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Cervical Screening Test (Pap smear)

Australian guidelines recommend two yearly pap smears from the age of 20 years or within two years of starting sexual activity. Regular screening enables early detection and treatment of cervical abnormalities to prevent progression to cervical cancer. Abnormal vaginal bleeding patterns such as intermenstrual bleeding or postcoital bleeding should be discussed with your GP as this may indicate cervical abnormalities.

All women between the ages of 18 and 69 years, who have ever been sexually active, should have a Pap test every two years.

Abnormal Pap smear

A Pap smear or Pap test is conducted as part of a woman's routine health examination, after the age of 20. It is not a diagnostic test, but is a screening tool used to detect any abnormal cells in the cervix, which is the lower part of the uterus that opens into the vagina.
A Pap smear helps in early detection of serious medical conditions such as cervical cancer.
However an abnormal Pap smear does not necessarily denote cancer, it may also indicate the presence of infection or abnormal cells called dysplasia. Abnormal results highlight the requirement of supplementary testing to identify and confirm an underlying problem.

Causes of abnormal Pap smear

An abnormal Pap smear may indicate any of the following:

  • Infection or inflammation

  • Herpes

  • Trichomoniasis

  • Dysplasia (abnormal cells that may be precancerous)

  • HPV (Human Papilloma Virus) infection

Presentation

Usually abnormal cells do not produce any symptoms for the woman. Moreover, even the presence of HPV in an abnormal Pap smear is asymptomatic.  A regular Pap smear is therefore very useful in early detection of any abnormalities.
An abnormal Pap smear, secondary to a sexually transmitted infection, however, may induce the following symptoms:

  • Abnormal discharge from the vagina, such as change in the amount, colour, odour or texture

  • Abnormal sensations such as pain, burning or itching in the pelvic or genital area during urination or sex

  • Sores, lumps, blisters, rashes or warts on or around the genitals

Treatment

Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells.

A repeat Pap smear or test for human papilloma virus (HPV), a major risk factor for cervical cancer, may also be recommended.
Depending on the age of the patient and the type of abnormal cells, the doctor may recommend the following treatment options:

  • Cryosurgery which involves freezing the abnormal cells which are then surgically removed.

  • Cone biopsy or LEEP procedure, where a triangle segment of cervical tissue including abnormal cells is removed by specially designed instruments for evaluation.

Abnormal Pap smear during pregnancy

A Pap smear during pregnancy is very safe. In case of an abnormal Pap smear, a colposcopy can be performed during pregnancy. However, further treatments are delayed until the birth of the baby. Often, the birth process washes away the abnormal cervical cells.

Cervical Cancer Vaccinations

Women after the age of 19 should have a tetanus-diphtheria booster every 10 years. Human papillomavirus (HPV) vaccination is recommended for women between the ages of 18 and 26. Women born after 1980, who have never had chickenpox, should receive two doses of varicella vaccine. Other vaccinations will be recommended by your healthcare provider if you are found to be at high risk for other diseases, such as pneumonia and shingles.

What is the HPV vaccine?

Human papillomaviruses (HPV) are the major cause of cervical cancer in women.  
HPV vaccine triggers the formation of antibodies to produce immunity and therefore protects the body from disease.
The HPV vaccine currently available in Australia is called Gardasil. This vaccine prevents infection with HPV types 16, 18, 6 and 11. HPV 16 and 18 are responsible for the majority (70% internationally; 80% in Australia) of cervical cancers. HPV 6 and 11 are responsible for 90% of genital warts. Having the vaccine will protect those who have never  been exposed to these types of HPV.

Does the vaccine protect against all HPV types?

There are over 100 different viruses in the HPV group. Some HPV types are more likely to lead to the development of cancer than others. At least 14 types of HPV have been found to cause cancer however the vaccine only protects against two out of the 14. Therefore, Pap tests are still critically important. Women between the ages of 18-70 years who have ever had sex need to have a Pap test every two years whether or not they have been vaccinated.

Who is eligible for the HPV vaccine?

The vaccine is most effective if given to girls and boys before the start of sexual activity and, therefore exposure to HPV. Under the National Immunisation, Program Gardasil is free for three groups:

  • 12-13 year old girls in a school-based program, generally delivered in the first year of high school

  • 12-13 year old boys in a school-based program, generally delivered in the first year of high school

  • A catch-up group of 14-15 year old boys in a school-based program, delivered in Year 9 during 2013 and 2014.

For all other people, the cost of the vaccine is around $460; this does not include the cost of the visit to the GP who must prescribe the vaccine.

How is the HPV vaccine administered?

GPs will administer the vaccine in three injections in the upper arm or thigh over a six-month period.

Will ‘boosters’ be required, and if so, how often?

Since the vaccine is new, more studies need to be done. It is not yet clear if or when boosters will be needed.

Is the HPV vaccine safe?

Tests of the vaccine showed only minor problems. Some people had a slight fever; others had redness or irritation of their skin at the site of where the vaccine was administered.

I can’t afford the vaccine. Are Pap tests still a good option?

Pap tests are still critically important. Women between the ages of 18-70 years who have ever had sex need to have a Pap test every two years whether or not they have been vaccinated.

Should I have my son vaccinated?

The HPV vaccine will be offered to 12-13 year old boys from 2013 as part of the National Vaccination Program. Genital warts and some cancers in males are related to HPV, including most anal cancer, and some cancers of the penis, head and neck.

I am sexually active. Will the vaccine benefit me?

You will not be protected if you have already have been infected with the HPV types covered by the vaccine, prior to vaccination. The Cancer Council recommends regular Pap tests every two years for all women who have ever had sex. For these women, Pap tests are still the best protection against cervical cancer.

What trials have been undertaken to test the vaccine?

Clinical trials across Australia and in the US have shown the vaccine to be close to 100% effective against HPV types 16 and 18.

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