Cervical screening

The Cervical Screening Test (CST) introduced in 2017 is more effective at detecting the human papillomavirus (HPV) that causes cervical abnormalities, at an earlier stage. Prior to 2017, the Pap test (or Pap smear) was utilised. It looked for cell changes in the cervix, whereas the Cervical Screening Test looks for the human papillomavirus (HPV) which can lead to cell changes in the cervix. 

Cervical cancer is rare, and it usually takes 10 years for abnormalities caused by HPV to develop into cervical cancer. The new CST is a more accurate, effective and safe test to have every five years instead of the two-yearly Pap test. 

Aggressive, fast-growing cancers are very rare and usually diagnosed when women see a doctor after noticing symptoms. All screening programs are designed for women without symptoms. 

Women of any age who have symptoms (including pain or abnormal vaginal bleeding or discharge) should see their doctor immediately.

The Cervical Screening Test (CST) detects human papillomavirus (HPV) infection, which is the first step in developing cervical cancer. Persistent HPV infections can cause abnormal cell changes that may lead to cervical cancer. However, this usually takes a long time, often more than 10 years from initial HPV infection. While the old Pap test (or Pap smear) could detect abnormal cell changes, the Cervical Screening Test will detect the persistent HPV infection that causes the abnormal cell changes, prior to the development of cancer. 

If you choose for your health practitioner to conduct the screening, the procedure for collecting the sample for HPV testing is the same as the procedure for having a Pap smear. A doctor or nurse takes a small sample of cells from the woman’s cervix.

If you choose self-collection, you will be given a self-collection kit and instructed on how to collect cells from your vagina. The samples collected are then sent away to a laboratory to be examined.

A self-collected sample is taken from the vagina and is checked for human papillomavirus (HPV). You will need to visit your doctor or nurse to get the kit and will then take your sample in a private space, such as a bathroom. All you need to do is insert a swab a few centimetres into your vagina and rotate it for 20 to 30 seconds. Learn how to take your own sample and find more information at Self-collection for the Cervical Screening Test.

To make an appointment with a health professional 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

• Read information on cervical screening so you know what to expect. Your health professional can collect your sample, or you can collect your own sample. Both choices are accurate and safe. 
• If you have been through menopause, you might like to ask about using an oestrogen cream in your vagina in the week before your appointment to make the test more comfortable.
• Wear loose comfortable clothing – you may need to remove clothing from the waist down.
• Empty your bladder before you arrive at the clinic or ask to use the toilet when you arrive.
• Try to stay as relaxed as possible – this will help minimise any discomfort. For example, try to take some long slow and deep breaths. 
• Make a list of any questions you have for the doctor.

A Cervical Screening Test (CST) is a relatively simple procedure that only takes a few minutes and should not be painful. Your screening experience should include:

• An option to have a support person present (e.g., relative/friend/clinic nurse).
• The choice to have your health professional collect your sample or to collect your own sample.
• An easy-to-understand explanation of what to expect in your screening choice.
• Questions from your health professional about your period and contraception methods.
• Answers to any questions you have about the screening, appearance of your reproductive organs, when results will be available, how the results will be communicated with you and any follow up required.

• Privacy to undress and dress and a sheet to drape across your stomach and thighs.
• Sterilised medical instruments (at a comfortable temperature) to take a sample.
• Easy to understand instructions during the procedure and reassurance. You can ask the health professional questions and ask them to stop at any time.

• When you are ready, your health professional 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 it shouldn’t be painful. If you do feel any pain let your health professional know and they can adjust the speculum. You can insert the speculum yourself.
  • use a small 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 human papillomavirus (HPV).

• A private place to take the sample.
• Clear instructions about how to do the test and help if you need it.
• When taking the sample:
  • make sure you know which end of the swab can be held and which end is for taking the sample before you open the package. If you are unsure which end is which, ask your healthcare provider for advice.
  • take off your pants to make it as easy as possible to take the sample,
  • make sure your hands are clean and dry, 
  • get yourself in a comfortable position,
  • use your free hand to move the skin folds at the entrance of your vagina, 
  • gently insert the swab, taking end of the swab into your vagina a few centimetres,
  • rotate the swab gently for 20-30 seconds (in any direction). This may feel a bit uncomfortable but should not hurt.
  • gently remove the swab from your vagina,
  • place the swab back into the packaging with the end that took the sample going in first,
  • screw the cap back on,
  • get dressed and return the package to your healthcare professional.

Your GP or health professional should let you know if you need to have them more regularly. It is also important to check with a medical professional if between tests you have any unusual symptoms such as:

• unusual bleeding – after sex or between your usual periods
• unusual changes to the colour, smell or amount of vaginal discharge
• pain during or after sexual activity
• warts or other growths, lumps, or sores on your genitals, anus or in the mouth or throat
• pain or discomfort going to the toilet
• painful abdominal cramps or lower back pain – (NB these symptoms are very common for people with a cervix during their period, but if cramping is extremely painful or persistent, you should chat with your doctor.)

*Please note that these symptoms are very general and may not indicate cervical cancer.

The results of your Cervical Screening Test will usually be available within two weeks. You can either schedule a follow up appointment or call your health professional for the results. Your results will also be automatically sent to the National Cancer Screening Register that keeps a record of your screening history and contact you by post if you are overdue for your next test. If you do not wish for this to occur speak to your provider when you have your Cervical Screening Test. You can find out what different results mean at Understanding your Cervical Screening Test results.

It is important to see a health professional regarding specific health needs such as information on pregnancy, early sexual intercourse, sexual abuse, immunodeficiency, and DES exposure.

All women and people with a cervix commence cervical screening at 25 years of age. This starting point for cervical screening has been decided upon after years of research that has found:

• Cervical cancer in people under the age of 25 is rare.
• Most people under 25 years have been vaccinated for HPV and have robust immune systems that will usually clear the infection quickly and without treatment.
• Research has shown that screening people under the age of 25 does not reduce the incidence of cervical cancer in that age group
• Commencing screening at age 25 will reduce the investigation and treatment of common cervical abnormalities that would usually resolve by themselves in women and people with a cervix under the age of 25. This is because it can take 10 to 15 years for a persistent HPV infection to develop into cervical cancer.

Medicare does not cover routine cervical screening for women and people with a cervix under 25 years of age but if you are experiencing symptoms such as unusual bleeding, unusual discharge and pain, please make an appointment with your healthcare provider immediately.

For more information, please visit www.cancerscreening.gov.au/cervical or discuss with your GP what these changes mean for you.

Cervical Screening Tests are recommended every 5 years from the age of 25-74, unless your doctor advises otherwise. If you are 70 years or over and have had regular Cervical Screening Tests, you will be recommended to have an exit HPV Test, but you can continue to undertake cervical screening if you would like to. If you are over 70 years old and have never had a Cervical Screening Test, you can make an appointment to be screened.

There are some rare neuroendocrine cervical cancers that are not caused by HPV. This means they won’t be detected through routine cervical screening tests.

The current HPV vaccine provides protection against about 90% of cervical cancers so it is important that even if you are vaccinated, you are also screened for cervical cancer as you do not have 100% protection.