Prevention

“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 December 2017, the 2-yearly Pap test changed to a 5-yearly HPV test, a measure expected to prevent an additional 140 cervical cancer cases each year. This means that the 5-yearly HPV Test, or Cervical Screening Test, is now the primary way women will be screened for cervical changes in Australia. To read more about this test click here.

Vaccination

There are two cervical cancer vaccines Gardasil 9 and Cervarix® currently available in Australia.

Gardasil 9 protects against nine HPV types which cause around 90% of cervical cancers in women, 95% of all HPV-related cancers in men and 90% of genital warts in both men and women. HPV-related cancers include almost all cancers of the cervix, and a proportion of cancers of the anus, vulva, vagina, penis, head, neck and throat.

Two doses of the Gardasil 9 vaccine provides protection against nine types of HPV including:

  • types 16 and 18, the two types that cause 90% of cervical cancer and the majority of HPV-related cancers
  • the five next most common HPV types associated with cervical cancer (types 31, 33, 45, 52 and 58)
  • two non-cancer-causing HPV types (types 6 and 11), which cause 90% of genital warts.

From 2018, ‘Gardasil 9’ will be offered to Australian High school students as part of the school-based National HPV Vaccination Program. The vaccine is available for free for Australian girls and boys in Year 7 and 8. The vaccine is most effective if you receive 2 doses, 6 months a part (given at 0 and 6 months).

In Australia, Gardasil 9 has replaced the previous Gardasil vaccine (Cervarix) which protected against four HPV types (6, 11, 16 & 18) and was in use between 2007 and 2017.

The Gardasil vaccine was originally developed at University of Queensland in Brisbane, Queensland by Professor Ian Frazer and his late colleague, Dr. Jian Zhou.  Professor Ian Fraser was awarded Australian of the Year in 2006 for the invention.

More than 270 million doses of HPV vaccines have been administered worldwide (as of May 2017). Over 10 million doses of Gardasil 9 have been given in the US in the past year1.

To read more about the HPV Vaccine please visit: http://www.hpvvaccine.org.au/

National HPV Vaccination Program

From 2018, ‘Gardasil 9’ will be offered to Australian High school students as part of the National HPV Vaccination Program. Gardasil 9 protects against 9 HPV strains total – ensuring protection against the 7 types of HPV that are responsible for 90% of cervical cancers, as well as two strains of HPV responsible for 90% of genital warts.

The vaccine is available for free for Australian girls and boys in Year 7 and 8. The vaccine is most effective if you receive 2 doses over a period of 6 months.

Previously, (prior to 2018) the ‘Gardasil’ or ‘Cervarix’ vaccine protected against four strains of HPV. This includes HPV 16 & 18, responsible for 70% of cervical cancers, in addition to the two strains of HPV responsible for genital warts (HPV 6 & 11).

As of 1 July 2017, all individuals (10-19 years of age) are eligible to receive catch up doses of the HPV vaccine for free through the National Immunisation Program. Previously, if they were no longer in the eligible age bracket, they would incur an out of pocket expense ($150 per dose). Individuals can receive the catch up doses through a GP or local immunisation provider.

To read more about the school based National HPV Vaccination program, please visit: http://www.hpvregister.org.au/

What happens if I miss a dose?
As of 1 July 2017, all individuals (10-19 years of age) are eligible to receive catch up doses of the HPV vaccine for free through the National Immunisation Program. Previously, if they were no longer in the eligible age bracket, they would incur an out of pocket expense ($150 per dose). Individuals can receive the catch up doses through a GP or local immunisation provider.

What happens if I'm older than 15?
Students over the age of 15 who have never received a dose of either ‘Gardasil’ or ‘Gardasil 9’ will require 3 doses of the vaccine (given at 0, 2 and 6 months apart). This is also true for individuals who are significantly immunocompromised.

Can an HPV schedule started with Gardasil be completed with the Gardasil 9 vaccine?
Yes. It is safe and effective to use Gardasil 9 in order to complete a vaccination schedule, which commenced with the previous vaccine. This will provide the same protection as 3 doses of Gardasil.

What if I’ve previously completed a course of Gardasil – should I now receive Gardasil 9?
Giving additional doses of Gardasil 9 to those who have completed a course with the previous vaccine will provide an increased protection against the extra HPV types (31, 33, 45, 52 and 58). However these extra doses are not funded under the National Immunisation Program and must be purchased privately. It is important to remember that a course completed with the former vaccine still protects against HPV 16 & 18, which are responsible for 70% of cervical cancers and HPV 6 & 11 which are responsible for 90% of genital warts.

How does the vaccine work?
It’s important to note that Gardasil and Gardasil 9 do not contain live viruses – rather, the vaccine is made to “look” like the real virus so your immune system is tricked in to making virus-fighting antibodies. This means that if, or when you come in contact with the HPV virus, your body will recognise it and know how to clear it from the body.

Why is it administered in Year 7 or 8?
Essentially there are two reasons – first, because the vaccine is most effective if administered before you are exposed to HPV through sexual activity. Secondly, studies show that the body’s immune response to the vaccine is best between the ages of 9 and 14.

Vaccine Information
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.

Dr Frazer - needle v2

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 Cervical Screening Test every 5 years is still vitally important for all women, aged 25-74, who’ve ever been sexually active.

HPV Types
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:

Read more about the Gardasil® vaccination program for boys and girls in Australia or talk to your doctor.

Cervical Screening

The Cervical Screening Program changed on the 1st of December, 2017. The Pap test has been replaced by a HPV Test, or Cervical Screening Test.

The new Cervical Screening Test is more accurate at detecting Human Papillomavirus (known as HPV). The Pap test used to look for cell changes in the cervix, whereas the new Cervical Screening Test looks for HPV which can lead to cell changes in the cervix.

HPV is a common virus that can cause changes to cells in your cervix, which in rare cases can develop into cervical cancer.

Once you have had your first Cervical Screening Test, you will only need to have one every five years instead of every two, if your results are normal. This is because it takes HPV over 10 years to develop into cervical cancer, and cervical cancer is a rare outcome of HPV infection.

Planning or going for a cervical screening (also known as a HPV test or Cervical Screening Test) 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.

Early changes in the cells of the cervix are caused by a viral infection called the Human Papilloma Virus (HPV), that in rare cases may over time become cancerous cells. This is why the HPV test is more accurate in preventing cervical cancer by identifying the presence of HPV, as at the early stage cervical abnormalities can be treated very easily and prevent the onset of cervical cancer.

paptest
Image from cancer.org

The current guidelines recommend that every woman from the ages of 25-74 who has ever had sex should have a HPV test every five 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 types of HPV that are responsible for 70-80% of cervical cancer, but not all, so Cervical Screening 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 Cervical Screening Tests, which is alarming as evidence shows the women most likely to get cervical cancer in Australia are those who have not had regular cervical screening.

What having HPV means
The Cervical Screening Test will identify if you have been infected with the 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 may not be cleared by the immune system and stays in the cervix. If undetected, there is a risk that abnormalities may develop that can lead to cancer over many years. This is one of the reasons why regular Cervical Screening Tests are vital for any woman who has ever been sexually active. To read more about Cervical Screening Test results, visit the National Cervical Screening Program.

What do my results mean?

If you test negative for HPV:

  • Your results indicate that you do not have an HPV infection.
  • You will return to have your next cervical screening in 5 years time
  • You will receive an invitation from the National Cervical Screening Program Register to attend in 5 years.

Repeat HPV Testing in 12 months time:

  • Your results may indicate that you have an HPV infection (but it is a low risk type).
  • A low risk type means that your immune system is likely to clear the virus from the body within the next 12 months..
  • A repeat test in 12 months time checks that the virus has been cleared and that you are safe to move over to the 5 yearly schedule.
  • If the repeat test shows that you haven’t cleared the virus, you may need further investigation from a specialist.
  • This does not mean that you have developed cancer – cervical cancer is a rare outcome and normally develops over a period of 10-15 years.

An Unsatisfactory Test Result:

  • This does not indicate something is wrong – it simply means your sample cannot be read properly and you will need to repeat the test in six weeks.
  • There are a number of reasons why the sample cannot be read properly i.e. the collection of cells was too small.

Refer to a specialist:

  • Your results may indicate that you have a type of HPV infection that requires further investigation.
  • You will be referred to a specialist for a follow-up test, known as a Colposcopy.
How to prepare for your Cervical Screening 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.


Where can I go to have a Cervical Screening Test?
To make an appointment to have a Cervical Screening 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 to expect when going for a Cervical Screening Test
A Cervical Screening 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 the presence of HPV. 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.

Results
The results of your Cervical Screening 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 the National Cancer Screening 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 Cervical Screening 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 positive for HPV. If this is the case, don’t panic, but discuss with your GP or Cervical Screening Test provider what your next steps are. It may simply mean that you need to have a repeat Cervical Screening Test in 12 months rather than 5 years.

What having HPV means
The Cervical Screening Test will identify if you have been infected 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 Cervical Screening Tests are vital for any woman who has been sexually active.To read more about Cervical Screening Test results, visit the National Cervical Screening Program.

Feeling comfortable
The most important thing about having a Cervical Screening 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.

Amale – Arabic
Amale – English
Shalinee – Hindi
Shalinee – English

More videos can be viewed at Family Planning NSW’s website.

More information
To learn more about a Cervical Screening Test, talk to your doctor. You can also call us here at the ACCF 1300 760 363 or the Cancer Council Helpline on 13 11 20.

1Courtesy of the Cancer Council from http://www.hpvvaccine.org.au/about-the-vaccine/vaccine-background.aspx

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