20. Transition to the renewed National Cervical Screening Program

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Background

At the transition of the renewed National Cervical Screening Program (NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.) there will be women who have had a previous screen detected abnormality and who are currently undergoing investigation, treatment or follow-up for:

  • abnormal Pap test result
  • histologically confirmed high-grade squamous intraepithelial lesion (HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).) (cervical intraepithelial neoplasia grades 2 to 3 (CIN2/3))
  • histologically confirmed adenocarcinoma in situ (AISAdenocarcinoma in situ).

This chapter describes how these women should be transitioned to the renewed program after 1 December 2017, when the Pap test will be replaced by primary screening using human papillomavirus (HPVHuman papillomavirus) testing, with reflex liquid-based cytology (LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) for women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result.

Women who have participated in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. and have not had any previous abnormality, or who have returned to routine screening after a Test of Cure, will be transitioned in accordance with NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. transition policy.

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Recommendations

Flowchart 20.1. Transition to the renewed National Cervical Screening Program

Transition to the renewed NCSP.PNG



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REC20.1: HPV test replaces the Pap test

All Pap tests are replaced by HPV testing.

Conventional Pap tests are no longer used.

Reflex LBCReflex liquid-based cytologyA test performed on a liquid-based cytology sample when there is a positive oncogenic HPV test result. Reflex LBC may allow for the triage of women along different pathways, negative, LSIL and HSIL, glandular. For women who have HPV16 and/or 18, and who are being referred directly to colposcopy, the reflex LBC result would inform the colposcopic assessment. will be performed on any sample with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result.

Co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) to be performed only as recommended in these guidelines, in the follow-up of screen-detected abnormalities or the investigation of abnormal vaginal bleeding.

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REC20.2: HPV testing for women in follow-up after pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.
Women who are in follow-up for pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. cytology in the previous program (pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.) should have a HPV test at their next scheduled follow-up appointment.

  • Women with a positive oncogenic HPV (any type)Women with a positive HPV test result of any oncogenic HPV types detected using routine HPV testing in a pathology laboratory. test result should be referred for colposcopic assessment informed by reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory..
  • If oncogenic HPV is not detected, the woman can return to 5-yearly screening.
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REC20.3: Colposcopic management of a prior screen-detected abnormality should continue
Women who have been referred for colposcopic assessment following any cytological abnormality in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. should continue their colposcopic management according to these guidelines.

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REC20.4: Prior treatment and Test of Cure
Women who have been treated for HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). (CIN2/3) in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. and are undergoing, or have not yet commenced Test of Cure, should start or continue Test of Cure in accordance with these guidelines.

Women should have an annual co-testHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) performed at 12 months after treatment, and annually thereafter, until both tests are negative on two consecutive occasions, when they can return to routine 5-yearly screening.

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REC20.5: Prior treatment for AISAdenocarcinoma in situ
Women who have been treated for AISAdenocarcinoma in situ in the pre-renewal NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears., and are undergoing or have not yet commenced surveillance, should have annual co-testingHPV test and LBC both requested and performed on a cervical sample. (HPV and LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.) indefinitely.

Until sufficient data become available that may support a policy decision that cessation of testing is appropriate.

See also:

Chapter 10. Management of histologically confirmed high-grade squamous abnormalities

Chapter 11. Management of glandular abnormalities

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