Why Pap smear tests are changing

Ladies, soon you won't need to have another Pap smear.

They're being phased out in favour of an alternative known as HPV tests — which will start at a later age, with more than double the time in between examinations.

The move, slated for early December, will improve early detection and save lives, experts say.

But before you start celebrating: the end of the Pap smear won't mean the end of invasive examinations.

Pap smears aren't usually a highlight on women's calendars because they involve a doctor inserting a speculum — a tool that looks like a duck's bill — into the vagina to prise the walls apart.

That enables them to access the cervix — the opening to the uterus — where they can take a sample of cells using a special brush.

The procedure for having a HPV test will be the exact same.

"Women will not notice the difference," Mr Tooma said.

"It is just a different way the test sample is preserved in liquid and sent to the pathologist for analysis."

What else is changing?

But the changes from Pap smear to HPV screening do bring some good news:

You'll be tested every five years, instead of every two

You won't start having tests until you're 25 years old, up from 18 years old

Self-collection using vaginal swabs will be an option for some women

Also on the downside, tests will now continue until you're 74, instead of stopping when you turn 69.

Is the new HPV test actually better than the Pap smear?

HPV stands for Human Papilloma Virus and it is the virus that causes about 99 per cent of cervical cancer cases. The new test looks for the presence of the HPV virus rather than looking for pre-cancerous changes in cells (that can occur because of the virus). It is a more accurate test and can detect potential problems earlier, experts said.

And a new study has found DNA screening for HPV, the virus that causes cervical cancer, is more effective than pap-smear-like methods for detecting pre-cancerous cells, even in women vaccinated against the virus.

"The traditional Pap smear test collects cells from the cervix to test if these are abnormal or not," Australian Cervical Cancer Foundation chief executive Joe Tooma said.

"The new Cervical Screening Test will go the step before this and test for the presence of Human Papilloma Virus (HPV) rather than testing for abnormal cells, which may not happen until many years after initial infection with HPV."

Mr Tooma said health modelling had shown HPV testing would reduce cervical cancer deaths by up to 30 per cent.

Australian Medical Association (AMA) president Dr Michael Gannon said it was "a move forward for women's health".

"This is a good news story. It's government listening to the experts," Dr Gannon said.

In an effort to further reduce deaths, self-collection will now be an option for some women.

Women who are overdue for a test by more than two years or have never been tested may be able to take a vaginal swab themselves under a medical professional's supervision.

While doctor-collected cervical samples are more accurate, Mr Tooma said self-collection could be a positive option for some women who otherwise might go untested.

"Experts believe [self-collected vaginal swabs] will be a much better option than not being tested at all," Mr Tooma said.

If you have HPV, will you definitely get cervical cancer?


In fact, many of us are likely to have HPV at some point and not even realise.

The virus clears in most women, and they does not develop cervical cancer.

"HPV is a common virus transmitted by genital skin-to-genital skin contact," a federal Department of Health spokeswoman said.

"Four out of five people will have it at some point in their lives but never know as there are usually no signs or symptoms.

"The body normally clears the virus itself, but when persistent, cells can change and cervical cancer can develop. This can take more than 10 years."

So, what happens if you test positive?

If the new test detects a HPV infection during testing, your cell sample will then undergo another test in the lab looking for abnormal cell changes, called a reflex liquid-based cytology (LBC).

"The combined result of the Cervical Screening Test and the LBC test (if performed) will determine a woman's risk of developing cervical cancer and her clinical management," the Department of Health spokeswoman said.

If you test positive, you can be closely monitored for potential cell changes.

Will problems be missed by only testing every five years?

Experts have rejected concerns problems could go undetected by extending the time between tests from two to five years.

"The change is being made because of new evidence about cervical screening which has demonstrated that screening for HPV every five years is more effective than, and just as safe as, screening with a Pap test every two years," the spokeswoman said.

The cell changes caused by HPV that can lead to cervical cancer often take more than 10 years, she said. So looking for the presence of the virus is detecting a potential problem much earlier - which more than makes up for the increased time between tests.

And fewer invasive examinations will likely be welcomed by many women, Dr Gannon said.

"There are a great number of women who will be very happy about the idea they will only be invited for cervical screening on a five-yearly basis, rather than a two-yearly basis," Dr Gannon said.

So, if you had your last Pap smear two years ago, does that mean you should now wait another three years before getting the HPV test?

"No," the Department of Health said.

"Women will be due for their first Cervical Screening Test two years after their last Pap test."

And if you have symptoms including unusual bleeding, discharge and pain at any time, you should see your healthcare professional.

Why is screening now starting at 25 years old?

There have been concerns potential problems could be missed in young women by raising the age women begin screening from 18 to 25 years old.

But cervical cancer is rare in women younger than 25 years old and screening that age group had not reduced the number of cases or deaths from cervical cancer.

In fact, it said screening younger women may actually do more harm than good.

"Evidence has shown that, while HPV infection and cell abnormalities are common in women younger than 25, both usually clear up without needing treatment," a department spokeswoman said.

"Treatment of these common abnormalities that may resolve can increase the risk of pregnancy complications later in life."

Dr Gannon agreed it would be good for women.

"It's going to mean that literally tens of thousands of women each year will not face the anxiety of an abnormal Pap smear result, will not face the expense and inconvenience of referral to a gynaecologist for a colposcopy [visual inspection of the cervic which might lead to a biopsy], they will not face the anxiety of waiting for results," he said.

"And they will not face the risks both acute and in terms of their future pregnancies of what amounts to in many cases unnecessary surgery on their cervix."

The HPV vaccine has also been shown to reduce cervical abnormalities in women under 25 years old, and "is ultimately expected to reduce cervical cancer in this age group", the Department of Health said.

Do you still have to have the test if you're HPV vaccinated?


Even if you've had the HPV vaccine, you could still get it, and should be tested.

"The HPV vaccine does not protect against all the types of HPV that cause cervical cancer," the department said.

The vaccine, which is given to girls and boys aged between 12 and 14 as part of Australia's National HPV Vaccination Program, protects against the two most common types of HPV — but not all.

Is this just a way for the Government to save money?

Dr Gannon said, while the changes will likely save taxpayers millions of dollars, with tests starting later and occurring less often, concerns they are a Government spending cut are "completely wrong".

He said the saving was just an "added bonus" to a "well thought out, evidence-based change".

Women are also likely to save money, with fewer visits to their GP and less referred to gynaecologists for colposcopies, Dr Gannon said.

As with Pap smears, the new test will be Government funded, with women only needing to pay for their health professional's consultation, if applicable.

Are HPV tests used in other countries?

The tests have actually already been used in Australia for more than 10 years — just not as a way of screening for cervical cancer.

"It's been around for a long time," Dr Gannon said.

"It's been used to assist with the follow-up of patients after high-risk abnormalities."

Australia will be "one of the first countries" to use the test for cervical screening, the Department of Health said

The changes are due to come into effect from December 1, but are dependent on the introduction of the new National Cancer Screening Register — which has already been delayed by seven months.

The register's aim is to draw together the current bowel and cervical cancer screening databases to give doctors and patients better reminders on when check-ups are due.