Cervical Screening

Question 1

Cervical Screening:
When did HPV testing it replace papsmears and the main differences?

Answer 1

-2017 was the transition
-previously a 2 yearly cytological evaluation, starting from age 18
-CST is dual stage screening in normal risk individuals from age 25
a) HPV PCR testing
b) reflexive liquid based cytology if HPV is present
*HPV testing detects HSIL earlier than the older cytological method

Question 2

Cervical Screening:
Human Papilloma Virus (HPV) vaccination and general knowledge?

Answer 2

-Introduced in 2007 (girls only 12-13 then 14-26), boys in 2013
-current vaccine is Gardasil 9 valent (HPV 6, 11, 16, 18, 31, 33, 45, 52, 58)
-2 needed unless immunocompromised then will need 3
-vaccination is protective of 90% of cervical cancers (16, 18, 31, 45) and genital warts (HPV 6 and 11)
-vaccination reduces the risk of developing HSIL by 41%
-15 of the 40 HPV types are oncogenic
-infection through any sexual contact regardless of sex of partner involved
-usually transient and cleared within 2 years (“the common cold of the cervix”)

Question 3

Cervical Screening:
Cervical cancer lifecycle?

Answer 3

1) HPV infection
2) HPV persistence
3) Precancerous abnormalities in cervix
-LSIL conversion to HSIL takes about 7 years (a small proportion 3.6% within 12 months)
-30% of HSIL will regress
4) Carcinoma in-situ
-LSIL conversion to Carcinoma takes approximately 10 years
-LSIL to invasive cancer takes on average 30 years (accounts for 1%)
at any stage of the precancerous process the cycle can be reversed by the immune clearance of HPV

Question 4

Cervical Screening:
Types of cervical cancers?

Answer 4

1) Squamous Cell Carcinoma (SCC) - cells outside the Os (generally) - MOST common
2) Adenocarcinoma - endocervical canal - 28%
3) Adenosquamous carcinoma (mix of glandular and squamous lesion)
4) Others

Question 5

Cervical Screening:
Cervical Cancer risk factors?

Answer 5

-no or under-screened (70% of cervical cancers)
-over 35 years (70% in over 60 years)
-smokers
-COCP for more than 5 years
-past cervical cancer
-more than 5 children
-Diethylstilboestrol (DES) exposure when in utero (administered between 1940 - 1970’s to pregnant women to prevent miscarriages)

Question 6

Cervical Screening:
Screening general approach?

Answer 6

Test ANYONE who has a cervix and has been sexually active EVER

1) Start at age 25yo
-if sexual activity prior to age 14 AND prior to HPV vaccinations OR has a longterm immunocompromising condition then can have a single HPV test between 20 -24yo.
-5 yearly for average risk
-3 yearly if immunocompromised
-annually if DES exposed

Exit between 70 - 74yo if a previous negative HPV result in this age bracket.

2) Ideally clinician collected sample OR self collected sample (All women since July 2022) - Copan Floq swab

3) Co-testing (HPV and LBC) is indicated if
-abnormality follow up
-test of cure post treatment/hysterectomy
-past adenocarcinoma
-abnormal vaginal bleeding

Question 7

Cervical Screening:
Test result management?

Answer 7

no HPV = 5 yearly screening

HPV 16/18 = Colposcopy

Other non 16/18 HPV:
-AND HSIL = Colposcopy
-AND negative/LSIL = retest in 1 year

1st retest:
-Any non 16/18 HPV AND negative/LSIL = retest in 1 year
-HPV 16/18 = colposcopy

2nd retest:
Any HPV at all = colposcopy
HPV negative = 5 yearly screening

Question 8

Cervical Screening:
Post hysterectomy management?