Summary

• Almost all cervical cancer is caused by long-term infection from high-risk types of the human papillomavirus (HPV).
• HPV is a very common virus and usually it clears up by itself – like a cold or the flu.
• Sometimes it doesn’t clear up and, over time, the virus causes cells to change in the cervix, the lower part of the uterus or womb. Eventually, cancer can develop.
• Cervical screening testing helps prevent cervical cancer. by detecting signs (genetic material) of HPV.
• Sometimes, a second test called a cervical co-test is needed. This looks for possible cell changes in the cervix. It uses the same sample that has already been collected for your HPV test.

What is cervical screening?

The cervical screening test detects human papillomavirus (HPV) infection in the cervix, the lower part of the uterus or womb, and looks for cell changes that can occur as a result.  

HPV infection is very common. Most people who are sexually active will be infected by HPV at some time. It usually clears up naturally, like a cold or the flu, but sometimes the infection persists.

There are many different strains of the virus but only some strains have the potential to cause cervical cancer. These are termed high-risk strains. A long-term infection of one of the high-risk types of HPV can cause the cells in your cervix to change. Over time, if a high-risk HPV is not detected and not treated, it may cause cancer.  Almost all cervical cancer is caused by long-term infection by high-risk types of HPV.

The HPV test looks for genetic material from the virus. If your test shows that you have one of these high-risk strains of the virus, the laboratory which is testing your sample will do a further test. This is called the cervical co-test and it will be done on the same sample.

This co-test looks for cell changes in the cervix. These are cell changes (called intraepithelial neoplasia) that can cause cancer. The results of this test will decide whether you need to be monitored or further investigated for possible cervical cancer. It's important to note that the vast majority of abnormal cell changes can be treated quickly.

High-risk HPV can also cause other types of cancer including cancer of the anus, penis, throat, vagina and vulva. 

Who should have a cervical screening test?

Australia’s National Cervical Screening Program has been in place since 1991 with the aim of preventing cervical cancer through free testing. The accuracy of the HPV test means that it only needs to be done every five years after as long as you do not have any symptoms between tests.

You should have the cervical screening test if you are:

• aged between 25 and 74.
• sexually active or ever have been.
• a woman or person with a cervix.

It makes no difference if you:

• are gay, lesbian, bisexual, transgender or straight.
• have had the HPV vaccination or not.
• are no longer sexually active.
• have been through menopause.
• have been with only one sexual partner.
• have experienced traditional cutting or circumcision of the cervix.
• have had a baby.
• are pregnant (ensure to let your health care professional know).

If you're outside the target age range:

Under 25

Many women will not need to have a cervical screen before the age of 25. This is because HPV and other infections usually go away by themselves. Cervical cancer is also rare in young people. For most, starting at age 25 means a lot of unnecessary tests and treatments are avoided.

Over 75

If you are over 75 you can still ask to have a free cervical screening test via the National Cervical Screening Program.

Symptoms 

Speak with your doctor if you have symptoms such as:

• abnormal vaginal bleeding.
• pain during sex.
• unusual vaginal discharge.

Having a sample collected

A sample of cells is taken from the cervical area using a type of spatula, swab, or brush during a pelvic examination at your GP’s rooms or health clinic. The cells are placed in a special liquid in a tube and are transported to the laboratory for HPV testing. 

Self-collection

If you do not have symptoms, you can choose to do your own collection. This involves putting a swab into your vagina and rotating it. Because self-collected samples are only tested for HPV – not cervical cell changes – if you need to go on to have a cervical co-test, you will need to have another sample collected by your doctor or health clinic.

You should speak to your doctor or health clinic about whether self-collect is the right option for you. More information on self-collection is available from the Department of Health and Aged Care.

Both options are covered by Medicare. If you decide to collect your own vaginal sample, you will be provided with a swab and instructions on how to do the test. 

What does the HPV test look for?

HPV is detected by a genetic test. The test is programmed to detect the genetic material of certain high-risk types of HPV. They are classified:

• HPV types 6 and 11 typically cause genital warts, but (along with types 42, 43 and 44) have a low risk of progressing to cancer.
• HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82 have a higher risk of progressing to cancer.

If your test identifies you as being at high risk, there is no guarantee that the predicted risk is correct because other factors are involved in the development of cancer.  

When your sample needs further investigation – the cervical co-test

If the test detects high-risk HPV, or if you are being treated or monitored for cervical cell changes, or if you are the daughter of someone who was treated with the drug Diethyl-stilboestrol, your sample will be sent to another department in the laboratory where a cytologist (a specialist scientist) and/or a cytopathologist (specialist pathologist) with training in cervical cancer will examine the sample under a microscope. This examination will look for precancerous cells or cervical cancer. This test is called the Liquid Based Cytology (LBC) test or co-test.  

The co-test is classified as a diagnostic test, rather than a screening test, and requires the pathology laboratory to perform both an HPV and an LBC test on the same sample. For more on this and what the results may mean, see cervical co-test.

Your results

Screening test result – HPV Not detected

This means no HPV was found and you will be asked to return to screen in five years.

You should get a reminder letter a few months before your next test is due.

Screening test result – Unsatisfactory test result

An unsatisfactory test result means that your sample could not be tested properly by the laboratory. It does not mean something is wrong. You should have another test in six weeks.

Screening test result – Return for another sample collected by your healthcare provider 

This means that you have provided a self-collect sample, and your screening results show you have an HPV infection. It is important to check if the infection has caused changes to the cells in your cervix. As a self-collect sample does not have cervical cells to check for cell changes, you need to have your doctor collect a sample that can be tested through an LBC (see cervical co-test).

Return to screen in 12 months

This means that you have an HPV infection and will need another cervical screening test in 12 months. In this time, your body will probably clear the HPV by itself.

If the second test is clear, you will not need another test for five years. If the second test shows that you still have the HPV infection, you may need to see a gynaecologist.

Referral to a specialist 

This means that your results show you have a type of HPV infection that needs further investigation by a specialist. This does not mean you have developed cancer. You will be referred to a specialist for a follow-up test, known as a colposcopy. This is an examination of your cervix which is usually performed by a gynaecologist. The specialist will insert a speculum into your vagina and put a small amount of liquid on to your cervix to highlight any abnormal areas. They will use a colposcope (like a pair of binoculars on a stand) to carefully examine the cervix and vagina.

Your results will be sent to the National Cancer Screening Register.

Questions to ask your doctor

The choice of tests your doctor makes will be based on your medical history and if you have any symptoms that could suggest cervical cancer. These symptoms include abnormal bleeding, pain during sex or abnormal discharge. It is important that you tell them everything you think might help.

You play a central role in making sure your test results are accurate. Do everything you can to make sure the information you provide is correct and follow instructions closely.

Talk to your doctor about any medications you are taking. Find out if you need to fast or stop any particular foods, medications or supplements. These may affect your results. Ask:

• Why does this test need to be done?
• Do I need to prepare (such as fast or avoid medications) for the sample collection?
• Will an abnormal result mean I need further tests?
• How could it change the course of my care?
• What will happen next, after the test?

More information

Pathology and diagnostic imaging reports can be added to your My Health Record.

You and your healthcare provider can now access your results whenever and wherever needed. Get further trustworthy health information and advice from healthdirect.