Elimination of deadly disease ‘on track’

Matt Woodley

11/07/2019 4:04:32 PM

Australia is well placed to eliminate cervical cancer by 2035, but GPs can still do more, a women’s health expert has said.

Women are avoiding cervical screening tests
GPs need to be comfortable in providing the test, or if not, able to provide a referral to a clinic or service that is.

The claim was made in response to new Australian Cervical Cancer Foundation (ACCF) research, which highlights barriers preventing women from accessing cervical screening tests (CSTs).
According to the ACCF, more than a quarter of Australian women are reluctant to make appointments due to embarrassment, while one third delay getting the test ‘because it’s awkward’.
Additionally, only 34% of women know the test screens for human papillomavirus (HPV), while the majority are not aware that the CST has moved to a five-yearly cycle.
Despite these findings, ACCF has launched a cerFIX2035 campaign aimed at helping Australia become the first country in the world to eradicate cervical cancer by 2035.
The campaign will focus on educating women about cervical health, but women’s health GP Dr Wendy Pakes believes some clinicians involved in cervical screenings may also need upskilling.
Dr Pakes told newsGP while Australia is ‘very much on track’ to eliminating cervical cancer, there is still room for improvement.
‘GPs have to be able to explain the test adequately, and they have to have their practice records up to date so that women are recalled at the appropriate time. Some may need to upskill so they’re providing an experience that is appropriate and doesn’t discourage women from coming back,’ she said.
‘My concern is that some GPs may not suggest cervical screening because they don’t feel confident due to insufficient opportunity to develop appropriate experience.’
It’s estimated 951 females will contract cervical cancer in 2019 – equivalent to 1.4% of all new female cancer cases – with 256 proving fatal.
Yet despite efforts to educate GPs on how to provide a comfortable environment and encourage women to engage in cervical screening, Dr Pakes said she has heard anecdotal stories of testing that have left women ‘horrified’ and reluctant to return.
‘They’re left on couches with no cover and the doctor will perhaps be answering queries or opening the door. Providing appropriate privacy is really important and needs to be ensured,’ she said.
‘The patient should have a curtained area, she should be provided with cover, the door should be locked so people can’t come in and the doctor should not be interrupted unless there’s an absolute emergency.’
It’s also important, according to Dr Pakes, for the GP to be comfortable in providing the test. If not, they should be able to provide a referral to a clinic or service that is.

If this happens, it is vital for the clinician to ensure that the patient is followed up.
Additionally, women may sense if the clinician is unconfident or inexperienced, which may result in them being  tenser and the examination more uncomfortable.

Dr Pakes says there are many opportunities to attend training courses to upskill if necessary, while the introduction of the HPV self-collection option, for women who are unable to tolerate a speculum examination for any reason, may help improve participation for patients who fulfil the strict eligibility requirements.

Outside of the CST itself, Dr Pakes says it is vital that patients know what they are being tested for, how they will receive the results, and what the results mean.
‘From my experience, the nuances of what it means for the patient if they’re HPV negative or positive are not always explained as well as they could be,’ she said.
‘Some women are distressed if they receive an HPV-positive result, considering it similar to chlamydia or herpes.
‘It needs to be culturally normalised – if you have sex you can get HPV.’
In order to increase CST participation rates to more than 70% – the threshold identified by ACCF as necessary to help eliminate the disease – Dr Pakes believes some areas of record keeping needs to improve.
Clinical audits are useful for easily identifying patients who are overdue, but are only possible if data are entered into the practice’s medical software in an appropriate manner. It is also important that every effort needs to be made to deliver any abnormal results and arrange appropriate follow up for patients.
‘All of the medical software has a cervical screening results tab, yet some GPs do not put the cervical screening results in the specific tab,’ she said.
‘If it’s not in there, then the data extraction tools cannot determine which patients are under-screened, and there’s no way of knowing other than ad hoc “are you up to date with your screening test?” questions during appointments.
‘Sometimes women don’t return for whatever reason, but it’s a GP’s legal and moral obligation to make every effort to follow them up.’
More information on cervical cancer, HPV and the cervical screening test can be found in the RACGP’s Guidelines for preventive activities in general practice.

cervical cancer cervical screening test HPV human papillomavirus women's health

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Dr Shelly   12/07/2019 9:59:24 AM

If a non-partnered patient is in her 60s, has been celibate for 20+ years, had regular Pap tests and now the latest 5-yearly CST, all with NEGATIVE results, why continue screening?

This starts to look like over-servicing to patients who are at very low, or dare I say, no risk. And can lead to a lack of trust in her GP.

Dr Mary-Jane   12/07/2019 8:27:38 PM

Dear Dr Shelly-continued screening until a normal exit screen between 70-75 is important.One of the main at risk age groups are older women who are under screened.HPV does not usually reflect recent sexual activity and new infection but a reactivation-So please keep screening these women.A good reference is the wikicancer cervical screening guidelines

EEB   22/07/2019 12:37:58 AM

A reactivation?
In the Netherlands, women who test HPV- and are no longer sexually active or confidently monogamous might choose to stop all further testing.
I doubt that would be the case if HPV could reactivate...
Our program is still excessive, the Dutch offer 5 HPV tests or self testing at ages 30, 35.40,50 and 60 (The Dutch and Finns have never tested before 30, it doesn't help but leads to lots of potentially damaging over-treatment)
Not sure why our programs ignore some of the evidence and side with excess, it certainly doesn't benefit women.
Of course, all cancer screening is nothing more than an option, informed consent is a must, some women may choose not to screen, that's their absolute right, it should be respected, not trigger debate, judgment or pressure.
I think women have been treated fairly poorly by cancer screening programs in this country - very little real information, no respect for choice or informed consent & excessive and non-evidence based screening.