Cervical cancer screening in Australia how we measure up
The recommended interval between pap smears could be stretched to three years from the current two, cancer experts have claimed.
A study published in the latest edition of the Medical Journal of Australia (MJA) has reviewed Australia's recommended screening intervals for pap smears.
Dr Karen Canfell, a cancer epidemiologist from the Cancer Council NSW, and colleagues compared cervical screening policy and changes in cervical cancer incidence and mortality in Australia and the UK.
They found similar reductions in incidence and mortality after the introduction of organised screening, despite the interval for re-screening being three years in the UK and two years in Australia.
The study showed the average rates of cervical cancer in women aged 20-69 years fell by 33% in both Australia and the UK between 1991-1993 and 1998-2000. Deaths from cervical cancer fell by 36% in both countries during the same period.
The International Agency for Research on Cancer has recommended that women aged 25-49 years be re-screened at three year intervals, and women over the age of 50 at five year intervals.
"It seems timely to reconsider screening intervals in Australia," says Dr Canfell.
"This could be done in conjunction with considering other future options, including the possible introduction of new test technologies and the implementation of prophylactic HPV vaccination."
In an accompanying editorial, Dr Gerard Wain, gynaecological oncologist and Director of the NSW Cervical Screening Program, says Australia's national cervical screening program, although outstandingly successful, needs broader changes than just a variation to the screening interval.
Dr Wain said since the program began in 1992, the incidence and mortality of cervical cancer in Australia have halved.
But he says doctors and scientists now know of the critical role of human papillomavirus (HPV) in causing cervical cancer, and a vaccine against HPV became available this year.
Uptake of the vaccine, which is not yet publicly funded, has the potential to further reduce cervical cancer incidence and mortality and reduce the burdens of the current program on women and screening resources, he says.
He adds that other issues that need to be addressed are whether the available medical and laboratory workforce can sustain the current screening program, and the problematic current register system that only reminds women when they are overdue for a test, rather than recalling them for a test when it is actually due.
Dr Wain highlights the need for review, but notes that "…the Australian Screening Advisory Committee was disbanded in May 2006 … this leaves no national structures available to consider, promote or implement any change within the screening program".
The Medical Journal of Australia is a publication of the Australian Medical Association.
Both these journal articles can be accessed at www.mja.com.au.