Role of Health Care Professionals

Information for health care professionals about their role in the National Cervical Screening Program and how to increase participation in cervical screening.

Page last updated: 17 May 2017

The renewed National Cervical Screening Program

The Renewal of the National Cervical Screening Program will be implemented on 1 December 2017.

Until the renewed National Cervical Screening Program is implemented, our world-class cervical cancer screening program will continue. It is important that women aged between 18-69 years continue to have Pap smears every two years and talk to their doctor or health care professional if they have any questions.

Read more about the Future changes to the National Cervical Screening Program 

More information for health care professionals on the arrangements for cervical cancer screening between now and 1 December 2017 is available on our FAQ page

Health care professionals can increase women's confidence in cervical screening by helping them to understand:
  • both the benefits and the limitations of the Pap smear
  • the importance of regular screening, where no abnormality has been previously detected
  • the natural history of cervical cancer, HPV and abnormalities
  • all treatment options, if they have an abnormality
  • that any symptoms, such as bleeding, discharge or pain between Pap smears may require investigation even if the previous result was normal.

The important role of health care professionals in increasing the number of women who screen regularly

The majority of Australian women consult a general practitioner at least once a year, which means general practitioners play a crucial role in encouraging women to screen regularly.

As general practitioners and practice nurses take around 80 per cent of all Pap smears, they are also in a key position to help women understand that cervical cancer is preventable.

Even if a woman is embarrassed about having a Pap smear, research has shown that most will accept their health professionals’ advice about having one.

The availability of female general practitioners, nurses or Aboriginal health workers can also improve participation.

Encouraging regular cervical screening

There are many reasons why some women do not regularly participate in cervical screening. Some of these reasons are outlined below along with suggestions for how to help women overcome their reluctance.

Common reasons women give for not screening regularly include:
  • forgetting when their next Pap smear is due
    • talk to women about the cervical screening register and/or your own practice's reminder system, if one is in place.
  • embarrassment, anxiety or fear about the procedure
    • ask them what would make them feel more comfortable about having a Pap smear.
  • lack of knowledge about the benefits of regular screening
    • explain that Pap smears are not a test for cancer, they are a test to help prevent cervical cancer. Pap smears are currently the best way for a woman to reduce her risk of developing cervical cancer.
  • some women are reluctant to have a Pap smear taken by a general practitioner they know well
    • suggest an alternative practitioner or provide information on a local health service, family planning or sexual health clinic or Aboriginal Medical Service.
  • an expectation that if the general practitioner does not suggest a Pap smear, then the test is not important
    • even if a woman is embarrassed about having a Pap smear, research has shown that most women will accept their general practitioner's advice about having one. Some women rely on their general practitioner to raise the issue.

Aboriginal and Torres Strait Islander women

Research shows that the rate of Aboriginal and Torres Strait Islander women who die from cervical cancer is higher than that of non-Indigenous women.

PapScreen Victoria have the following resources that may assist you in speaking with Aboriginal and Torres Strait Islander women about cervical screening.

Conducting cervical screening

There are two important components in ensuring accurate Pap smear reports – good smear taking technique and rigorous cytological examination.

An optimal Pap smear sample contains:
  • sufficient mature and metaplastic squamous cells to indicate adequate sampling from the transformation zone
  • sufficient endocervical cells to indicate that the upper limit of the transformation zone was sampled, and to provide a sample for screening for adenocarcinoma and its precursors.
To help ensure an optimal specimen is obtained, it is preferable to avoid smear taking during menstruation, if obvious vaginal infection is present, or within 24 hours of use of vaginal creams or pessaries.

Communicating with the pathologist

Good communication with the pathologist is essential. Cervical screening results cannot be read in isolation and should be considered in conjunction with details about the reason for the Pap smear and clinical history, especially symptoms such as bleeding.

Providing such details on the request form ensures the most accurate result possible is obtained.

Medicare Benefits items for cytology include:
  • 73053 – a routine screening Pap smear taken at the usual two year interval on asymptomatic women
  • 73055 – a Pap smear taken as part of the investigation or management of women with symptoms or history of cervical pathology
  • 73057 – a vaginal vault smear.

Benefits and limitations of cervical screening

There is robust evidence that a systematic approach to screening provides better protection against cervical cancer than opportunistic screening. Regular Pap smears can help prevent up to 90 per cent of the most common types of cervical cancer.

However, not all cervical cancers can be detected with cervical screening. This includes rare neuroendocrine cancers of the cervix.

It is also important to remember that no screening test is 100 per cent accurate and the body changes over time, which is why it is important for women to be screened at regular intervals.

Test of cure – Management of women previously treated for high-grade abnormalities

The NHMRC guidelines recommend that a woman who has had treatment for a biopsy-confirmed high-grade cervical abnormality should:
  1. have colposcopy and cervical cytology at four-six months after treatment
  2. have cervical cytology and high risk HPV DNA testing at 12 months after treatment and then annually until she has tested negative by both tests on two consecutive occasions
  3. then return to the usual two-yearly screening interval.
HPV DNA testing for this purpose is subsidised by a Medicare rebate (MBS item 69418).

Women who test negative for high risk HPV subtypes following treatment for high-grade abnormalities have a very low risk of further high-grade cervical abnormalities.

Further information is available in the NHMRC Guidelines.

Colposcopy Quality Improvement Program

The Colposcopy Quality Improvement Program (C-QUIP) is a Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) initiative, which aims to improve the care of women who are referred for colposcopy and treatment of screen-detected abnormalities.

The C-QUIP offers all medical practitioners in Australia and New Zealand who are currently practicing colposcopy the opportunity to be certified in this field.

After 1 December 2017, the National Cancer Screening Register will support colposcopists to send colposcopy data to the Register and receive aggregated reports about the tests and treatments they have administered as part of the National Cervical Screening Program. These reports will assist Health Care Professionals to participate in the CQUIP program in the future.

More information is available from the C-QUIP website.

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