Changes in cervical screening.

Farnsworth A. 2008. The changing landscape for cervical screening. MJA 189:1;6.

National screening using the conventional Pap smear has significantly reduced the incidence of and mortality from cervical cancer in Australia. With the increased knowledge that certain oncogenic subtypes of human papillomavirus (HPV) cause the development of the disease, a national program of vaccination against two of the 15 oncogenic viruses began in April 2007. Tests to detect HPV are now available and new technologies for superior screening of cervical samples have been developed.

This has resulted in a substantial reduction in the lifetime risk of cervical cancer in Australia's screened population from 2.4% to 0.78%. With continued screening this risk is predicted to further decrease to 0.38% following vaccination of 12 year old girls, 0.43% for 14 year old girls and 0.59% for 26 year old women.

Screening should continue after vaccination however the interval of screening will be determined by population based research over the next 5-10 years. There has been considerable discussion about replacing cervical cytology tests with HPV testing for primary screening. Currently it is considered that HPV testing has a limited role in women under the age of 30 years as large studies have shown that 25% of women in this age group test positive for the oncogenic virus. The great majority of these women clear the virus naturally, usually via a cell mediated immune response. Such infected women may not show any sign of disease.