Australian Government Department of Health
National Cervical Screening Program
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NHMRC Cervical Guidelines

The latest guidelines from the National Health and Medical Research Council on the management of women without symptoms who have screen detected cervical abnormalities.

The NHMRC Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities

In June 2005 the National Health and Medical Research Council (NHMRC) approved the Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities. These guidelines replace the 1994 guidelines, which have been rescinded.

The 2005 guidelines were formulated in line with NHMRC standards for clinical practice guidelines to assist women and health professionals to achieve the best outcomes in the management of abnormal Pap test results. The guidelines are based on epidemiological and scientific evidence and a new understanding of the role of HPV in cervical cancer.

The guidelines address the:
  • current state of cervical cancer in Australia;
  • natural history of cervical cancer;
  • revised terminology for cervical cytology;
  • management of squamous abnormalities, glandular abnormalities and special clinical circumstances; and
  • psychosocial, economic and implementation issues.
Implementation of the guidelines occured from 3 July 2006. At that time the Australian Modified Bethesda System 2004 (AMBS 2004) was introduced to replace the pathology reporting system that was in use. The length of the implementation period allowed for a smooth transition to the new terminology and practices.

A national steering group was established to guide the process and provide input from professional bodies and consumers. The steering group oversaw the development of resources including materials for consumers and health professionals. These products have been widely available since July 2006.

A Safety Monitoring Committee has been convened to monitor the safety of the guidelines, with particular reference to treated high-grade intraepithelial disease and low-grade squamous intraepithelial disease. The Safety Monitoring Committee reports to the Screening Subcommittee of the Australian Population Health Development Principal Committee and will alert it should any concerns about the guidelines arise.

Since the endorsement of the new guidelines, states, territories and the Australian government have been working to standardise data collections in the eight cervical screening registers across Australia. This has included drafting a national coding sheet for pathology laboratories reporting cervical cytology, standardisation of follow-up and reminder protocols across jurisdictions, and the development of a common data dictionary.

For further information on the guidelines:

Safety Monitoring Committee

The Safety Monitoring Committee meets regularly to review information collected by the cervical cytology registers on cervical abnormalities and cervical cancer. A comparison between information collected before the new guidelines were in place (pre-2005) and information collected after the guidelines were in place (post-2006) is being undertaken.

The Safety Monitoring Committee will notify the Department of Health immediately based on pre-determined criteria if the information collected indicates the new guidelines are not considered to be safe.

Analyses conducted up to 30 June 2011 have not raised any safety concerns about the guidelines. Data will continue to be collected over the coming years.

More information on the Safety Monitoring Committee and the methodology for assessing the safety of the guidelines.
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Rural Health Education Foundation Satellite Broadcast

The NHMRC Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities include a number of recommendations which will require health practitioners to change the way they manage women who are found to have a low-grade abnormality on their Pap smear. To assist in the implementation of the Guidelines the Australian Government contracted the Rural Health Education Foundation to undertake a rural health satellite broadcast to provide rural and remote health practitioners with practical advice on how best to manage the required change of practice.

The broadcast took place on 14 March 2006 and focused on the changes to clinical management outlined in the Guidelines. An expert panel discussed these changes within the context of general practice, using case studies to highlight the management of women with diverse screen detected abnormalities. The panel was chaired by Dr Norman Swan and included Professor Ian Hammond (Director of Gynaecology, King Edward Memorial Hospital for Women, WA), Dr Stella Heley (Sexual Health Physician, Victorian Cytology Service, Melbourne), Dr Marion Saville (Pathologist, Victorian Cytology Service) and Dr Jenny May (Rural General Practitioner).

The objectives of the Program are that viewers will understand:
  • revised management recommendations for women presenting with various abnormalities;
  • the new terminology for cervical cytology reporting in Australia;
  • the recommended rigorous safety monitoring and referral pathways; and
  • the need for monitoring, supportive care and followup for affected patients.
Further information on the satellite broadcast, view the broadcast and webcast

To order a copy of the broadcast 'Cervical Cancer Screening is Changing: What You Need to Know' on DVD, please use the online order form.
The DVD version contains navigational aids, facilitator’s notes and an embedded copy of the NHMRC Screening to prevent cervical cancer: guidelines for the management of asymptomatic women with screen detected abnormalities.

Page currency, Latest update: 03 November, 2012