Read the latest updates from the National Cervical Screening Program. This update includes important information on:
- Cervical screening for women under 25 years
- Pathology request form
- Self-collection
- Accessing test results/screening histories and participant follow-up
1. Cervical screening for women under 25 years
Key points:
- Under the renewed National Cervical Screening Program (NCSP), women are eligible to start routine cervical screening at 25 years of age.
- Some women under 25 years of age will present with an expectation for routine screening, having had previous Pap tests. It is important that these women are aware that Medicare does not fund routine HPV cervical screening tests in asymptomatic women under 25.
- Cervical cancer in women under 25 years of age is rare, and screening has not changed the incidence of cervical cancer or mortality from this disease in this age group.
- Commencing screening at age 25 will reduce the investigation and treatment of common cervical abnormalities that would usually resolve by themselves. The time from persistenthuman papillomavirus(HPV) infection to cervical cancer is usually 10 to 15 years.
Current issues around under 25 screening:
- It was anticipated that some women under 25 years of age would still present for routine cervical screening under the renewed Cervical Screening Program, having had previous Pap tests.
- From 1 December 2017, the Department of Health (the Department) became aware that larger than expected number of samples from individuals under 25 years were being collected for laboratory testing.
- The Department continues to work in partnership with state, territory, industry peak organisations and colleges to reinforce the messaging to healthcare providers regarding eligibility for routine cervical screening. This includes a targeted social media strategy for participants in this particular cohort.
Exceptions:
- Women of any age who are symptomatic should be offered a co-test (joint HPV and liquid-based cytology).
- Women under 25 years of age who are currently under clinical management for a cervical abnormality should be managed according to the recommendations on transitioning women in the 2016 Guidelines.
- For women who experienced early sexual activity at a young age (under 14 years) and who had not received the HPV vaccine before sexual debut, a single HPV test between 20 and 24 years of age can be considered on an individual basis. More information is available in Chapter 15 of the 2016 Guidelines.
- The Pathology Test Guide for Cervical and Vaginal Testing provides information for healthcare providers on what test to order based upon a woman’s cervical history and clinical situation.
2. Pathology request form
- The Pap test is no longer covered under the Medicare Benefits Schedule (MBS), which means that if a healthcare provider writes ‘Pap test’ or ‘smear’ on the pathology request form after 1 December 2017, the participant may be charged.
- MBS items under the renewed NCSP have changed. Pathology request forms need to be filled in differently from what was previously practiced, and it is important that the appropriate test name and supporting patient information is written on the request form.
- Detailed information on the new MBS items can be found at can be found via MBS Online.
- Detailed information on the new naming conventions to write on the pathology request forms can be found in the Pathology Test Guide for Cervical and Vaginal Testing.
Why pathology laboratories need to have adequate information on the request form:
- Pathology laboratories assign pathology MBS item numbers based on what a healthcare providers writes on the request form. Appropriate assignment of MBS numbers by pathology labs is important in ensuring that patients avoid unnecessary out-of-pocket expenses.
- It also enables laboratories to provide the correct clinical management recommendations, and accurate and timely reports on test results to the NCSR. This will help to support the ongoing monitoring and evaluation of the renewed NCSP.
3. Self-collection
- Self-collection of vaginal samples for HPV is available under the renewed NCSP for women aged 30 years or over, who have declined to have a cervical sample collected by a healthcare provider, and are either:
- overdue for cervical screening by two years or longer (i.e. four years or more since their last Pap test, or seven years or more since their last Cervical Screening Test), or
- have never screened.
- The department is aware that one large pathology laboratory is accredited to process self-collected samples. Prior to offering self-collection as an option to patients, healthcare providers are encouraged to check with their pathology laboratory on availability.
Self-collection
Self-collection is not suitable if a patient is:
- Under 30 years of age
- Pregnant, or thinks they might be pregnant,
- Symptomatic (experiencing unusual bleeding, pain or discharge), or
- Been exposed to diethyl-stilboestrol (DES) in utero.
Resources
- A suite of self-collection resources including fact sheets, instruction guides in different languages (including Aboriginal and Torres Strait Islander languages) and a quick reference guide are available at cancerscreening.gov.au/cervical
4. Accessing test results/screening histories and participant follow-up
- Continue to contact your state and territory register for screening histories up to 1 December 2017. For cervical screening histories post 1 December, please contact the National Cancer Screening Register (NCSR) on 1800 627 701.
- Participant follow-up of all received prior to 30 November 2017 will continue to be provided by the state and territory registers, while the NCSR will continue to follow-up of all results received post 1 December 2017.
- Participant follow-up is the primary responsibility of the healthcare provider requesting the test. The NCSR and state and territory registers will provider a safety net function of participant followup and correspondence until the second release is complete in June 2018.
- For further information, please refer to the Transition Quick Start Guide for Healthcare Providers available on the NCSR website.
Disclaimer: This article was provided by NWMPHN. While every effort has been made to ensure the information is accurate, North Western Melbourne Primary Health Network does not warrant or represent the accuracy, currency and completeness of any information or material included within.
