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Paul Hayes

18 Dec 2017
News

Cervical screening not recommended for women under 25

Paul Hayes

18/12/2017 12:26:47 PM

The Department of Health wants to reiterate that cervical screening is not recommended for women aged younger than 25 as part of the renewed National Cervical Screening Program, Australia’s Chief Medical Officer Professor Brendan Murphy told newsGP.

Chief Medical Officer Professor Brendan Murphy has praised GPs’ overall uptake of the renewed National Cervical Screening Program.
Chief Medical Officer Professor Brendan Murphy has praised GPs’ overall uptake of the renewed National Cervical Screening Program.

The Department of Health has reported that pathology laboratories around Australia have received a number of samples from women aged 24 or younger. Under the renewed National Cervical Screening Program, Pap smears have been replaced with five-yearly primary human papillomavirus (HPV) screening tests from age 25 (for sexually active women).
 
While some women may present to their GP with an expectation for screening, having had previous Pap smears, asymptomatic patients do not need to be screened.
 
‘The evidence is very strong that with the new human papillomavirus [HPV] testing there is no benefit in screening anyone under 25 in a routine sense,’ Professor Murphy told newsGP.
 
‘We want to get that message out there: you need to find out how old the woman is – even if they’ve had a previous Pap smear they may not be old enough to have one of the new HPV tests – and there is no risk to them waiting until they are 25. All the scientific data proves that.’
 
While there is no clinical risk in performing the screening, it does create unnecessary work and/or financial factors once samples are sent to a laboratory.
 
‘What the pathology lab usually does is ring the GP or the person who’s ordered the test and say, “You realise it’s ineligible?”, and they just throw it away, which is a waste. Or if they do go ahead with it then the woman gets a bill, which nobody wants,’ Professor Murphy said.
 
According to Professor Murphy, the number of unnecessary tests has been small and, overall, GPs should be praised for their uptake of the new program.
 
‘The vast majority of GPs are sending the new test in, and we are very grateful for the take-up and the seamless transition,’ he said. ‘It’s only a very small proportion of the tests that are coming from the ineligible age group, but we don’t want any woman or GP to do something that’s a waste of time.’
 
GPs can visit RACGP.TV to view Changes to cervical screening, a video resource presented by Dr Lara Roeske and Dr Stella Heley designed to support GPs and their practice teams in the transition to the new guidelines. In addition, resources supporting the renewed National Cervical Screening Program are available at VCS Pathology.

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newsGP weekly poll How often do you feel pressure from patients to prescribe antibiotics that are not clinically necessary?
 
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Valerie Heard   19/12/2017 11:02:20 AM

So a 24 year old G2P2 doesn’t get a cervical screening test ?

Michele Jacobs   20/12/2017 9:14:44 AM

Does the Health Dept guarantee that no cases of cervical Cancer will occur in the under 25 age group? Or is it just not cost effective to screen them?
If a woman under 25 is happy to pay the cost of the HPV and or LBC, I don't see how this can adversely affect anyone.
In the UK there have been cases of cervical cancer under 25. Why would Australia differ?

Kristina Kin   3/01/2018 6:46:54 PM

In the age of girls as young as 12 having intercourse with multiple partners, I do not understand this new screening program. It seems to be rather focusing on the costs than patient safety.
It might be cancelled once there will be more and more cases of missed cervical cancer under 25.

EEB   30/03/2018 1:57:28 PM

Long standing research shows cervical screening is ineffective up to age 30, that's why the Dutch and Finns have never tested before age 30, and tested no more than 5 yearly, as a result, they have sound results with MUCH lower false positive/excess biopsy/over-treatment rates.

Sadly, the deaths that occur before age 30 are usually from adenocarcinomas and the Pap test usually misses this even rarer type of cervical cancer. The Pap test was devised to detect/prevent squamous cell carcinoma of the cervix. so these rare and very early cases will continue whether you screen or not.
Research shows over and over that HPV testing should not be offered before age 30 so not sure why we're starting at 25. We seem to have a hard time following some of the evidence.
We've always seriously over-screened women, which provides no additional benefit (to women) but leads to lots of excess biopsies and the over-treatment of CIN.

Of course, many young women here will have had a "scare"...some of these women may even consider themselves survivors (MOST unlikely) so naturally, they'll be concerned about the safety of women waiting until they're 25.
1 in 3 Pap tests will be "abnormal" in women under 25, false positives caused by natural changes in the maturing cervix or by transient and harmless infections. I noticed so many of my young friends having "treatments" on their cervix after an early "abnormal" pap test. it prompted me to find out why, false positives thanks to early and excessive screening.

The new Dutch program is, in my opinion, the best in the world - evidence based and focused on women, all women, the few who might benefit and the vast majority who won't benefit, HPV- women.
The Dutch offer HPV testing or reliable HPV self-testing at ages 30,35,40,50 and 60 and only the roughly 5% who test HPV+ will be offered a 5 yearly Pap test, this will save more lives and just as importantly, takes most women out of pap testing and harms way. Those HPV- and no longer sexually active or confidently monogamous might choose to cease all testing.
Our new program is certainly better than the old over-screening program, but it still sides with excess and that's not good for women or scarce health resources.
Up until recently, you could obtain the Dutch invented HPV self-screener, but access appears to have been blocked, I assume to force women into the new program. This is unacceptable, there should be easy access to reliable HPV self-testing, even if women have to pay for it.
The speculum exam is intolerably painful for some women, especially older women, and can lead to bleeding, soreness, tearing, UTIs etc. We should not block access to reliable HPV self-testing.
I understand we'll offer a self-testing device to those women who decline the invasive test, I doubt it will be as good as the Dutch self-testing device - also, women won't be free to use it in the privacy of their own home, the test will need to be carried out at the GPs surgery.

Once again, this program seeks to control women and limit choices. (often better choices)
IMO, there has never been much respect for our legal right to make an informed decision about screening, to accept or decline...often there's no consent at all, women have been told for decades that it's "necessary" if they want the Pill (often denied the script if they refuse) or have been misled or pressured into testing.
Women have legal rights too, we're entitled to make up our own minds about cancer screening, so give us all the information, and access to reliable self-testing options - these program must not focus on coverage and targets, but the evidence, what's best for women, consent and informed consent.

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