Cervical pap smear presentation
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The document discusses upcoming changes to Australia's National Cervical Screening Program in 2017. Key changes include replacing the pap smear with an HPV test, increasing the screening interval from 2 to 5 years, starting screening at age 25 instead of 18-20, and using self-collection methods to improve participation. The goal is to further reduce cervical cancer rates through a safer, more effective, and cost-efficient screening approach enabled by new technologies and knowledge about HPV. Clinicians will receive a single report with HPV status and reflex cytology results.
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Cervical pap smear presentation
- 1. New Changes To Cervical Screening Program 2017 Dr DONALD ANGSTETRA Bsc(Med) | MBBS | FRANZCOG Obstetrician & Gynaecologist Advanced Gynaecological Laparoscopic Surgeon | Gold Coast University Hospital Visiting Medical Officer | Gold Coast Private Hospital Senior Lecturer | Griffith University
- 2. About me…
- 3. ∗ National Cervical Screening Program ∗ Introduced 1991 ∗ 2-yearly pap smear test ∗ Asymptomatic women who have been sexually active ∗ Age 18-69yo CURRENT Cervical Screening in Australia
- 4. Cervical Cancer in Australia ∗ Cervical cancer − last 20 years ∗ 1991-2002 − Incidence & mortality rates ↓~50% ∗ > 2002 − Rates have plateau ∗ Incidence of Cervical ca 9/100,000 ∗ Mortality rate 2/100,000 Pre-NCSP National Screening program Introduced in 1991 National Screening program Introduced in 1991
- 5. Cervical Cancer in Australia Pre-NCSP
- 6. So why change?? ∗ New Knowledge of HPV infection and Cervical Ca ∗ New technologies ∗ HPV DNA typing ∗ Liquid Based Cytology (LBC) ∗ Computer Assisted Image Analysis ∗ The National HPV Vaccination Program − Prevalence of HPV in community ∗ 2007 – Girls (12-13 year old) ∗ 2013 – Boys ∗ New Evidence - appropriate screening age ranges and ‘optimal’ intervals
- 7. Proposed New Cerical Screening Program ∗ Replace “Pap Smear” with HPV DNA test ∗ Genotyping HPV16, 18 +/- 45 ∗ IF +ve HPV DNA test will undergo further triaging -> Reflex liquid based cytology ∗ Entry age of 25; Exit HPV test at age 70-74 ∗ vaccinated and unvaccinated women ∗ Increases screening interval from 2yrs 5yrs ∗ HPV Self-Collection ∗ “Never screened” & “Under-Screened” population ∗ Registry – Invitation, Call & Recall
- 8. Patient Participation Will 5yr interval increase OR decrease participation? 2008-2012 Patient participation (age 20-69) 2yr interval – 57.7% 3yr interval – 70.2% 5yr interval – 83.3%
- 9. Proposed NCSP Algorithm ∗ Safe ∗ More effective ∗ Aim to ↓ further Cervical ca by additional 15% ∗ More cost-effective
- 11. What does this mean for the Clinician? ∗ Collect sample from cervix ∗ If HPV +ve Reflex cytology ∗ Clinician will receive a report with ∗ HPV status (+/- genotype) ∗ Cytology (if HPV +ve) ∗ Single recommendation
- 12. HPV and Cervical Cancer ∗ Double stranded DNA virus ∗ 100 different genotypes ∗ HPV infection is necessary, though not sufficient, for development Cervical ca ∗ HPV 16 & 18 ~70% of all Cervical ca ∗ 80% lifetime risk of acquiring HPV ∗ Majority infections are cleared within 2yrs
- 13. HPV and Cervical Cancer ∗ Cervical Ca - rare outcome of infection ∗ Natural progression of High Grade abnormalities over 1-25 years Common Diagnosis of HSIL 25-29 yo; Cervical Ca 44-49 yo CIN2 CIN3 Regression 43% 32% Persistence 35% 56% Progression 5% >12%
- 14. HPV DNA Testing ∗ Currently use HPV DNA testing ∗ NOT a diagnostic tool ∗ “Test of cure” for post treated High Grade lesion ∗ Can be requested any times, But NO Medicare rebate ($80-$100)
- 15. ∗ Order of TEST is IMPORTANT ∗ Applying More sensitive test first (HPV DNA) ∗ Negative Predictive Value (NPV of >99%) ∗ Reduce number of False Negatives ∗ Applying More specific test second (LBC) ∗ Good Positive Predictive Value ∗ Reduce number of False Positives ∗ ↓↓ unnecessary referral and follow-up WHY Combined HPV DNA Test + Reflex LBC?
- 16. Incidence of Cervical Cancer in <25yo ~2.3/100,000 (rare) NO effect on incidence of Cervical Ca Increased risk of future pregnancy HPV vaccination
- 17. HPV Vaccination & Abnormal Cervical Screening 2006 vs 2011: Decline high grade in <20 & 20-24
- 18. HPV Vaccination Program & Genital Warts women men
- 19. Improving Participation – SELF COLLECTION ∗ 20% did not participate in screening ∗ Victorian Cervical Cytology Register ∗ In 2009, 80% invasive Ca had never been screened OR lapsed screeners ∗ ATSI ∗ 2x incidence of Cervical Ca ∗ 4x mortality rate in comparison to non-indigenous ∗ Self-Collection ↑participation rates
- 20. A Paradigm Shift? Changing Perspective ∗ By using HPV DNA as primary diagnostic tool ∗ Disease no longer cytological / histological diagnosis ∗ BUT ∗ Sexually Transmitted Infection ∗ Altered patient perception -> stigma?
- 21. TAKE HOME MESSAGE ∗ Procedure for collecting sample remains the same ∗ 5-year screening ONLY applies to women with negative results ∗ Women with HPV +ve will require further investigation and closer monitoring ∗ SYMPTOMATIC women (post coital bleeding, intermenstrual bleeding) need investigation ∗ The ‘NEW’ NCSP applies only to asymptomatic women ∗ HPV vaccinated women will still require screening