Screening for preventable diseases is more important now than ever. Don’t let COVID-19 be the reason you receive a diagnosis for cervical cancer.
The Australian Department of Health is closely monitoring the impact of the COVID-19 pandemic on health services. On April 21, the Australian government announced that they would lift restrictions on some elective surgeries and screening programs. COVID-19 may be impacting your usual GP or cervical testing provider, so if you have received a reminder about cervical screening and you have any questions, please call your doctor or health care provider to talk about your circumstances. More information on COVID-19 is available through the Department of Health website or through the COVID-19 hotline on 1800 020 080.
Prevention
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 30% of 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.
There are two ways to prevent cervical cancer; vaccination and cervical screening.
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’ has been 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 since 2018, Gardasil 9 replaced the previous Gardasil vaccine (2007 and 2017). Protecting against four HPV types (6, 11, 16 & 18), immunisation was originally only available to girls, with boys added to the schedule since 2013. The school-based vaccination program, comprising of 2 doses given six months apart, is available free of charge to all 12-13 year old students. Any missed doses can be caught up with a GP and are bulk billed up until you turn 19. Immunisation provides 90% protection from developing cervical cancer, 95% protection against other HPV related cancers and 90% protection against genital warts.
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/
From 2018, Gardasil®9 has been 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 95% of genital warts. The vaccine is available for free for Australian girls and boys in Year 7 and 8. It is most effective if you receive 2 doses over a period of 6 months. 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). All individuals up to 19 years of age are eligible to receive catch up doses of the HPV vaccine for free through the National Immunisation Program. Vaccination of all adults aged 19 years and older is not routinely recommended, as many are likely to have been exposed to one or more vaccine HPV types through sexual activity. To read more about the school based National HPV Vaccination program, please visit: https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/human-papillomavirus-hpv Up to 19 years of age you are eligible to receive catch up doses of the HPV vaccine for free through the National Immunisation Program. Individuals can receive the catch up doses through a GP or local immunisation provider. If over 19 you need to discuss the value of receiving the vaccine with your doctor. Individuals can receive the catch up doses through a GP or local immunisation provider. 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. 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®. Essentially there are two reasons: The vaccine is most effective if given before the start of sexual activity. It’s currently free for girls and boys of 12-13 years of age as part of the school-based National Immunisation Program. 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. Gardasil®9 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58. It is registered in Australia for females aged 9–45 years and males aged 9–26 years. From 2018 Gardasil®9 is the HPV vaccine used in Australia’s National HPV Vaccination Program. Gardasil® protects against HPV types 16, 18, 6 and 11 and is registered in Australia for females aged 9–45 years and in males aged 9–26 years. Gardasil® was the HPV vaccine used in the National HPV Vaccination Program from 2007 to 2017. Cervarix® protects against HPV types 16 and 18, is registered in Australia for females aged 10–45 years. Cervarix® is not registered for use in males of any age. It is supplied in Australia only on the private market. Read more about HPV disease, vaccines and recommendations for boys and girls in Australia or talk to your doctor. In this short video Professor Ian Frazer AC (co-inventor of the vaccine) talks about the vaccine: 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 (also referred to as CST). 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 with the Pap test, 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 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 papillomavirus (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. 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 70-90% 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 do my results mean? If you test negative for HPV: Repeat HPV Testing in 12 months time: An Unsatisfactory Test Result: Refer to a specialist: Updated Screening Guidelines This change has occurred due to new evidence collected during the first two years of the National Cervical Screening Program, demonstrating a low risk of progression in developing premalignant lesions and cervical cancer. More information from the Australian Government can be found here. * You can receive a free SMS reminder by signing up to ACCF’s Get the Text COVID-19 and your Cervical Screening Test Our world has changed since COVID-19 and we understand people are concerned about their wellbeing and health risks when attending medical appointments. The good news is that across Australia screening programs have adapted to ensure the safety of all patients. Your GP or health professional should meet CovidSafe guidelines and have the correct practices in place to protect against the transmission of COVID-19, including: There are also a number of things you can do to help keep yourself and others safe such as: When you book your Cervical Screening Test appointment, ask your clinic what measures they have in place to keep you COVID safe. To be reminded when your Cervical Screening test is due, sign up to ‘Get the Text’, a free service which will send you a reminder message. 1Courtesy of the Cancer Council from http://www.hpvvaccine.org.au/about-the-vaccine/vaccine-background.aspx
Read more about the Gardasil® vaccination program for boys and girls in Australia or talk to your doctor. Cervical Screening
Image from cancer.org
As of February 1, 2021 changes have been made to cervical screening follow up for those people considered to be at intermediate risk of cervical cancer. It is now recommended that women with a 12-month follow-up HPV test result of HPV (not-16/18) detected, with LBC prediction of negative, pLSIL or LSIL be regarded as still at Intermediate risk and undertake a second HPV follow-up test in a further 12 months’ time.
