Clinical changes to cervical cancer screening program

Medical News: Changes to the National Cervical Screening Program (NCSP) Guidelines for the clinical management of women at intermediate risk has now come into effect. This follows the Cancer Council Australia Clinical Guidelines working party review of national data from the renewed program.

A review of the national clinical program data was undertaken for women at intermediate risk, whose follow-up test is Human papillomavirus (HPV) (not-16/18) positive, liquid based cytology (LBC) prediction negative, possible low-grade squamous intraepithelial lesion or low-grade squamous intraepithelial lesion. 

Results from the review showed that these women will have a low likelihood of histologically-confirmed high grade squamous intraepithelial lesion (CIN2/3) or worse.

It is now recommended that women with a 12-month follow up HPV (not-16/18) result with LBC prediction negative, pLSIL or LSIL (intermediate risk result) should be recommended to undertake a further HPV follow up test in 12 months’ time following their previous HPV test instead of referral to colposcopy.

Dr Lara Roeske is a member of the Cancer Council Australia Cervical Cancer Screening Guidelines Working Party and co-author of the National Cervical Screening Guidelines.

Dr Roeske said “The risk (of invasive cervical cancer) for these women is extremely low. In fact, it’s under 0.02%.

“When the clinical guidelines for the renewed NCSP were released in 2016, there was really a cautious approach adopted, which meant there was universal referral for colposcopy.

“But what the data is showing very clearly is the majority of women will either clear this infection, or they’ll have a persistent infection without serious abnormality developing in the cervix, and they can be monitored.”

Healthcare professionals may be reluctant to delay colposcopy in women who have a positive oncogenic HPV (not 16/18) test result, despite this being their current practice with low-grade cytology.

Some women may also be reluctant to accept a 12-month delay in referral for colposcopy, especially if they are aware of their HPV test result. Education of women and careful explanation by their healthcare provider will be of paramount importance.

Colposcopy waiting lists will need to be re-prioritised and primary health providers may find that women previously referred to colposcopy are returned to primary care for a further follow-up HPV test.

Laboratories will need to rework their procedures for reporting recommended management in these cases and for many laboratories a software adjustment will be needed, where decision support software is in place. The NCSR will also need to adjust its follow-up communications accordingly.

Some groups of women may be at higher risk of harbouring a high-grade abnormality and should be referred to colposcopy if HPV is detected at 12 months, regardless of the LBC result. These include:

• women 2 or more years overdue for screening at the time of the initial screen
• Women who identify as being of Aboriginal or Torres Strait Islander
• Women aged 50 years or older.

Click here for more information on the clinical changes.