Information for Health Professionals
- Your role in screening
- Taking a Pap smear
- Communicating with the pathologist
- Benefits and limitations of cervical screening
- Test of cure - post treatment of high-grade abnormalities
- Colposcopy Quality Improvement Program
Your role in screening
How can I help to increase the number of women who screen regularly?Regular Pap smears can help prevent up to 90 per cent of the most common type of cervical cancer.
The majority of Australian women consult a general practitioner at least once a year, which means general practitioners play a crucial role in encouraging women to screen regularly.
As general practitioners take around 80% of all Pap smears, they are also in a key position to help women understand that cervical cancer is preventable.
Even if a woman is embarrassed about having a Pap smear, research has shown that most will accept their general practitioner's advice about having one.
Why do some women not have regular Pap smears?There are many reasons why some women do not have regular Pap smears. Some of these reasons are outlined below along with suggestions for how to help women overcome their reluctance.
Common reasons women give for not having a Pap smear include:
- forgetting when their next Pap smear is due
Talk to women about the cervical screening register and/or your own practice's reminder system, if one is in place.
- embarrassment, anxiety or fear about the procedure
Ask them what would make them feel more comfortable about having a Pap smear.
- lack of knowledge about the benefits of regular Pap smears
Explain that Pap smears are not a test for cancer, they are a test to help prevent cervical cancer. Pap smears are the best way for a woman to reduce her risk of developing cervical cancer.
- some women are reluctant to have a Pap smear taken by a general practitioner they know well
Suggest an alternative practitioner or provide information on a local health service, family planning or sexual health clinic or Aboriginal Medical Service.
- expectation that the general practitioner will suggest a Pap smear if one is necessary, and that if the doctor doesn't, then the test is not important.
Even if a woman is embarrassed about having a Pap smear, research has shown that most women will accept their general practitioner's advice about having one. Some women rely on their general practitioner to raise the issue.
When should women commence cervical screening?The National Cervical Screening Program recommends that all women who have ever been sexually active should start having Pap smears between the ages of 18 and 20 years, or one or two years after first having sexual intercourse, whichever is later.
Routine screening is not required for women under 18 years of age even if they are sexually active. There is no evidence to support encouraging women under 18 years of age to have a Pap smear.
The decision to screen a woman below the age of 18 years is at the discretion of the clinician and would depend on the individual circumstances of the patient. In making this decision the potential harms of screening and early treatment (such as overtreatment of lesions with little invasive potential) should be considered alongside the potential benefits.
Women of any age who have symptoms should have appropriate clinical assessment.
It is important to discuss cervical screening with young women and advise them of the most appropriate time to commence Pap smears.
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Which groups of women are screening less often than recommended?
Older womenIt is important for older women to continue cervical screening. About half of the new cases of cervical cancer diagnosed each year are in women over 50 years of age. Regular screening enables cervical cancers and their pre-cursor lesions to be detected early when treatment is more likely to be successful.
Women under 30Women under 30 participate at a lower rate than other women. Young women may feel that they are unlikely to get cervical cancer as the rate of cervical cancer has decreased significantly since the introduction of the program. Many women who are diagnosed with cervical cancer have never received a Pap smear.
Women who have received the HPV vaccine may think they no longer need Pap smears. It is important for these women to continue cervical screening as the HPV vaccine does not protect against all strains of HPV that cause cervical cancer.
Aboriginal and Torres Strait Islander womenResearch shows that the rate of Aboriginal and Torres Strait Islander women who die from cervical cancer is much higher than that of non-Indigenous women. Some strategies to support Aboriginal and Torres Strait Islander women to participate in screening include:
- being aware of language barriers and addressing these (for instance, using an interpreter);
- acknowledging specific cultural beliefs and the belief in privacy (women’s business);
- acknowledging shame, fear and embarrassment;
- ensuring the practice is culturally safe and culturally effective;
- seeking a female colleague to perform the Pap smear; and
- arranging for an Aboriginal health worker to accompany the woman if she would find this helpful.
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What is the Practice Incentive Program (PIP)?The Practice Incentives Program (PIP) provides a range of incentives to support general practices improve the quality of care provided to patients. Practices must be accredited or registered for accreditation against the Royal Australian College of General Practitioners Standards for General Practices to participate in the PIP.
The PIP Cervical Screening Incentive offers financial incentives to encourage general practitioners to take cervical smears from unscreened and underscreened women aged between 20 and 69 years. Underscreened women are those who have not received a cervical smear for four years or more. The Initiative also rewards general practices that reach an overall practice screening target rate.
The incentive has three components: a Sign-on Payment, a Service Incentive Payment (SIP) and an Outcomes Payment.
Sign-on PaymentPIP practices receive a one-off sign-on payment when they join the incentive.
Service Incentive Payment (SIP)A SIP for cervical screening is paid when a GP screens a woman aged between 20 and 69 years who has not had a cervical smear in the last four years. The SIP is available in addition to a consultation fee.
Outcomes PaymentThe outcomes payment rewards practices that adopt a systematic approach to cervical screening. Practices participating in the Cervical Screening Incentive that reach the target screening rate will automatically receive an outcomes payment.
Application forms and further information can be obtained from the PIP Information Line 1800 222 032
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What is the current participation rate?Recent data (Cervical screening in Australia 2007-2008 Data Report, May 2010) shows that the participation rate in cervical screening for women in the target age group was 61.2%.
What is the mortality rate from cervical cancer?The lifetime probability to age 75 years of a woman in Australia developing cervical cancer is one in 197. In 2007, 208 women died from the disease.
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Taking a Pap smearThere are two important components in ensuring accurate Pap smear reports - good smear taking technique and rigorous cytological examination.
An optimal Pap smear sample contains:
- sufficient mature and metaplastic squamous cells to indicate adequate sampling from the transformation zone; and
- sufficient endocervical cells to indicate that the upper limit of the transformation zone was sampled, and to provide a sample for screening for adenocarcinoma and its precursors.
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Communicating with the pathologistGood communication with the pathologist is essential. Pap smears cannot be read in isolation, but must be read in the presence of details about the reason for the Pap smear and clinical history especially symptoms such as bleeding.
Providing such details on the request form ensures the most accurate result possible is obtained.
Cytology items covering Pap and vaginal vault smears were revised in 1991 in conjunction with the development of the national policy. Smears need to be designated on the cytology form as one of the following:
- 73053 - a routine screening Pap smear taken at the usual two year interval on asymptomatic women;
- 73055 - a Pap smear taken as part of the investigation or management of women with symptoms or history of cervical pathology; or
- 73057 - a vaginal vault smear.
Benefits & limitations of cervical screeningThere is convincing evidence that a systematic approach to screening provides better protection against cervical cancer than purely opportunistic screening.
Although the Pap smear is not a perfect test there is currently no better way for preventing the development of cervical cancer.
Health professionals can increase women's confidence in cervical screening by helping them to understand:
- both the benefits and the limitations of the Pap smear;
- the importance of regular screening every two years, where no abnormality has been previously detected;
- the natural history of cervical cancer, HPV and abnormalities;
- all treatment options, if they have an abnormality;
- that any symptoms, such as bleeding, discharge or pain between Pap smears may require investigation even if the previous result was normal.
Test of cure – Management of women previously treated for high-grade abnormalitiesThe NHMRC guidelines recommend that a woman who has had treatment for a biopsy confirmed high-grade cervical abnormality should:
- have colposcopy and cervical cytology at 4-6 months after treatment;
- have cervical cytology and high risk HPV DNA testing at 12 months after treatment and then annually until she has tested negative by both tests on two consecutive occasions;
- then return to the usual two yearly screening interval.
Women who test negative for high risk HPV subtypes following treatment for high-grade abnormalities have a very low risk of further high-grade cervical abnormalities.
Please refer to the NHMRC Guidelines for more information.
Colposcopy Quality Improvement Program - certification opportunity for medical practitioners who perform colposcopies.Colposcopy Quality Improvement Program – certification opportunity for medical practitioners who perform colposcopies. The Colposcopy Quality Improvement Program (C-QUIP) is a Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) initiative, which aims to improve the care of women who are referred for colposcopy and treatment of screen detected abnormalities.
The C-QUIP would like to offer all medical practitioners in Australia and New Zealand who are currently practicing colposcopy the opportunity to be certified in this field.
Why be certified?Certification through this process will provide you with an opportunity to reflect on your practice and implement strategies for improvement if required.
ApplicationsTo complete the application process, please access the forms available from the C-QUIP website:
Applications will be accepted until 31 December 2011 via email, fax or post to:
Miss Jordan Chrisp
Phone: 03 9412 2978
Fax: 03 9417 7795
Mail: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG),
College House, 254-260 Albert Street,
East Melbourne, VIC 3002, Australia
Further informationFor more information, please see this information sheet (PDF 329 KB) provided by RANZCOG and visit the C QUIP website.
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Page currency, Latest update: 15 June, 2011