National cervical screening program

Changes to the National Cervical Screening Program Guidelines to support universal self-collection

Table of Contents

Foreword

Introduction

Summary of recommendations

1. Cervical cancer in Australia

2. The rationale for primary HPV screening

3. Terminology

• HPV testing terminology
• Cytology and AMBS 2004 terminology for reporting cervical cytology
• Preparation of cervical screening reports
• Colposcopy
• Histopathology
• Supplement. Sample reports

4. Unsatisfactory cervical screening results

5. Benefits, harms and cost-effectiveness of cervical screening

6. Management of oncogenic HPV test results

• Medical Services Advisory Committee recommendations for HPV testing
• Oncogenic HPV types not detected
• Oncogenic HPV types 16 and/or 18
• HPV oncogenic types not 16/18
• Self-collected vaginal samples
• Women undergoing exit testing
• Screening in women older than 75
• Discussion: Management of oncogenic HPV test results
• Flowcharts: Management of oncogenic HPV test results

7. Colposcopy

• Colposcopy terminology
• Principles of practice
• History, examination and investigation
• Colposcopy and treatment
• Colposcopy data for the National Cancer Screening Register
• Quality improvement in colposcopy
• Supplement. Colposcopy information for discussion with patient
• Supplement. Colposcopy technologies and documentation

8. Management of discordant colposcopic impression, histopathology and referral LBC prediction

• Normal colposcopic findings following LBC prediction of Negative, LSIL or HSIL
• Type 3 TZ (previously termed ‘unsatisfactory’) colposcopy following LBC prediction of Negative, LSIL or HSIL
• Discussion

9. Management of histologically confirmed low-grade squamous abnormalities

10. Management of histologically confirmed high-grade squamous abnormalities

• Diagnosis of HSIL
• Treatment of HSIL
• Test of Cure after treatment for HSIL (CIN2/3)
• Discussion

11. Management of glandular abnormalities

• Investigation of cytological glandular abnormalities
• Follow-up after excisional treatment for AIS
• Discussion

12. Screening in Aboriginal and Torres Strait Islander women

13. Screening after total hysterectomy

14. Screening in pregnancy

15. Screening in women who have experienced early sexual activity or have been victims of sexual abuse

16. Screening in immune-deficient women

17. Screening in DES-exposed women

18. Signs and symptoms of cervical cancer

• Investigation of abnormal bleeding
• Investigations of other symptoms – vaginal discharge and deep dyspareunia

19. Psychosocial care

20. Transitioning to the renewed National Cervical Screening Program

Appendices

• A. Modelled evaluation of the predicted benefits, harms and cost-effectiveness of the renewed National Cervical Screening Program (NCSP) in conjunction with these guideline recommendations
• B. Guidelines development process
• C. Clinical question list
• D. Technical report
• E. Working party members and contributors
• F. Project team contributions
• G. Conflict of interest register
• H. Safety monitoring of the Renewed cervical screening program
• I. Glossary (terms and abbreviations)
• J. Safety monitoring of renewed cervical screening program

Please see the Australian Department of Health Cancer Screening website for information about the National Cervical Screening Program (NCSP) and policies on transitioning women to the renewed NCSP.