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28 Jun 2019

The change from Pap smear tests to human papillomavirus (HPV) testing made by the National Cervical Screening Program (NCSP) in 2017 is resulting in earlier detection of potential cancer-causing infections.

The switch from biennial cytological Pap testing of asymptomatic women aged 18–69 years, to five-yearly primary HPV testing of women aged 25–74 years was a ‘major paradigm shift’, according to Dr Dorothy Machalek from the Centre for Women’s Infectious Diseases at Melbourne’s Royal Women’s Hospital.

Dr Machalek led a research team whose findings have bene recently published in the Medical Journal of Australia.

The NCSP Renewal program distinguishes between HPV specimens submitted for primary screening and those submitted for other indications (non-screening), requiring laboratories to classify all tests accordingly for Medicare billing purposes and for patient management.

Women with non-screening tests are regarded as being at higher risk than other women because of their symptoms or signs or a prior cervical abnormality.

Machalek and colleagues conducted a retrospective review of 195 606 specimens submitted for HPV testing between December 2017 and 31 May 2018, to measure HPV testing patterns and rates of oncogenic HPV-positivity.

Oncogenic HPV was detected in 8.1 per cent of screening tests and 20.9 per cent of non-screening tests. Among oncogenic HPV-positive screening tests from women of recommended screening age (25–74 years), 35.5 per cent also had a cytologic abnormality. The proportion of HPV16/18-positive samples with high-grade abnormality was 15.3 per cent. For samples positive for other oncogenic HPV types, the proportion was 6.3 per cent. Repeat HPV testing after 12 months was recommended for 5.4 per cent and direct colposcopy for 2.6 per cent of screened women aged 25–74 years.

“A key finding was that the rate of referral to colposcopy based on HPV primary screening sample results for women of recommended screening age (2.6 per cent) was considerably higher than that based on historical primary cytology screening results from our laboratory (0.8 per cent),” Dr Machalek and colleagues wrote.

“The higher rate is broadly consistent with clinical trial data and predictions from modelling.

“The switch from cytology- to primary HPV-based screening in Australia will ensure cervical screening is evidence-based and best practice.

“While the predicted long-term benefits are substantial, timely monitoring of the transitional phase is critical for ensuring the program performs as expected and community confidence in the policy is maintained.”

 


Published: 28 Jun 2019