Screening for cervical cancer
Cervical screening is the process of looking for cancer or precancerous changes in women who don’t have any symptoms. The cervical screening test detects cancer-causing types of human papillomavirus (HPV) in a sample of cells taken from the cervix.
The National Cervical Screening Program recommends that women aged 25–74 have a cervical screening test two years after their last Pap test, and then once every five years. Whether you identify as straight, lesbian, gay, bisexual, transgender or intersex, if you have a cervix you should have regular cervical screening tests.
During both the old Pap test and the new cervical screening test the doctor gently inserts an instrument called a speculum into the vagina to get a clear view of the cervix. The doctor uses a brush or spatula to remove some cells from the surface of the cervix. This can feel slightly uncomfortable, but it usually takes only a minute or two. The sample is placed into liquid in a small container and sent to a laboratory to check for HPV.
If HPV is found, a specialist doctor called a pathologist will do an additional test on the sample to check for cell abnormalities. This is called liquid-based cytology (LBC).
- a higher risk – your GP will refer you to a specialist (gynaecologist) for colposcopy
- an intermediate risk – you will be monitored by having a follow-up test (usually for HPV) in 12 months and more frequent screening tests in the future
- a low risk – you will be due for your next cervical screening test in five years.
A small number of women are diagnosed with cervical cancer because of an abnormal cervical screening test. For more information about screening tests, call Cancer Council 13 11 20 or visit cervicalscreening.org.au.
Sometimes the squamous cells and glandular cells in the cervix start to change. They no longer appear normal when they are examined under a microscope.
These early cervical cell changes may be precancerous. This means there is an area of abnormal tissue (a lesion) that is not cancer, but may lead to cancer. Only some women with precancerous changes of the cervix will develop cervical cancer.
Precancerous cervical cell changes are caused by certain types of the human papillomavirus (HPV). These cervical cell changes don’t have symptoms but can be found during a routine cervical screening test.
There are two main types of cervical cell changes:
Abnormal squamous cells – These are called squamous intraepithelial lesions (SIL). They can be classified as either low grade (LSIL) or high grade (HSIL).
SIL used to be called cervical intraepithelial neoplasia (CIN), which was graded according to how deep the abnormal cells were within the surface of the cervix:
- LSIL, previously graded as CIN 1, usually disappear without treatment.
- HSIL, previously graded as CIN 2 or 3, are precancerous. High-grade abnormalities have the potential to develop into early cervical cancer over 10–15 years if they are not found and treated. They can often be treated without affecting fertility.
Abnormal glandular cells – These are called adenocarcinoma in situ. They will need treatment to reduce the chance they develop into adenocarcinoma. Anyone with abnormal glandular cells in the cervix should be referred to a gynaecologist for a colposcopy.
Treating precancerous cervical cell changes will prevent them developing into cervical cancer.
A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecological Oncologists, TAS; Karina Campbell, Consumer; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; A/Prof Jim Nicklin, Director, Gynaecological Oncology, Royal Brisbane and Women’s Hospital, and Associate Professor Gynaecologic Oncology, The University of Queensland; Prof Martin K Oehler, Director, Gynaecological Oncology, Royal Adelaide Hospital, SA; Dr Megan Smith, Program Manager – Cervix, Cancer Council NSW; Pauline Tanner, Cancer Nurse Coordinator – Gynaecology, WA Cancer & Palliative Care Network, WA; Tamara Wraith, Senior Clinician, Physiotherapy Department, The Royal Women’s Hospital, VIC. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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