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/

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 (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.

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 70-90% 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.

• *This range differs based on whether you had the Gardasil (2007-2017) or Gardasil 9 (2018 onwards) vaccine, with Gardasil 9 offering the greater level of protection.

What do my results mean?

If you test negative for HPV:

• Your results indicate that you do not have a 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.

* You can receive a free SMS reminder by signing up to ACCF’s Get the Text

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