative.
Males and females outside of these ages may still benefit from the vaccine and should speak to their doctors to see if it’s right for them. As the vaccine won’t prevent all cervical cancers, it’s important to remember that, vaccinated or not, a Pap test every 2 years is still vitally important for all women, aged 18 to 70, who’ve ever been sexually active.
Both vaccines guard against HPV types 16 and 18 which are responsible for causing 70-80% of cervical cancers. Other types of HPV can also cause genital warts such as types 6 and 11.
Gardasil® protects against two of the cancer-causing strains of HPV and the two that are responsible for causing genital warts. Gardasil is recommended for girls from 9 years of age to young women up to 26 years. It guards against the HPV types 6, 11, 16 and 18.
Even for those who are already sexually active, it would be unlikely that you would have been exposed to all the types of HPV the vaccine guards against, so it can still guard against those viruses that you have not yet been exposed to.
Cervarix® protects against HPV types 16 and 18 only and is used to vaccinate both young girls from 10 years of age to women up to 45 years
In this short video Professor Ian Frazer AC (co-inventor of the vaccine) talks about the vaccine:
Until these changes are implemented, a Pap test is the best way to detect cervical cancer. Planning or going for a cervical screening (also known as a Pap test or Pap smear) can be daunting. It’s one of the most intimate examinations you can receive from your GP, but it’s also one of the most important. A simple examination could save your life.
A Pap test checks for changes in the cervix or neck of the womb at the top of the vagina. These may be early changes in the cells of the cervix which are caused by a viral infection called the Human Papilloma Virus (HPV), that in rare cases may over time become cancerous cells. Pap tests are vital in recognising these early changes, as at the early stage they can be treated very easily and prevent the onset of cervical cancer. By having regular Pap tests, you can help prevent up to 90% of the most common type of cervical cancer.
The current guidelines recommend that every woman from the ages of 18-70 who has ever had sex should have a Pap test every two years, whether or not they are still sexually active. These recommendations also apply to women who have been vaccinated against HPV and have had the cervical cancer vaccine. The vaccine protects against the two most common strains of HPV, but not all, so Pap tests remain your best protection against cervical cancer. Your GP or Health Professional should let you know if you need to have them more regularly. Recent research shows that about 43% of Australian women are not having the recommended 2-yearly Pap tests which is alarming as evidence shows the women most likely to get cervical cancer in Australia are those who have not had a regular Pap test. We also know that 57% of young women aged 18-25 are also not having the recommended 2-yearly Pap tests.
How to prepare for your Pap test
Schedule your appointment at any time in the month when you aren’t having your period. Your GP will most likely ask you about your last period, when it began and its duration, and also if you are using contraception which type of pills or method you use. It is good to write down any questions or concerns you have so you remember to mention them. On the day wear a top and skirt or similar as your doctor does require you to remove your clothing from the waist down so that they can examine you.
To make an appointment to have a Pap test, you can contact:
your general practitioner or practice nurse
a community or women’s health centre
a family planning or sexual health clinic
a women’s health nurse
an Aboriginal Medical Service
What types of Pap test are there?
There are currently two types of Pap tests available. One is the conventional Pap test where a sample of cervical cells will be taken and put on a slide and then sent to the laboratory for review under a microscope. This is the one offered as a standard by most health professionals. The second type is one done using technology known as liquid-based cytology, such as the ThinPrep Pap test commonly used in the UK. This method involves a sample of cervical cells also being taken but as well as the sample being placed on a slide, it is rinsed in a vial filled with liquid preservative solution that is then sent to the laboratory for further processing.
How much will it cost?
If you choose to have the conventional Pap test then the only cost you may incur is the consultation fee to see your health provider although some health providers will bulk bill the consultation. If you choose to have the liquid based cytology Pap test then an additional cost of about $40 or $50 may be incurred as well as your consultation if your health provider does not bulk bill. We urge women to talk to their GP about the right test for them.
What to expect when going for a Pap test
A Pap test is a relatively simple procedure that can be over and done with in just a few minutes and should not be painful. Empty your bladder for comfort prior to the procedure. Your doctor will ask you to remove your clothing from the waist down and lie on your back or side. It is likely your doctor will give you a sheet to cover your stomach and thighs to make you feel more comfortable. When you are ready, your doctor will ask you to bend your knees so they can insert an instrument called a speculum into your vagina. The speculum can be plastic or metal and holds the walls of the vagina open allowing a clear view of the cervix. This part of the exam can feel slightly uncomfortable or awkward as there may be some pressure on your pelvic area, but shouldn’t be painful. If you do feel any pain let your doctor know and they can adjust the speculum. Your doctor will then use a spatula or brush to gently collect a swab from the cervix. The cells collected on the swab are then sent off to a lab for examination to check for any abnormalities. And that’s it! You can go about your day. The exam doesn’t prevent any activity afterwards. You may have slight spotting after the test, however if you have any pain or heavy bleeding after the test then it is best to let your doctor know.
The results of your Pap test will usually be available within two weeks of your test. You can either schedule a follow up appointment or call your GP or the surgery for the results. Your results will also be automatically sent to your state or territory cervical cancer register who keep a record of your screening history and contact you if you are overdue for your next test. If you do not wish this to occur speak to your provider when you have your Pap test. You may be called back because the test is unreadable or inconclusive. Don’t be worried or panicked by this – this can happen and does not mean that your test is abnormal. The National Cervical Screening Program says about one in every 10 women may receive an abnormal result. If this is the case, don’t panic, but discuss with your GP or Pap test provider what your options are. It may simply mean that you need to have a repeat Pap test in 12 months rather than 2 years.
Some reasons why your result may be abnormal
Inflammation: This means that the cells of the cervix are slightly irritated. This irritation may be due to an infection like a bacterial infection or thrush. If the results are otherwise satisfactory you will most likely only need another exam in two years time. Low grade or high grade abnormality: These results may mean you have an infection with Human Papilloma Virus (HPV). This is a viral infection and does not mean you have cancer. In a small number of women the HPV infection is not cleared but stays in the cervix. Without treatment there is a risk abnormalities will develop that might lead to cancer over many years. This is one reason why regular Pap tests are vital for any woman who has been sexually active. In the case of a low grade abnormality you will be monitored with a repeat Pap test to make sure the infection clears. In the case of a high-grade abnormality you may be required to have a Colposcopy, which is an examination usually done by a specialist such as a Gynaecologist. In some exams an unsatisfactory sample may have been taken which means another test may have to be undertaken within 6 to 12 weeks. This is usually a result of a broken slide, not enough cells taken, or cells obscured by blood or mucus. To read more about abnormal Pap test results, visit the National Cervical Screening Program or download the brochure.
The most important thing about having a Pap test is that you feel comfortable with the person who does it. Take your time to find a Health Professional that you feel comfortable with and make sure you share any concerns or worries you have about it. A couple of minutes could literally save your life.
Cervical screening stories
Family Planning NSW has gathered excellent interviews from women of different cultural backgrounds, using video to share their experiences of cervical cancer screening in both their first language and English.