tag:theconversation.com,2011:/africa/topics/hpv-screening-10134/articlesHPV screening – The Conversation2021-06-27T19:48:07Ztag:theconversation.com,2011:article/1633602021-06-27T19:48:07Z2021-06-27T19:48:07ZSelf-collected cervical screening is a great way to prevent cervical cancer. How can we get more people doing it?<figure><img src="https://images.theconversation.com/files/408324/original/file-20210625-23-1nwyjle.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C992%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-having-consultation-female-doctor-office-534962014">from www.shutterstock.com</a></span></figcaption></figure><p>Cervical cancer is a <a href="https://pubmed.ncbi.nlm.nih.gov/28346680/">preventable cancer</a> — most cases are caused by long-term infection with high-risk types of human papillomavirus (HPV).</p>
<p>Screening aims to detect types of HPV associated with cervical abnormalities and cancer. Early detection allows preventative treatment, so cancer doesn’t develop.</p>
<p>Cervical screening is a reasonably invasive procedure, which requires a doctor or nurse to do a pelvic examination and insert a speculum, a medical tool used to help examine the cervix.</p>
<p>Since 2017, many Australian women have had access to “self-collection”, whereby they can collect their own vaginal sample using a small, soft swab (similar to the ones used to collect a COVID test). But many women who are eligible don’t know it’s an option.</p>
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Read more:
<a href="https://theconversation.com/never-had-a-pap-smear-now-theres-a-diy-option-for-you-70706">Never had a Pap smear? Now there's a DIY option for you</a>
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<p>Our <a href="http://doi.org/10.5694/mja2.51137">new study</a>, published today in the Medical Journal of Australia, found many women prefer this option, and doctors and nurses like having it available.</p>
<p>However, it’s significantly underused in Australia. Between 2017 and 2019, <a href="https://www.mja.com.au/journal/2020/213/5/hpv-swab-self-collection-and-cervical-cancer-women-who-have-sex-women">only 6,000 of these tests were conducted</a>, out of an estimated one million women eligible. </p>
<p>To prevent as many cases of cervical cancer as possible, we need to find out why this option is being used so rarely, and how can we increase access.</p>
<h2>Wait, what’s cervical screening again?</h2>
<p>In 2020, the World Health Organization (WHO) called on countries to progress towards the <a href="https://www.who.int/news-room/events/detail/2020/11/17/default-calendar/launch-of-the-global-strategy-to-accelerate-the-elimination-of-cervical-cancer">elimination of cervical cancer</a> as a public health problem.</p>
<p>Australia is considered a global leader in preventing cervical cancer. We have an effective <a href="https://www.health.gov.au/health-topics/immunisation/immunisation-services/human-papillomavirus-hpv-immunisation-service">HPV vaccination program</a> delivered through schools, and a longstanding <a href="https://www.health.gov.au/initiatives-and-programs/national-cervical-screening-program">cervical screening program</a>.</p>
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<img alt="Copan FLOQ Swab used for self-collection cervical screening in the Australian National Cervical Screening Program" src="https://images.theconversation.com/files/408318/original/file-20210625-27-1myhjaz.jpg?ixlib=rb-1.1.0&rect=0%2C241%2C4030%2C1617&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408318/original/file-20210625-27-1myhjaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=278&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408318/original/file-20210625-27-1myhjaz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=278&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408318/original/file-20210625-27-1myhjaz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=278&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408318/original/file-20210625-27-1myhjaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=349&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408318/original/file-20210625-27-1myhjaz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=349&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408318/original/file-20210625-27-1myhjaz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=349&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Only 6,000 of one million eligible women used self-collection in cervical screening in 2017-2019.</span>
<span class="attribution"><span class="source">VCS Foundation</span>, <span class="license">Author provided</span></span>
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<p>Having HPV won’t necessarily cause cancer. There are more than 100 types of HPV, and <a href="https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer">only 14 are associated with it</a>. Having HPV at some point in your life is quite normal. We just need to make sure we pick up any types of HPV associated with cervical cancer.</p>
<p>In Australia, women (and people with a cervix) aged 25-74 are invited to have a cervical screening test every five years. This more accurate test replaced the “Pap” test <a href="https://www.health.gov.au/initiatives-and-programs/national-cervical-screening-program/about-the-national-cervical-screening-program">in December 2017</a>, which used to be recommended every two years.</p>
<p>We know women find the test <a href="https://pubmed.ncbi.nlm.nih.gov/31353682/">uncomfortable</a>. For many, other barriers — such as <a href="https://srh.bmj.com/content/38/4/214">past trauma</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/29173823/#:%7E:text=Results%3A%20Lack%20of%20knowledge%20about,identified%20as%20barriers%20to%20screening.">cultural sensitivity</a> — prevent them having the test. </p>
<p>In Australia, <a href="https://www.aihw.gov.au/getmedia/d29dfe9e-894b-4d24-91f6-a465713bcff8/aihw-can-115.pdf.aspx?inline=true">72% of cervical cancer cases</a> occur in women who are overdue for screening, or who have never been screened. This is concerning, considering only <a href="https://www.cervicalcancercontrol.org.au/wp-content/uploads/2021/03/2021-C4-CRE-Elim-Report.pdf">55%</a> of 35-year-old women have been screened at least once with an HPV test. This is below the WHO’s elimination target of 70% by 2030.</p>
<h2>How does self-collection work?</h2>
<p>In December 2017, Australia introduced a new <a href="https://www.health.gov.au/initiatives-and-programs/national-cervical-screening-program">screening option</a> where women could take their own samples. This option is only available to women who:</p>
<ul>
<li><p>are over 30 years old</p></li>
<li><p>are more than two years overdue (so four or more years since their last Pap test) </p></li>
<li><p>or who have never been screened</p></li>
<li><p>and decline a traditional test.</p></li>
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<p>A self-collected test still requires a consultation with a doctor or nurse. But in this supported environment, a woman can collect her own sample.</p>
<p>Self-collection is as <a href="https://www.bmj.com/content/363/bmj.k4823">accurate</a> as the sample collected by a doctor or nurse. Australian <a href="https://www.mja.com.au/journal/2016/204/5/impact-hpv-sample-self-collection-underscreened-women-renewed-cervical-screening">modelling</a> <a href="https://cebp.aacrjournals.org/content/30/2/268.long">studies</a> suggest self-collection can save lives.</p>
<p><a href="https://www.aihw.gov.au/reports/cancer-screening/national-cervical-screening-monitoring-report-2020/contents/summary">About 6%</a> of people who test positive for some types of HPV need to return to their doctor or nurse for a traditional test to look for cell changes. So the main downside is a small percentage of people who’ve done self-collection will also need to return for a traditional test. Another roughly 2% of women will require referral to a specialist for further assessment.</p>
<h2>Both women and health-care providers support self-collection</h2>
<p>Data <a href="https://www.bmj.com/content/363/bmj.k4823">from overseas</a> suggest self-collection is an effective way to screen women who traditionally haven’t been screened enough (or at all).</p>
<p>One Australian study demonstrated <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832287/">85% of under-screened</a> women who were offered self-collection opted to screen.</p>
<p>Our work with Victorian Aboriginal women indicates self-collection is key to improving the accessibility and acceptability of cervical screening. A <a href="https://www.sciencedirect.com/science/article/pii/S0091743520303388">review</a> assessing progress towards elimination of cervical cancer for Indigenous people in high-income countries highlighted the critical role that self-collection is likely to play in increasing participation in cervical screening.</p>
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Read more:
<a href="https://theconversation.com/five-myths-about-the-new-cervical-screening-program-that-refuse-to-die-74077">Five myths about the new cervical screening program that refuse to die</a>
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<p><a href="http://doi.org/10.5694/mja2.51137">Our new study</a> was done in collaboration with cervical cancer prevention organisation the <a href="https://www.vcs.org.au/">VCS Foundation</a> and the Victorian government. It provides the first insight into what women and doctors and nurses thought about their experience of using self-collection.</p>
<p>Women appreciated the availability of an alternative option — one that addressed many of their barriers. Doctors and nurses regarded self-collection as a “progressive” change, and thought self-collection was effective at re-engaging those who decline a traditional test.</p>
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<h2>Why is self-collection being used so rarely?</h2>
<p>Our study also identified barriers making it difficult for doctors and nurses to use or offer the option of self-collection.</p>
<p>Doctors and nurses found it difficult and time-consuming to determine whether women fit the eligibility criteria. They said it took too long for them to work out who was eligible.</p>
<p>Some doctors and nurses were uncertain about the process. For example, many were unclear whether women could take the test home to complete (they can). This reduced some doctors’ and nurses’ confidence in offering self-collection.</p>
<p>This lack of confidence is consistent with <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228042">another Australian study</a>, which found only 59% of doctors and nurses were confident in discussing self-collection and only 36% believed the test was reliable.</p>
<h2>4 ways to increase access</h2>
<p>It’s important we increase access to self-collection. This can be achieved through addressing four main points.</p>
<p>First, we need to remove the restrictive eligibility criteria. We’re encouraged the Medical Services Advisory Council recently <a href="http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1664-public">recommended</a> giving all women the choice of collecting their own sample. We eagerly await the federal government’s decision regarding this recommendation.</p>
<p>Second, we need more education for doctors and nurses to increase their confidence in offering self-collection. This should include clearer guidelines for them.</p>
<p>Third, more HPV tests need to be approved for use with self-collection samples, enabling more pathology labs to process them.</p>
<p>Fourth, we need the National Cervical Screening Program, general practitioners, and nurses and community health organisations to more widely communicate and promote the self-collection option. Women who are hesitant to be screened should know there’s another option. </p>
<p>Increasing access to self-collection is critical to increasing equity in Australia’s screening program. We have the tools to create equity and <a href="https://www.who.int/news-room/events/detail/2020/11/17/default-calendar/launch-of-the-global-strategy-to-accelerate-the-elimination-of-cervical-cancer">eliminate cervical cancer</a> as a public health problem in Australia. We need to use them.</p><img src="https://counter.theconversation.com/content/163360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicola Creagh works for the University of Melbourne. She receives funding from the Commonwealth Department of Health. </span></em></p><p class="fine-print"><em><span>Claire Nightingale works for the University of Melbourne. She receives funding from the Victorian Cancer Agency, and the Commonwealth Department of Health</span></em></p><p class="fine-print"><em><span>Claire Zammit works for the University of Melbourne. </span></em></p>Only 6,000 women used self-collection in cervical screening between 2017 and 2019, out of about one million women eligible. We need to boost those numbers if we’re ever to eliminate cervical cancer.Nicola Creagh, Research Assistant in Evaluation and Implementation Science, Centre for Health Policy, Melbourne School of Population and Global Health, The University of MelbourneClaire Nightingale, Research Fellow in Implementation Science at the Centre for Health Policy, The University of MelbourneClaire Zammit, Research Associate in Evaluation and Implementation Science at the Centre for Health Policy, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1226882019-08-30T11:36:08Z2019-08-30T11:36:08ZMeasles epidemic: parents reluctant to vaccinate their children need to hear of the horrors of forgotten diseases<figure><img src="https://images.theconversation.com/files/290185/original/file-20190829-106508-36u29k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-holding-syringe-vaccine-616263095?src=-1-13">Billion Photos/Shutterstock</a></span></figcaption></figure><p>There’s been a surge in measles cases across Europe, putting people’s lives at risk according to new findings from the <a href="http://www.euro.who.int/en/media-centre/sections/press-releases/2019/european-region-loses-ground-in-effort-to-eliminate-measles">World Health Organization</a>. </p>
<p>The official figures show that approximately 90,000 cases have been reported for the first half of 2019. This is already more than the number of cases recorded for the whole of 2018 (84,462). </p>
<p>This has in part been put down to disinformation about the MMR (measles, mumps and rubella) vaccine on social media <a href="https://www.pathologyinpractice.com/story/27090/measles-the-importance-of-vaccination-disease-monitoring-and-surveillance">putting parents off vaccinating </a>their children.</p>
<p>Recent outbreaks of measles, which is much more infectious than mumps and rubella, have been widely <a href="https://www.independent.co.uk/topic/measles">reported</a>. But what is less well known is that there have been a few babies born with congenital rubella syndrome in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954604/">the UK in the past few years</a>. This is an illness resulting from an infection of the rubella virus during pregnancy.</p>
<h2>Rubella babies</h2>
<p>People under the age of 50 are unlikely to have heard about “Rubella babies”, but in the 1940s, the Australian paediatric ophthalmologist, Norman Gregg, made <a href="https://sydney.edu.au/medicine/museum/mwmuseum/index.php/Gregg,_Sir_Norman_McAlister">the connection</a> between women being infected with German measles (rubella) during pregnancy and their children being born deaf and blind and sometimes with other disabilities.</p>
<p>Many babies infected with the virus while in the womb do not survive, but in the 1960s in the UK about 300 children each year were born with “congenital rubella syndrome” and needed care. By 1970, a safe effective Rubella vaccine was available and the UK began <a href="https://academic.oup.com/cid/article/7/Supplement_1/S11/398615">vaccinating school girls</a>. A screening programme, which involved testing blood samples from women of childbearing age to see whether they had previous immunity to the virus, also began. Those who did not did not have protection were offered the vaccine.</p>
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<a href="https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Rubella is a viral illness that causes a mild fever and a skin rash.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/treatment-rubella-viral-infection-concept-girls-1056168554?src=-1-0">OneSideProFoto/Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/measles-should-vaccinations-be-compulsory-114481">Measles: should vaccinations be compulsory?</a>
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<p>Although women starting in particular jobs – such as health care and teaching – were screened, most of the tests were done on pregnant women as part of their 12 week check. In 1988, the Rubella vaccine become the R in the MMR and the strategy changed to vaccinating <a href="https://www.nhs.uk/conditions/vaccinations/mmr-vaccine/">all pre-school children</a>.</p>
<p>The idea was that if all young children were protected, then these infections would eventually not be circulating at all. During 2016 and 2017, routine screening for Rubella antibodies during pregnancy was phased out across the UK. It was considered not cost-effective, since Rubella infection during pregnancy was extremely rare and most people in the UK of child bearing age should have received MMR as children. But the recent outbreaks of measles across the world have illustrated the <a href="https://www.pathologyinpractice.com/story/27090/measles-the-importance-of-vaccination-disease-monitoring-and-surveillance">problems with MMR uptake</a>.</p>
<h2>Misinformation and memory</h2>
<p>Why are people reluctant to have screening tests and vaccinations to prevent diseases? While some of the reasons may include loss of trust in “experts” and people in authority, I wonder if it is also partly because the stories of such diseases have been long forgotten. </p>
<p>When Eva Peron, the First Lady of Argentina, died from cervical cancer at the <a href="https://www.biography.com/political-figure/eva-peron">age of 33 in 1952</a>, for example, early diagnosis was not possible – and chemotherapy treatment was in its infancy. So for women who developed this disease, a distressing illness and painful death were more or less inevitable. </p>
<p>The design of a laboratory method for detecting early changes in the appearance of cells in the cervical region – the “Pap smear” – eventually made regular mass screening possible. Since the introduction of the scheme into the UK in 1988, it has prevented thousands of <a href="https://www.sciencedirect.com/science/article/pii/S0140673604166749">premature deaths in women each year</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=470&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=470&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=470&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=590&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=590&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=590&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">‘Vaccinating the poor of New York City against smallpox in 1872’. In 1863, mass production of smallpox vaccine was developed, allowing for broad immunisation of North American and European populations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/vaccinating-poor-new-york-city-against-242820433?src=-1-2">Everett Historical/Shutterstock</a></span>
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<p>The discovery that most but, crucially, not all cases of cervical cancer are attributable to Human Papillomavirus (HPV) infection led to the development of the HPV vaccine which is now given routinely to <a href="https://www.who.int/immunization/diseases/hpv/en/">teenage girls</a> – and in some countries boys as well. Evidence from the UK programme, which began in 2009, suggests the vaccine is very effective and this should help to further reduce the number of women with cervical cancer among the under 30s. </p>
<p>Yet despite all that’s known about cervical cancer and the importance of going for a regular smear test, many women still appear to be reluctant to go. It’s estimated that about <a href="https://www.bbc.co.uk/news/uk-england-45593583">three million women</a> across England have not had a smear test for at least three-and-a-half years.</p>
<p>In the 20th-century, there were major advances in disease prevention, which improved both life expectancy and quality of life. But it seems these health and societal developments are now being overlooked. Indeed, giving people information and instructions is no longer working. So perhaps it’s time to appeal to people’s hearts by telling the stories of these diseases – and how they have affected real people. </p>
<p><a href="https://www.who.int/bulletin/volumes/87/8/09-069559/en/">Gruesome photos on cigarette packages</a>, for example, massively help to reduce tobacco use, so maybe something similar now needs to happen in terms of vaccinations to tackle the latest epidemic and anti-vaxxer campaigns around the world.</p><img src="https://counter.theconversation.com/content/122688/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Pitt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s not just measles you need to worry about.Sarah Pitt, Principal Lecturer, Microbiology and Biomedical Science Practice, University of BrightonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/707062017-11-30T19:04:34Z2017-11-30T19:04:34ZNever had a Pap smear? Now there’s a DIY option for you<figure><img src="https://images.theconversation.com/files/184851/original/file-20170906-9871-h8ptwr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women who've never had a Pap smear or who've skipped a few don't need to miss out on cervical screening. For the first time, some can take their own sample if that makes them feel more comfortable.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/675222802?src=KjbCpk_Urj3uCCmHvoyywg-2-3&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>This month sees the end of Pap smears every two years for women aged 18-69 and the start of a <a href="http://www.health.gov.au/internet/screening/publishing.nsf/Content/future-changes-cervical">new screening regime</a> for cervical cancer.</p>
<p>As has been much discussed, women will now start testing at age 25 with a test for the <a href="http://www.health.gov.au/internet/immunise/publishing.nsf/content/immunise-hpv">human papillomavirus</a> (HPV), then tested every five years until they are aged 70-74.</p>
<p>Even though the more sensitive HPV screening program will only screen women around ten times in their lifetime (instead of the current 26 times), it <a href="https://theconversation.com/recommended-cervical-screening-regime-will-save-even-more-lives-26034">will save more lives</a>. </p>
<p>It’s expected to reduce the number of new cases of cervical cancer and deaths from cervical cancer <a href="http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30007-5/fulltext">by at least 20%</a>.</p>
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Read more:
<a href="https://theconversation.com/recommended-cervical-screening-regime-will-save-even-more-lives-26034">Recommended cervical screening regime will save even more lives</a>
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<p>The new screening program should also make it easier for women who have missed out on screening (or have skipped a few Pap smears) to take part.</p>
<p>That’s a sizeable number of women. <a href="https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2014-2015/contents/table-of-contents">At least one million</a> Australian women are more than a year overdue for cervical screening. And <a href="https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2014-2015/contents/table-of-contents">only about 60% of women</a> are screened every two years as recommended, a statistic that hasn’t moved in over a decade.</p>
<p>What makes reaching under-screened women so important is these are the ones most likely to be diagnosed with cervical cancer. <a href="http://www.vccr.org/site/VCCR/filesystem/documents/dataandresearch/StatisticalReports/VCCR_StatisticsReport_2014_Digital_FinalApproved.pdf">About two-thirds</a> of all cervical cancers are found in women who have never been screened or are more than 18 months overdue for screening.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184855/original/file-20170906-9862-1kd08zl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The switch from the old Pap smear to the new test for human papillomavirus (HPV) should make it easier for under-screened women to be screened for cervical cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/655946152?src=LJOvOZMI5_-UB3t7TBxFwA-1-12&size=medium_jpg">from www.shutterstock.com</a></span>
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</figure>
<h2>Easier to be screened</h2>
<p>From this month, under-screened women should find it easier to be screened for two main reasons.</p>
<p>First, a new reminder system will invite all women for screening by letter on their 25th birthday, and every five years after their first HPV test. The current system only reminds women if they’re already late for screening.</p>
<p>Second, from next year there will be a new option offered specifically to under-screened women. Unlike the old Pap smear, which a GP or nurse collected, some women will have the option of collecting their own sample for testing (known as “self-collection”).</p>
<p>In trials, women who have never been screened or who are under-screened are <a href="http://onlinelibrary.wiley.com/doi/10.1002/ijc.30031/abstract">more likely</a> to take part in cervical cancer screening if they are offering “self-collection” rather than the reminder letters used in our current system.</p>
<h2>Why don’t women get screened?</h2>
<p>There are <a href="http://discovery.ucl.ac.uk/1478246/3/Chorley_et_al-2016-Experiences%20of%20cervical%20screening.pdf">many reasons</a> women are not screened regularly enough (or at all). <a href="http://journals.sagepub.com/doi/full/10.1258/jms.2009.009073">These include</a> feeling embarrassed, fearful or anxious about the procedure, perhaps after a bad experience in the past. Others say they’re unaware of the importance of cervical screening, or are too busy to make an appointment.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
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</em>
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<p>For Aboriginal women, difficulty accessing culturally appropriate health services and education, or limited access due to remoteness are only a few factors in a <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.29954/full">complex picture of under-screening</a>.</p>
<p>We know from a recent study using Queensland data that for at least a decade <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.29954/full">fewer than 40%</a> of Indigenous women have been screened every two years.</p>
<p>Sadly, outcomes in terms of cervical cancer are worse for Indigenous women, with rates of new cases <a href="https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2014-2015/contents/table-of-contents">more than twice</a> those in the general population.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-myths-about-the-new-cervical-screening-program-that-refuse-to-die-74077">Five myths about the new cervical screening program that refuse to die</a>
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<p>Other women who may not be screened as often as recommended, and so are likely to benefit from the new self-collection option, include: <a href="http://www.sciencedirect.com/science/article/pii/S187778211200118X">culturally and linguistically diverse</a> women, survivors of sexual abuse, women with <a href="http://www.papscreen.org.au/downloads/research_eval/screened_out.pdf">disabilities</a>, women living in <a href="https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2014-2015/contents/table-of-contents">disadvantaged areas</a>, or in <a href="https://www.aihw.gov.au/reports/cancer-screening/cervical-screening-in-australia-2014-2015/contents/table-of-contents">rural and remote areas</a>, women who have experienced female genital cutting, and <a href="https://ses.library.usyd.edu.au/bitstream/2123/12702/1/Papsmear-rates-PP-2015.pdf">LGBTI</a> women.</p>
<h2>Who can take their own sample and does it work?</h2>
<p>Women will only be eligible to take their own sample if they are aged 30 or older and are two or more years overdue for screening. </p>
<p>Eligible women will be able to collect a sample privately. A medical practitioner will still need to offer the self-collection option, and he or she will advise how to collect the sample.</p>
<p>While self-collection is <a href="http://cebp.aacrjournals.org/content/24/5/769">not quite as effective</a> as a doctor or nurse collecting a sample, it’s much better than not being screened at all.</p>
<p><a href="https://www.mja.com.au/journal/2016/204/5/impact-hpv-sample-self-collection-underscreened-women-renewed-cervical-screening">Our study</a> estimated the impact of different cervical screening decisions by a group of previously unscreened women who were eligible for self-collection tests.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184854/original/file-20170906-9846-1713uzz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A doctor or nurse will tell you how to collect your own sample, which you can do in private if it makes you feel more comfortable.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/683551744?src=C5gw6Pj60S9LmzXYBY_OTA-1-18&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>We calculated that even one round of HPV screening using a self-collected sample would reduce cervical cancer risk by around 41% over a woman’s lifetime when tested at age 30-40, compared to the risk if she remained unscreened. Even at older ages, self-collection can offer important protection compared to remaining unscreened.</p>
<p>If unscreened women joined the routine screening program at age 30 (instead of a one-off screen at the same age), the number of cervical cancer cases and deaths that could be prevented doubles.</p>
<p>In absolute numbers, we estimated undergoing just one round of self-collected HPV testing at age 30 or 40 could prevent over 900 diagnoses and 360 cervical cancer deaths over the lifetime of 100,000 unscreened women. </p>
<p>If those unscreened women joined the routine screening program at age 30, there would be over 2,000 fewer cervical cancer diagnoses compared to them remaining unscreened.</p>
<h2>Breaking down the barriers</h2>
<p>These findings show the potential for self-collection to reduce cancer risk in under-screened and unscreened women. But we also have to find new ways of encouraging all women to attend for a clinician-collected sample, as we know this is even more effective in reducing that risk.</p>
<p>Breaking down the barriers that prevent some women from participating in cervical screening is important to further reduce cervical cancer rates in Australia. These include addressing cultural barriers in the health system, improving access to health services (including at convenient times for women), increasing awareness of the importance of cervical screening, and reducing any additional costs for women.</p>
<p>Lastly, if you have symptoms of cervical cancer – including pain or irregular bleeding – you should see your doctor, regardless of how long it’s been since your last screening test, and no matter how old you are.</p><img src="https://counter.theconversation.com/content/70706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Canfell receives funding from the NHMRC, Cancer Council Australia, The Australian Government, The NZ Ministry of Health, The US National Cancer Institute, and Cancer Council NSW. She is also co-PI of an investigator-initiated trial of cytology and primary HPV screening in Australia and NZ (‘Compass’). Compass Australia is conducted and funded by the Victorian Cytology Service (VCS), a government-funded health promotion charity. The VCS have received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and Ventana Inc USA. However neither she nor her institution on her behalf (Cancer Council NSW) receives direct funding from industry for this trial or any other project. </span></em></p><p class="fine-print"><em><span>Megan Smith is Program Manager - Cervix/ HPV Group at Cancer Council NSW. </span></em></p>For the first time, some Australian women will be eligible to collect their own sample for cervical screening. While it’s not as accurate as one from a GP or nurse, it could still save your life.Karen Canfell, Adjunct professor, UNSW SydneyMegan Smith, Program Manager - Cervix/ HPV Group, Cancer Council NSW, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/872192017-11-10T10:47:13Z2017-11-10T10:47:13ZHPV jab and better tests mean women will need only three cervical screens from 2021<figure><img src="https://images.theconversation.com/files/194154/original/file-20171110-29374-kl6kw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The HPV jab given from 2008 with new testing procedures from 2019 could mean women need fewer tests over a lifetime.</span> <span class="attribution"><span class="source">Image Point Fr/Shutterstock</span></span></figcaption></figure><p>The human papillomavirus or HPV is an incredibly common sexually transmitted infection: more than <a href="https://www.ncbi.nlm.nih.gov/pubmed/25299412">85% of women will be infected during their lifetimes</a> and, according to the US Center for Disease Control: “<a href="https://www.cdc.gov/std/hpv/stdfact-hpv.htm">HPV is so common that nearly all sexually active people get it at some point in their lives</a>”. While the vast majority of infections clear on their own, a small proportion progress to cause <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet">cervical and other cancers</a>. </p>
<p>The risk of cervical cancer has been shown to be much higher for women with HPV, with the risk varying by type of HPV virus. HPV types 16 and 18 bring the highest risk, responsible for around 70% of cervical cancers between them. Compared to a woman without an HPV infection, women infected with HPV16/18 are <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa021641#t=articleTop">more than 300 times more likely to have cervical cancer</a>. The fact is that if there were no HPV, there would be almost no cervical cancer. Which means tackling HPV infection is of vital importance.</p>
<p>It’s this understanding of the carcinogenic effects of HPV that has led health authorities in the UK to offer <a href="https://www.gov.uk/government/news/hpv-vaccine-to-change-in-september-2012">HPV vaccination to girls aged 12</a> at school, free of charge, since 2008. The current vaccine, Gardasil, protects against four strains of HPV: types 16 and 18 that cause around 70% of all cervical cancers, and types 6 and 11 that cause around 90% of genital warts. Gardasil has been proven to have <a href="http://www.tandfonline.com/doi/abs/10.4161/hv.29532">96% efficacy against HPV infection</a> when followed up after nine years.</p>
<p>We built a microsimulation model of the natural history of cervical cancer in a cohort of girls from age 12 to 80, and considered a variety of vaccination and screening combinations in order to analyse the effects of the HPV vaccine and cervical screening on women. Our <a href="http://onlinelibrary.wiley.com/doi/10.1002/ijc.31094/full">study</a>, published in the International Journal of Cancer, found that the combined effects of vaccination and improved screening measures would mean that women require far fewer cervical cancer screenings – a relief for women, and an enormous cost saving for the NHS and taxpayer.</p>
<h2>Better checks with less fuss</h2>
<p>The current cervical screening, or smear test, first looks for abnormal cells. If these are detected, the sample is then tested for the presence of HPV. However the <a href="https://phescreening.blog.gov.uk/2017/06/14/what-gps-need-to-know-about-the-introduction-of-primary-hpv-testing-in-cervical-screening/">screening programme is due to change in 2019</a> to the more efficient approach of first testing samples for HPV, following a <a href="https://legacyscreening.phe.org.uk/policydb_download.php?doc=560">pilot study</a> which began in England in 2013. Our modelling suggests that seven screens over a lifetime will provide the same protection for women who have not been vaccinated against HPV as the 12 screens recommended under the current programme. </p>
<p>For young women who have been vaccinated against HPV and who are therefore at much lower risk of cervical cancer, our model suggested that the number of lifetime screens would fall from 12 to three. Women vaccinated aged 12 in 2008 are now 21, and would start being screened in 2021 under the current screening programme – which invites women for their first screen aged 25. So this forthcoming change in 2019 presents a great opportunity for health authorities to draw up adjusted guidelines for the lower number of screens required by vaccinated women to account for the lower risk they face. </p>
<p>In 2015 a new vaccine, Gardasil-9, which protects against 9 types of HPV and prevents around 90% of cervical cancers, was approved for use in Europe. If this vaccine replaces the current vaccine, women will only require two screens during their lives.</p>
<p>The <a href="https://www.nature.com/articles/srep02362">cost of cervical cancer screening in England in 2013 was around £175m</a>. The switch to the new testing regime would mean not only less women getting cervical cancer, but also substantial cost savings. We’d need more results from the pilot to get an accurate estimate, but it’s likely that savings would be in the region of £40-80 million each year – money that can be reinvested into other services. In any case, as cervical screening isn’t a fun experience, anything that reduces the number of times women need it is good news.</p><img src="https://counter.theconversation.com/content/87219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Landy receives funding from Cancer Research UK.</span></em></p>Smear tests are no fun for women, and the HPV vaccine and better screening will offer better protection from cancer and fewer trips to the women.Rebecca Landy, Cancer Screening Statistician, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/740772017-03-09T19:23:31Z2017-03-09T19:23:31ZFive myths about the new cervical screening program that refuse to die<figure><img src="https://images.theconversation.com/files/160114/original/image-20170309-21034-c9ch1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women are confused about what changes to the cervical screening program will mean for their sexual health.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>The <a href="https://www.change.org/p/malcolm-turnbull-stop-may-1st-changes-to-pap-smears-save-women-s-lives?source_location=minibar">online petition</a> against changes to Australia’s <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-1">cervical cancer screening program</a> has revealed more than 70,000 people (most of whom we could assume are women) are deeply concerned about what the upcoming changes mean.</p>
<p>Their comments also reveal a number of misconceptions about the new screening program, which will now be rolled out in <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr17-dept-dept002.htm">December 2017</a>, rather than in May as planned.</p>
<p>It seems that in concentrating on the science behind shifting away from Pap smears every two years to <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/content/future-changes-cervical">testing for the human papillomavirus (HPV) every five years</a>, our medical authorities have <a href="https://theconversation.com/delays-and-confusion-cloud-roll-out-of-new-cervical-cancer-screening-program-73605">failed to convince</a> many Australian women this move <a href="https://theconversation.com/recommended-cervical-screening-regime-will-save-even-more-lives-26034">will save lives</a>.</p>
<p>Convincing women to come on board is, of course, critical to the success of the new screening program, which is forecast to <a href="http://www.thelancet.com/pdfs/journals/lanpub/PIIS2468-2667%2817%2930007-5.pdf">improve cervical cancer detection rates</a> by at least 15% and is <a href="http://www.smh.com.au/comment/the-end-of-the-pap-smear-is-good-news-for-women-20170227-gum0q2.html">good news for women</a>.</p>
<p>So let’s have a look at some common misconceptions and concerns about <a href="http://www.nps.org.au/__data/assets/pdf_file/0016/310534/HPV-testing-for-primary-cervical-screening.pdf">changes</a> to the cervical cancer screening program raised by some of my patients and by the many people signing up to the <a href="https://www.change.org/p/malcolm-turnbull-stop-may-1st-changes-to-pap-smears-save-women-s-lives?source_location=minibar">change.org petition</a>.</p>
<h2>Myth #1: no more Pap tests means no more invasive examinations</h2>
<p>Quite a few of my patients have thought the new screening program means the end of invasive examinations. And I say “unfortunately not”. For most women the collection procedure will be exactly the same as before. This means you will still have to lie on a couch and a doctor or nurse will still insert the dreaded speculum. This instrument is needed to hold the vaginal walls gently apart so that the cervix at the end of the vagina can be seen. </p>
<p>Two small brushes are used to sample cells from both the outside of the cervix and from the opening which leads up to the uterus. Rather than the specimen being smeared on a slide (as with Pap smears), the two brushes are swizzled around in a preservative liquid, which separates out most of the collected cells and any HPV, the virus responsible for <a href="https://www.ncbi.nlm.nih.gov/pubmed/10451482">at least 99.7%</a> of cervical cancers.</p>
<p>But it’s not until the specimen gets to the pathology lab that the process really changes.</p>
<p>First, the specimen is checked for HPV and only if HPV is present will cells be examined for signs of pre-cancer or cancer. </p>
<p>There is also the option for women who have previously avoided having Pap tests for cultural, religious or personal reasons to collect their own HPV sample. It is estimated that even if a woman has only <a href="https://www.ncbi.nlm.nih.gov/pubmed/26985849">one self-collected test</a> at age 30 she reduces her risk of cervical cancer by about 40%.</p>
<h2>Myth #2: the new test could miss types of cervical cancer not related to HPV</h2>
<p>Almost 85% of cervical cancers are actually skin cancers, triggered not by the sun but by HPV. This type of cervical cancer usually takes about <a href="http://www.who.int/mediacentre/factsheets/fs380/en/">15-20 years</a> to develop. So, HPV testing gives us a chance to detect potential problems long before there is anything to see on a Pap test. </p>
<p>In the new program, women who carry the highest risk HPV types will then have their cells examined using a more sensitive test known as liquid-based cytology. They will also be automatically referred to a gynaecologist for further tests. If other kinds of HPV are found, a check whether the cells show any changes will guide whether the woman is referred for other tests or simply monitored more closely. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/159912/original/image-20170308-27341-1f9p2dt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159912/original/image-20170308-27341-1f9p2dt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159912/original/image-20170308-27341-1f9p2dt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159912/original/image-20170308-27341-1f9p2dt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159912/original/image-20170308-27341-1f9p2dt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159912/original/image-20170308-27341-1f9p2dt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159912/original/image-20170308-27341-1f9p2dt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The new screening program relies on detecting human papillomavirus (HPV), which cause the vast majorities of cervical cancers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/391299166?src=JfnpCIQhNAVe0XK5cR8iCQ-2-64&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Some 15% of cervical cancers start in glandular cells. HPV also triggers these cancers but they are often beyond the reach of the little brushes used to collect cells in a Pap test. They can hide away quietly, growing and spreading for many years before they are detected. </p>
<p>When you hear of someone diagnosed with cervical cancer after previously normal Pap tests it is almost always a <a href="https://www.jostrust.org.uk/forum/cervical-cancer-newly-diagnosed/smear-missed-my-cancer-anyone-else-out-there-same">glandular-type cancer</a>. </p>
<p>The good news is that HPV testing should pick up this kind of cancer earlier and more reliably than a regular Pap test.</p>
<p>There are also some very rare cervical cancers (less than 1%) that start off from muscle, nerve or pigment cells deep within the cervix and are not related to HPV infection. It is true that the new screening program is not designed to detect these types of cancer but then they were also almost impossible to detect on a traditional Pap test as well.</p>
<h2>Myth #3: young women will miss out on early detection if screening starts at 25</h2>
<p>There are many online testimonies from women signing the change.org petition saying they had cervical cancer before the age of 25. It is more likely that most of these were pre-cancerous changes because cervical cancer in this age group is really rare – around <a href="https://cervical-cancer.canceraustralia.gov.au/statistics">1.7 in 100,000</a> Australian women under 25.</p>
<p>Unfortunately, in the nearly 30 years our present screening program has been running there has been <a href="https://www.mja.com.au/journal/2016/205/8/impact-australian-national-cervical-screening-program-women-different-ages">no significant impact</a> on the numbers of cervical cancers reported in Australian women under 25. </p>
<p>Another complication in this younger age group is that cellular changes may look worse than they actually are because of a robust immune reaction to the HPV infection. Unfortunately this can lead to well-meaning advice to treat changes that are very likely to get better on their own.</p>
<h2>Myth #4: less cervical testing reduces the chances of picking up other cancers such as ovarian and uterine cancer</h2>
<p>Pap tests were designed to pick up pre-cancerous changes in the cells of the cervix. They are absolutely useless at detecting endometriosis, polyps, ovarian cancer or sexually transmitted infections other than HPV. They occasionally pick up uterine cancer if it is advanced enough for the cells to be shedding through the cervix that day. </p>
<p>The important point here is that screening tests are only for women with no symptoms. If a woman develops symptoms, such as irregular bleeding, pain or abnormal vaginal discharge, she needs to see her doctor for advice regardless of when she had her last cervical screening test. </p>
<h2>Myth #5: the government is motivated by a cheaper option and will shift the costs of the test to the woman herself</h2>
<p>The new tests are more expensive than a traditional Pap test, but because they are so much more sensitive there is no need to do them as frequently. </p>
<p>They will be funded under Medicare just as the Pap test is now. Any out-of-pocket costs depend on whether health care providers bulk bill (as they often do with screening tests) or charge the scheduled fee.</p><img src="https://counter.theconversation.com/content/74077/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terri Foran does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is a lot of misinformation about the government’s new cervical cancer screening program that involves less frequent tests. Here are the facts.Terri Foran, Lecturer in the School of Women's and Children's Health, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/736052017-02-28T01:28:42Z2017-02-28T01:28:42ZDelays and confusion cloud roll-out of new cervical cancer screening program<figure><img src="https://images.theconversation.com/files/158464/original/image-20170227-27378-19j2afc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women are confused about how the new test for human papillomavirus (HPV), pictured here, will help them prevent cervical cancer. Let's fix that.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/384228760?src=xBaqrpZc9AFre8W2uFNr6g-1-67&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Australia’s new <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-1">national cervical cancer screening program</a> has had a bad week.</p>
<p>The government <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr17-dept-dept001.htm">announced it would delay</a> the May 1 roll-out of its new program until <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr17-dept-dept002.htm">Dec 1, 2017</a>. And a <a href="https://www.change.org/p/malcolm-turnbull-stop-may-1st-changes-to-pap-smears-save-women-s-lives?recruiter=9728543&utm_source=share_petition&utm_medium=facebook&utm_campaign=autopublish&utm_term=mob-xs-share_petition-reason_msg">petition</a> opposing the new program swept social media.</p>
<p>But it’s not all bad news. The delay gives the <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/standing-committee-on-screening">Standing Committee on Screening</a>, which is responsible for implementing the <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/E6A211A6FFC29E2CCA257CED007FB678/$File/Executive%20Summary%20notated%2013.6.14.pdf">new program</a>, the chance to engage with the public and communicate why the changes are being made and what they mean.</p>
<p>If the online petition is anything to go by, this is badly needed to counter the widespread misunderstanding of the <a href="https://theconversation.com/recommended-cervical-screening-regime-will-save-even-more-lives-26034">new cervical screening program</a> and the role of human papillomavirus (HPV) in causing cervical cancer.</p>
<h2>How did we get here?</h2>
<p>In 2014 the <a href="http://www.msac.gov.au/">Medical Services Advisory Committee</a> recommended the national cervical screening program be “<a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/overview-of-the-renewal">renewed</a>” to provide better protection against cervical cancer.</p>
<p>Key <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/MSAC-recommendations">changes</a> included raising the screening age to 25 and replacing Pap tests every two years with HPV tests every five years. The HPV test is more accurate than the existing Pap test, which looks for abnormal cells on the cervix rather than HPV, and its accuracy means <a href="https://theconversation.com/recommended-cervical-screening-regime-will-save-even-more-lives-26034">it is safer</a> for women to go longer between tests. </p>
<p>Another important change is setting up a national cancer screening <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/National-Cancer-Screening-Register">register</a> to record people’s cervical cancer screening histories.</p>
<p>But last week, Commonwealth Chief Medical Officer Brendan Murphy <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr17-dept-dept001.htm">announced</a> the <a href="https://theconversation.com/telstra-health-will-hold-australians-cancer-details-so-we-need-to-ensure-their-privacy-is-protected-60104">Telstra Health-managed register</a> would not be ready for May.</p>
<p>As a result, the new cervical screening test will not be made available on the Medicare Benefits Schedule from May 1; instead, the health department advised women continue to be screened using the existing Pap test.</p>
<h2>Online petition shows women want to know more</h2>
<p>The past week saw 70,000 people (so far) sign an <a href="https://www.change.org/p/malcolm-turnbull-stop-may-1st-changes-to-pap-smears-save-women-s-lives?recruiter=9728543&utm_source=share_petition&utm_medium=facebook&utm_campaign=autopublish&utm_term=mob-xs-share_petition-reason_msg">online petition</a> opposing the changes to the cervical screening program.</p>
<p>The letter accompanying the petition, since removed, unfortunately misrepresented the effectiveness of screening women <a href="https://theconversation.com/cervical-cancer-screening-shouldnt-start-until-25-11314">under the age of 25</a>, the <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet">role of HPV</a> as the cause of cervical cancer and the rationale behind the new screening program.</p>
<p>The petition struck a chord and quickly gathered steam.</p>
<p>In an <a href="http://www.smh.com.au/national/health/petition-against-cervical-screening-changes-woefully-misinformed-says-ama-20170223-gujtda.html">interview</a>, the person behind the petition said she was motivated by “concern and worry”, because “[she] didn’t know about it and no one seemed to know about it”, and because “[she’d] love someone to be able to get down on our level and explain the testing”.</p>
<p>Responses to her petition indicated widespread concern about safety of the new starting age and the wider screening interval. In addition, women perceived the renewed program as a cutback – that less screening is being driven by cost-savings rather than the availability of a <a href="https://theconversation.com/recommended-cervical-screening-regime-will-save-even-more-lives-26034">better test</a>. </p>
<p>A <a href="https://ama.com.au/ausmed/cervical-cancer-screening">response</a> from Michael Gannon for the Australian Medical Association provided a large number of facts.</p>
<p>It also portrayed the petitioners as “well-intentioned […] but woefully misinformed and misguided”, but did not respond to the factors motivating the anger in many petition comments.</p>
<h2>How to handle concerns?</h2>
<p>Petitioners’ concerns <a href="https://theconversation.com/how-to-cut-through-when-talking-to-anti-vaxxers-and-anti-fluoriders-72504">should not be dismissed</a>. If the public is “misinformed and misguided” about changes to cervical screening, it is the result of a failure to effectively communicate the changes and their rationale. </p>
<p>An implementation phase was to be undertaken that included engaging with the public to assess acceptability and educating clinicians and women about the changes. No public information has been released about this phase, so it is not clear what has been done or who may have been consulted.</p>
<p>Other countries that have introduced HPV testing to their cervical screening programs have noted the importance of <a href="http://jfprhc.bmj.com/content/41/2/134">responding to women’s concerns</a> around screening changes, especially when and how they receive information about HPV. Research also
highlights some people’s <a href="http://www.amjmed.com/article/S0002-9343(04)00668-0/abstract">reluctance</a> to accept less-frequent screening.</p>
<h2>How do we communicate change?</h2>
<p>Screening programs generally change because the evidence about screening changes. It’s a good thing for screening programs to be responsive, to make adjustments when it becomes apparent harms may be occurring, or that benefits can be retained with less burden on participants and the health system. </p>
<p>Now, with the delay to the cancer screening register, there is an opportunity to take seriously the responsibilities of a screening program to communicate well with the population it serves. </p>
<p>The epidemiology that guides screening is complex, but its simple communication is a vital part of any public health program. Good communication and understanding what matters to stakeholders are as important as the scientific evidence that programs are based on. </p>
<p>In this case, a reasonable message to take from the petition opposing the renewal is that communication and consultation have not been sufficient or effective.</p>
<p>Unfortunately, this seems to have become a feature of Australian health policy. For instance, last year people were confused about <a href="https://theconversation.com/true-blood-cutting-through-confusion-about-pathology-cuts-55140">pathology rebates</a> and <a href="https://theconversation.com/confused-about-the-medicare-rebate-freeze-heres-what-you-need-to-know-59661">GP rebate freezes</a>.</p>
<p>Meaningful public engagement and communication are neither easy nor cheap, but shying away from them is not an acceptable response.</p><img src="https://counter.theconversation.com/content/73605/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally Wortley was part of the evaluation team that conducted the review of the clinical effectiveness evidence for the National Cervical Cancer Screening Renewal.</span></em></p><p class="fine-print"><em><span>Jane Williams does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The roll-out of a new screening program for cervical cancer has been delayed, leaving Australian women understandably confused about if or when they need Pap smears. Here’s what they need to know.Jane Williams, Researcher at the Centre for Values, Ethics and the Law in Medicine (VELiM), University of SydneySally Wortley, Research Fellow and PhD candidate School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/678662016-11-01T23:32:46Z2016-11-01T23:32:46ZWomen’s cancers: curable for the rich, often a death sentence for the poor<p>Every minute, a woman dies of breast cancer. Every two minutes, a woman dies of cervical cancer. Perhaps you know <a href="http://gco.iarc.fr/today/fact-sheets-cancers?cancer=29&type=0&sex=0">these statistics</a>, and perhaps these cancers have directly affected you, or someone you love. </p>
<p>Each year 2.7 million women will be diagnosed with cancers of the breast, cervix, endometrium, or ovaries, and more than a million of them will die from these cancers. </p>
<p>Did you know that most of those women live in developing countries? </p>
<p>A woman diagnosed with breast cancer in most high-income countries is <a href="http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/survival#heading-Zero3">very likely to survive</a>. The opposite is true for the hundreds of thousands of women facing the same diagnosis in poor countries. Survival should not be a fluke of geography. </p>
<p>A woman’s agency – that is, her ability to seek and receive an accurate diagnosis and care early in the course of disease – can be the difference between life and death. Pervasive myths regarding cancer as a death sentence, and the stigma that accompanies a diagnosis of breast or gynaecological cancer only make these barriers harder to overcome. </p>
<h2>Rich and poor</h2>
<p>In the case of cervical cancer, 85% of women diagnosed, and 87% of those who die are from poorer countries. Cervical cancer is almost entirely preventable via <a href="http://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html">HPV vaccination for girls</a> and cervical screening, with treatment of pre-cancererous growths. None of this requires an oncologist or high-level cancer centre. </p>
<p>These cost-effective interventions can save millions of lives, if made affordable. Many low-income countries are <a href="http://www.gavi.org/support/apply/countries-eligible-for-support/">eligible for lower-cost HPV vaccines</a> through <a href="http://www.gavi.org/library/news/press-releases/2013/hpv-price-announcement/">Gavi, the Vaccine Alliance</a>, but many women with a high risk of death from cervical cancer live in <a href="http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/abstract">countries deemed too wealthy</a> for this special access, while other countries risk losing the vaccine upon “graduation”. In other words, developing countries can effectively be disadvantaged by virtue of their economic success. </p>
<h2>Bridging the gap</h2>
<p>In a <a href="http://www.thelancet.com/series/womens-cancers">series in The Lancet medical journal</a>, we highlight the gross inequities in access to prevention, early detection, and treatment for these two common cancers. We review what type of interventions could close this divide, including HPV vaccination and screen-and-treat approaches for cervical cancer prevention. </p>
<p>For breast cancer, key interventions include improving a woman’s access to early diagnosis. Increased public awareness, timely access to diagnostic imaging and a biopsy for accurate diagnosis, and improved access to surgery can make a world of difference. </p>
<p>For the majority of women whose breast cancers are “hormone positive”, the addition of an estrogen-blocking drug such as tamoxifen (which is generic, inexpensive and widely available with low rates of serious toxicity) can greatly improve survival. </p>
<p>There are challenges in taking these interventions to scale, beyond issues of cost. For example, there continues to be <a href="http://www.hpv.org.nz/hpv-vaccine/hpv-vaccine-myth-vs-facts">widespread misinformation</a> regarding the safety as well as the effectiveness of the HPV vaccine, a problem we must urgently overcome to increase coverage globally. </p>
<p>There are pragmatic approaches that can be taken to meet these challenges. Task-sharing – for example, where a nurse receives additional training to perform a visual inspection of the cervix with acetic acid – can greatly improve access to this life-saving intervention, particularly where gynaecologists or other trained physicians are scarce. </p>
<p>Zambia has been <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122169">successful in this approach</a>, which also includes taking digital photographs of the cervix for quality assurance by a remote gynaecologist </p>
<p>Telemedicine can also help bridge the gap, for example when community health workers use smartphones to encourage women to attend the clinic if they have a suspicious breast lump. Nurses can also use smartphones for digital photos as well as data-tracking and follow-up communication between physician and patient.</p>
<h2>A question of funding</h2>
<p>There is stark lack of global funding for cancer, in spite of the fact that cancer <a href="http://www.who.int/gho/en/">kills more people</a>, in fact twice as many, than HIV/AIDS, malaria, and tuberculosis combined.</p>
<p>Breast and cervical cancer alone account for half a million more deaths – mostly of women in the prime of their lives – than the number of women who die from <a href="http://www.unfpa.org/maternal-health">complications of pregnancy or childbirth</a>.</p>
<p>Any time a woman dies in childbirth, it is a tragedy. But equally tragic is a woman who survives her pregnancy, only to succumb to breast cancer when her child is not yet five. But where is the cry for global investments? Where is the fund for women’s cancer in the developing world?</p>
<p>The case must also be made for leverage existing resources, for example by providing breast health education and cervical screening at reproductive health clinics. Women who are living with HIV are four to five times more likely to develop cervical cancer. This is why UNAIDS and the WHO <a href="http://www.unaids.org/en/resources/documents/2016/HPV-HIV-cervical-cancer">recommend</a> combining HIV services with cervical cancer education, screening and treatment, in settings where HIV prevalence is high.</p>
<p>That said, the total funding for all <a href="http://www.who.int/mediacentre/factsheets/fs355/en/">non-communicable diseases</a> is a mere fraction of what is required, and each day millions of families face catastrophic expenditures, which come from largely out-of-pocket sources. </p>
<p>A 2015 report from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539728/">eight ASEAN countries</a> found that one year after a cancer diagnosis, 48% experienced financial catastrophe, 29% of adults had died, and just 23% were alive with no financial catastrophe. </p>
<p>Investments must be made now, including direct international assistance for health, as well as increased expenditures from national governments. Countries moving towards universal health coverage must expand beyond traditional packages that focus exclusively on infectious diseases and mother-and-child health to incorporate services for breast and cervical cancer.</p>
<h2>The threat to development</h2>
<p>Women’s cancers are a major threat to development. It is imperative that we work together, across disciplines, and recognise the role of other partners, including in the UN system, academia, civil society, and the private sector in advocating for women’s health and rights. </p>
<p>Gender equality has its own goal in the United Nations’ <a href="http://www.un.org/sustainabledevelopment/development-agenda/">Sustainable Development Agenda for 2030</a>, and thus presents a critical opportunity for advocates and activists in the gender equality, sexual and reproductive health and rights, and cancer associations and communities to link forces with other women’s advocates to drive greater investment in fighting cancer. </p>
<p>The “life course” approach raised in the UN programme, <a href="http://www.everywomaneverychild.org/">Every Woman Every Child</a>, is essential to improve the health of women and girls. And caring for people throughout their life course also involves screening for, and treating, women’s cancers. </p>
<p>The good news about women’s cancers is that they are often preventable and treatable. Our greatest challenge now is to make sure that is the case for all women, not just those who are lucky enough to be born in the wealthiest parts of the world. </p>
<p><em>This article was co-authored by Rengaswamy Sankaranarayanan from the International Agency for Research on Cancer. He receives funding from the Bill and Melinda Gates Foundation; the US National Cancer Institute and the Association for International Cancer Research.</em></p><img src="https://counter.theconversation.com/content/67866/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ophira Ginsburg receives funding from Grand Challenges Canada.</span></em></p><p class="fine-print"><em><span>Lynette Denny has received funding from Glaxosmith Kilne, Merck and Roche</span></em></p><p class="fine-print"><em><span>Lesong Conteh and Richard Sullivan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Of women who die from cervical cancer, 87% live in poor countries.Ophira Ginsburg, Associate Professor, Women’s College Hospital and Research Institute, University of TorontoLesong Conteh, Senior Lecturer in Health Economics, Imperial College LondonLynette Denny, Chair and Professor of Obstetrics & Gynaecology, University of Cape TownRichard Sullivan, Director, Institute of Cancer Policy, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/260342014-04-29T05:57:51Z2014-04-29T05:57:51ZRecommended cervical screening regime will save even more lives<figure><img src="https://images.theconversation.com/files/47226/original/38nfgngf-1398740182.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The HPV vaccination program has had a profound impact on lowering the risk of cervical cancer in young women and suggested changes complement it.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/free-stock/6882423442">Emilian Robert Vicol/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Australian women may soon have fewer of those uncomfortable visits to the doctor for cervical cancer screening.</p>
<p>After an extensive evidence review, the Medical Services Advisory Committee <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/ncsp-renewal#Medical-Services-Advisory-Committee-recommendations">has recommended</a> the Australian government replace two-yearly cytology (Pap) screening with five-yearly testing for the human papillomavirus (HPV). </p>
<p>The committee, which is comprised of independent experts, has also recommended screening start at age 25 rather than the current 18 to 20 years. It has recommended that women continue to screen until their early 70s, when they can stop if their exit test is clear. Women with certain symptoms, including pain or bleeding, should have a test whatever their age. </p>
<p>Many women find the experience of cervical cancer screening embarrassing and difficult so they’ll welcome the proposed changes, which would mean the number of tests they undergo drops from 26 to around ten. </p>
<h2>A better test</h2>
<p>Although the screening visit to the doctor will remain a similar experience for women, the testing performed on the cervical sample in the laboratory will be fundamentally different. </p>
<p>The Pap smear involves inspecting a sample of cells under a microscope and relies on precancerous changes being visible. This is why the test has to be done comparatively frequently to be effective.</p>
<p>By contrast, HPV testing detects the presence of viral DNA at the molecular level. HPV is the fundamental, necessary cause of cervical cancer. It’s a very common virus that’s usually transmitted through sexual contact. </p>
<p>Women who test negative for HPV have very low risk over the next five years of developing the high-grade cervical abnormalities that may lead to cervical cancer. </p>
<p>The risk of developing the most serious grade of precancerous lesion or cancer (known as CIN3+) five years after a negative HPV test has actually been shown to be <a href="http://www.bmj.com/content/337/bmj.a1754">lower than the risk two years after a negative Pap smear</a>. </p>
<p>A recent <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62218-7/abstract">analysis of data on over 175,000 women</a> also found HPV screening provides substantially greater protection than Pap tests against the development of invasive cervical cancer. </p>
<p>This accumulation of evidence about the safety and efficacy of HPV testing underpins <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm394773.htm">last week’s FDA approval</a> of HPV testing as a primary screening test in the United States.</p>
<h2>Tailored responses</h2>
<p>If the new recommendations are implemented, only those found to be HPV-negative will be followed up at five-yearly intervals. Samples from women found to have an HPV infection during a screening test will undergo further testing and, if required, they will have more intensive evaluation and follow-up. </p>
<p>Of course, women with a history of cervical abnormalities will continue to have management tailored to their circumstances. </p>
<p>Although the presence of an HPV infection indicates the need for more intensive surveillance, it’s also important to understand the majority of these infections take many years to develop into cervical cancer, and many regress naturally.</p>
<p>Most other countries start screening at age 25 or even later, and a large body of evidence to support this recommendation has emerged since the National Cervical Screening Program was originally introduced. </p>
<p>This evidence shows cervical screening is much less effective in women under the age of 25 years and that HPV infection and cervical abnormalities in this age group tend to be transient and naturally regress. </p>
<p>The HPV vaccine has also had a profound impact on lowering the risk of cervical cancer in young women, and this is a key safety aspect underpinning the increased age for starting screening.</p>
<p>The vaccine protects against infections with two types of HPV that cause about 70% of cervical cancers. Australia started a National HPV Vaccination Program in 2007 and this early implementation, coupled with comparatively high coverage rates (<a href="https://www.mja.com.au/journal/2013/199/9/human-papillomavirus-vaccine-coverage-among-female-australian-adolescents-success?0=ip_login_no_cache%3Da0038b255e8dace74910a842357d056d">about 73% in 12 to 13-year-old girls</a>) and the wide vaccination catch-up age range (women up to 26 years old were offered free vaccination until 2009), means this is the first country where the impact of vaccination has been observed.</p>
<h2>A world-class approach</h2>
<p>For the recommendations to be implemented, the government would have to endorse them before starting the roll-out, which wouldn’t happen until 2016 at the earliest. </p>
<p>In the meantime, a major new clinical trial being conducted in Victoria, known as <a href="http://www.compasstrial.org.au">Compass</a>, will provide a sentinel experience of the roll-out of primary HPV screening in Australia. Unless they are participating in Compass, sexually active women aged 18 to 69 years should continue to have regular Pap smears every two years according to the current recommendations, whether vaccinated or not.</p>
<p>Australia’s National Cervical Screening Program has been a major success story, with reductions of 50% in both cervical cancer incidence and mortality since the Pap smear-based program was introduced over 20 years ago. </p>
<p>The new screening approach is expected to reduce cervical cancer rates even further. The evaluation supporting the recommendations predicts a 15% or more drop in cervical cancer incidence and mortality if the changes are implemented. </p>
<p>This means that of the 750 or more Australian women currently diagnosed with cervical cancer each year, up to 100 or more will be now be spared, and up to 30 more lives will be saved every year.</p>
<p>If these changes are implemented, Australia will be able to complement its world-first HPV vaccination program with a world-leading cervical screening program that’s based on direct detection of the virus that plays such a critical role in cervical cancer.</p><img src="https://counter.theconversation.com/content/26034/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Canfell is primarily funded via NHMRC and other competitive grants and government consulting projects. However, she is a co-primary investigator of an investigator-initiated trial of primary HPV screening in Australia (Compass), discussed in this article, which has received a funding contribution from Roche Molecular Diagnostics, USA.
Her group performed the economic evaluation for the current national review of the National Cervical Screening Program in Australia, which is discussed in this article.</span></em></p>Australian women may soon have fewer of those uncomfortable visits to the doctor for cervical cancer screening. After an extensive evidence review, the Medical Services Advisory Committee has recommended…Karen Canfell, Associate Professor, Senior Research Fellow and Group Leader - Cancer Modelling Group, Lowy Cancer Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.