At a Glance:
- Cervical Cancer is estimated to be diagnosed 913 times in Australia in 2021. 237 women are estimated to have died from cervical cancer in 2021
- Since 1991, incidences of and mortality from cervical cancer in Australia have halved
- This is due in large part to the National Australian Cervical Screening Program that offered free Pap tests to women every two years
- Due to the understanding that Human Papillomavirus (HPV) is present in nearly all (99.7%) of cervical cancer cases, a new test, the Cervical Screen has become the new main test for cervical cancer
- Although HPV is found in relation to most cases of cervical cancer, most types of HPV are not cancer causing and infections typically clear up by themselves
Both the incidences of and mortality from cervical cancer has halved since 1991, the year in which Australia introduced the National Australian Cervical Screening Program. Until late 2017, the Cervical Screening Program offered free Pap tests to women every two years.
Since then, there have been a few changes to the screening program thanks to the introduction of a vaccine for Human Papillomavirus (HPV), an extremely common sexually transmitted infection. The vast majority of cases of HPV are asymptomatic and clear up by themselves. Some strains may cause genital warts. A few specific strains are responsible for almost all cases (99.7%) of cervical cancer.
As a result of the HPV vaccine, screening for cervical cancer has changed - the Cervical Scan is now the standard test for cervical cancer rather than the Pap test.
What’s the Difference Between a Pap Test and a Cervical Screen?
Both a Pap test and cervical screening are performed similarly. The doctor or nurse performing the test will take a cell sample from the cervix for testing. Whereas the Pap test was designed to look for abnormal cell growth, the cervical screening test looks for the presence of HPV. As a result, the cervical screening test can identify risk factors for the development of cervical cancer much earlier than a Pap test.
Before the advent of the HPV vaccine and the cervical screening test, it was recommended that women get a Pap test every two years starting at the age of 18. It is now recommended that women have their first cervical screening test at the age of 25, due to the fact that younger women are likely to be immunised against HPV infection, and that cervical cancer is extremely rare in women under that age.
After the initial test, women should have a cervical screening test every five years.
Every woman aged 25 and over should have regular cervical scans to detect any sign of possible HPV infection or developing cervical cancer.
If you need a test, or have been experiencing abdominal pain or vaginal bleeding, schedule an appointment to see a doctor for your screening. The fastest and easiest way to search for and book healthcare appointments online is through MyHealth1st.
What Happens if My Cervical Screen is Positive?
Don’t panic. While HPV is a factor in almost all cases of cervical cancer, only a few strains of HPV actually contribute to the development of cervical cancer. The vast majority of HPV infections are asymptomatic and clear naturally, so a positive result is likely to be a benign infection.
HPV infection takes some time to clear - sometimes one or two years, so in the case of a positive result, your doctor may order a further screening in 12 months to see if the infection has cleared naturally. The longer an HPV infection takes to clear from the body the greater the risk of developing cervical cancer.
Further testing may also be ordered. One key test is called a Colposcopy. This test uses a specialised magnifying instrument to inspect the surface of the cervix to look for areas of abnormal cells.
The test is performed in a manner similar to a Pap test or cervical screen. The doctor or nurse will have you lie on a table as is standard for pelvic exams. A speculum is used to keep the vagina open so the practitioner can inspect the surface of the cervix using a colposcope.
A weak solution of acetic acid (akin to vinegar) applied to the cervix makes any areas of abnormal cells easier to see. If any abnormal areas are identified, a small biopsy (tissue sample) is taken for further testing. A biopsy is the best way to see if cells are precancerous or cancerous.
It should be noted that the majority of abnormal cells are not cancerous and as a result may be quickly and painlessly treated.
What Happens if Cervical Cancer is Diagnosed?
If a biopsy shows the presence of cancerous cells, a number of other tests may be ordered to see the extent of the cancer in your cervix and whether it has spread (metastasised) to other organs or parts of the body.
These tests typically include:
- Blood Tests - a blood test may be ordered to get an idea of your general health. This may help a doctor decide on potential courses of treatment or the need for further tests
- Chest X-Ray - an x-ray of the chest may be ordered to determine in the cancer has spread to the lungs
- CT, MRI and PET Scans - computerised tomography (CT) is a form of x-ray that utilises a special scanner to construct a 3D image of the body. A CT scan is used to see if the cancer has spread to the lymph nodes or other organs.
In some cases, a CT scan will require the person being scanned to drink a solution that helps with contrast. Similarly, a woman having a CT scan may need to insert a special contrast tampon or have a contract liquid put into their rectum to obtain optimum results from the scan.
An MRI uses magnetic fields and radio waves to make a detailed 3D model of the human body enabling the doctor to see if the cancer has spread or the extent to which the cancer has grown in the cervix.
A PET scan is similar to a CT scan but rather than having to drink a contract formula, the person being tested is injected with a slightly radioactive solution before the scan. WHile all cells in the body absorb some of this radioactive material, cancerous cells absorb more than other cells, making them stand out clearly in the scan.
- Examination Under General Anaesthetic - a manual examination of the vagina, cervix, bladder and rectum performed under a general anaesthetic. The doctor puts the person being examined under a general anaesthetic and then specialised tools are used to perform a thorough examination.
While the patient is under, a doctor may also perform a dilation and curettage (D&C) - the removal of some cells from the lining of the uterus for testing
Once testing has been completed and the results gathered, the cancer will be given a grade and stage. The grade and stage given to a cancer help your doctor (oncologist) determine how treatment will proceed.
A cancer’s grade is a comparison of how similar the abnormal cells are to normal cells and is determined by the cells taken for biopsy. Low grade tumours typically grow slowly, whereas high-grade tumours typically grow fast.
The stage of cancer is a reference to how much the cancer has spread around the body, with a range between 0 and 4.
- Stage 0 - the cancer cells are only present in the surface layer of the cervix. This is sometimes referred to as carcinoma in situ
- Stage 1 - the cancer cells have spread deeper into the tissues of the cervix but so far have not spread beyond the cervix
- Stage 2 - the cancer has spread through the uterus and beyond but has not spread to the pelvic wall or to lower parts of the vagina
- Stage 3 - the cancer has spread through the uterus and beyond to the pelvic wall or lower vagina
- Stage 4 - the cancer has spread further, such as to the bladder, rectum or to more distant organs such as the lungs