20. Transition to the renewed National Cervical Screening Program

GUIDELINE UPDATES - This guideline was last updated 01/07/2022

Background

This chapter describes the management for women who participated in cervical screening before the introduction of the renewed National Cervical Screening Program (NCSP) on 1 December 2017, when the Pap test was replaced by primary screening using human papillomavirus (HPV) testing, with reflex liquid-based cytology (LBC) for women with a positive oncogenic HPV (any type) test result.

Among women attending for their first test since the renewal of the NCSP there will be women who have had a previous screen detected abnormality and who are currently undergoing investigation, treatment or follow-up for:

abnormal Pap test result
histologically confirmed high-grade squamous intraepithelial lesion (HSIL) (cervical intraepithelial neoplasia grades 2 to 3 (CIN2/3))
histologically confirmed adenocarcinoma in situ (AIS).

Women who have participated in the pre-renewal NCSP and have not had any previous abnormality, or who have returned to routine screening after a Test of Cure, are recommended to attend for their first HPV test 2 years after their most recent Pap test or at age 25, whichever is later.

Recommendations

Flowchart 20.1. Transitioning to the renewed National Cervical Screening Program

Flowchart 20.1. Transition to the renewed National Cervical Screening Program

Practice point

REC20.1: HPV test has replaced the Pap test

All Pap tests have been replaced by HPV testing.

Conventional Pap tests are no longer used.

Reflex LBC is performed on any clinician-collected sample with a positive oncogenic HPV (any type) test result.

Co-testing (HPV and LBC) should be performed only as recommended in these guidelines, in the follow-up of screen-detected abnormalities or the investigation of abnormal vaginal bleeding.

Practice point

REC20.2: HPV testing for women in follow-up after pLSIL/LSIL
Women who are in follow-up for pLSIL/LSIL cytology in the previous program (pre-renewal NCSP) should have a HPV test at their next scheduled follow-up appointment.

Women with a positive oncogenic HPV (any type) test result should be referred for colposcopic assessment. If the test sample was collected by a healthcare professional then the laboratory will undertake, reflex LBC. If the test sample was self-collected then a sample for LBC should be collected at the time of colposcopy.
If oncogenic HPV is not detected, the woman can return to 5-yearly screening.

Practice point

REC20.3: Colposcopic management of a prior screen-detected abnormality should continue
Women who have been referred for colposcopic assessment following any cytological abnormality in the pre-renewal NCSP should continue their colposcopic management according to these guidelines.

Practice point

REC20.4: Prior treatment and Test of Cure
Women who have been treated for HSIL (CIN2/3) in the pre-renewal NCSP and are undergoing, or have not yet commenced Test of Cure, should start or continue Test of Cure in accordance with these guidelines.

Women should have an annual co-test (HPV and LBC) performed at 12 months after treatment, and annually thereafter, until both tests are negative on two consecutive occasions, when they can return to routine 5-yearly screening. A co-test cannot be performed on a self-collected sample.

Practice point

REC20.5: Prior treatment for AIS
Women who have been treated for AIS in the pre-renewal NCSP, and are undergoing or have not yet commenced surveillance, should have annual co-testing (HPV and LBC) indefinitely.^† A co-test cannot be performed on a self-collected sample.

^† Until sufficient data become available that may support a policy decision that cessation of testing is appropriate.

Author(s):

Professor Deborah Bateson – Co-author
Dr Vivienne Milch – Co-author
Dr Marsali Newman – Co-author
Ms Kirsteen Fleming – Co-author
Professor Karen Canfell — Co-author
Dr Lara Roeske — Contributor
Professor Marion Saville — Co-author
Cancer Council Australia Cervical Cancer Screening Guidelines Working Party — Co-author