An extract from an article by Dr Elina Safro, Chair of the Education Subcommittee of the Australasian Menopause Society, to inform GP’s.
National Cervical Screening Program (NCSP) has paved the way for Australia to become the first country in the world to eliminate cervical cancer within the next decade or two (1). However, the ongoing engagement in the program remains low, with only 56% of eligible participants between the ages of 25-74 screening as frequently as recommended. This means that almost 44% of eligible Australian women have either never screened or are lapsed screeners (2).
To improve participation in the NCSP, from July 1 2022 self-collection of vaginal samples has been introduced as an option for all eligible women, along with the clinician-collected option using a speculum to visualize the cervix. Self-collection could help to overcome common barriers to participation, boosting the engagement with the recommended 5-yearly screening for low-risk Cervical Screening Test (CST) results. The self-collected CST has been shown to be no less accurate than clinician-collected sampling in detecting oncogenic HPV [Human Papillomavirus] when using PCR testing (3).
The universal self-collection option can be a game-changer for menopausal women. For this group, common barriers to screening include fear of discomfort with the use of speculum due to vaginal dryness; hip and spine joint pain making genital examination challenging; and fear of embarrassment frequently associated with intimate examination.
Women choosing the self-collection option should be advised that, in some cases, they will need to return for a clinician-collected sample involving speculum examination to visualize the transformation zone. Routine inspection of vulva and vagina during cervical screening is not recommended, unless concerning symptoms are present including pain, bleeding, itching or PV discharge. All women aged 25-74 are eligible for self-collection, including those with total hysterectomy with no record of cervical pathology and an unknown cervical screening history.
The following presentations are not eligible for self-collection:
Practical points for self-collected CST samples:
Importantly, the recommendations for the following groups are different due to their higher risk of cervical cancer; they should be referred for colposcopy [detailed examination of the cervix by a specialist, requiring a speculum] if HPV (any type) is detected at 12 months as they may be at higher risk of a high-grade abnormality:
[For more information about how to arrange and conduct self-collected cervical screening tests, check out this excellent resource from the Cancer Council Victoria, or this from the Federal Government’s Department of Health and Aged Care]
Source content created July 2022
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