Pap smear

Question 1

What is the current routine screening programme in Australia?

Answer 1

Pap test screening is recommended every 2 years for women who have ever had sex and have an intact cervix, commencing from age 18–20 years (or up to 2 years after first having sexual intercourse, whichever is later).

Question 2

What age to cease pap smear screening?

Answer 2

Pap tests may cease at age 70 years for women who have had two normal Pap tests within the last 5 years. Women over age 70 years who have never had a Pap test, or who request a Pap test, should be screened.

Question 3

Do women with female partnes need screening?

Answer 3

Women with female sex partners are also at risk of developing cervical cancer and should be screened every 2 years

Question 4

What are the risk factors for developing cervical cancer?

Answer 4

• Persistent infection with high-risk HPV types is necessary for the development of cervical cancer.
• immunosuppression
• cigarette smoking
• use of combined oral contraception >5 years

Question 5

How to manage a low grade LSIL on the pap smear?

Answer 5

• Pap test report of possible/definite LSIL should have a repeat Pap test in 12 months. If the repeat test at 12 months shows LSIL (definite or possible) the woman should be referred for colposcopy.
• >30 years or more with a Pap test report of LSIL, without a history of negative smears in the preceding 2–3 years, should be offered either colposcopy or a repeat Pap smear at 6 months

Question 6

How to manage HSIL?

Answer 6

Refer for colposcopic assessment and targeted biopsy where indicated.

Question 7

How to manage glandular abnormality or adenocarcinoma on the pap smear?

Answer 7

• Refer for colposcopy by an experienced gynaecologist or gynaecological oncologist.
• If the woman is symptomatic or if she has a clinically abnormal cervix, referral for colposcopy is recommended.

Question 8

What instruments to use for pap test?

Answer 8

• A sample of the ectocervix – using an extended tip spatula – then the endocervix, using a cytobrush, provides the best method of sampling and can be used in all age groups of women.
• The cytobrush is not recommended for use during pregnancy.
• The cervical broom can be used on its own in premenopausal women if it is possible to sample from both sides of the transformation zone.

Question 9

How to follow-up unsatisfactory specimens?

Answer 9

• If the smear is reported as technically unsatisfactory, it should not be repeated before 6 weeks.

Question 10

How to perform pap smear in patients with atrophic vaginitis post-menopausal?

Answer 10

• In postmenopausal women with atrophic changes, it may be necessary to use vaginal oestrogen for 14–21 days prior to the test.

Question 11

Is HPV testing a primary screening tool in screening for cervical cancer?

Answer 11

• Current national guidelines do not support the use of HPV testing as a primary screening tool for cervical cancer

Question 12

Is HPV testing used in LSIL and HSIL?

Answer 12

• The use of HPV testing in the triage of LSIL is not currently recommended by the National Cervical Cancer Screening guidelines.
• In women treated for HSIL, cervical cytology plus HPV testing should be performed 12 months post-treatment and annually thereafter until both tests are negative on two consecutive occasions, at which point women can return to the routine cervical screening interval.

Question 13

What is the role of liquid based cytology in screening?

Answer 13

Liquid-based cytology can be used as an additional test to the conventional smear but not as a substitute. Its addition may be useful when repeating an unsatisfactory smear, or added if requested by the woman.

Question 14

What are the current guidelines on HPV vaccination?

Answer 14

• HPV is highly contagious and can cause HPV-related cancers and genital warts. Four out of five people will have a HPV infection at some point in their lives, infection is often asymptomatic.
• Males and females aged 12-13 years will receive the HPV vaccine at school. Males aged 14-15 years will also receive the vaccine as part of a catch-up program until the end of the 2014 school year.
• The program involves a three dose schedule, delivered at 0, 2 and 6 months at school.

Question 15

What genotypes does Gardasil cover?

Answer 15

• It is highly effective in providing protection against four HPV genotypes
  (6, 11, 16 and 18).
• The vaccine remains highly
  immunogenic and efficacious after 8.5 years

Question 16

Is pap smear indicated after HPV vaccine?

Answer 16

• Females should still continue to have regular Pap tests even if they have been vaccinated against HPV.

Question 17

Are there any side-effects with HPV vaccines?

Answer 17

• Local reactions are common
• Syncope and syncopal related seizures are common and is related to the pain of the vaccine

Question 18

What are the benefits of the vaccine?

Answer 18

• HPV related infections and genital warts have dropped in females
• Prevents cancer and warts in men and reduces 30% of disease in unvaccinated females these men are in contact with
• Reduced anal infection and anal cancer in MSM
• Gardasil (CSL) is approved for use in females aged 9­–45 years and males aged 9–26 years. It protects against HPV types 16 and 18 (which cause 70% of cervical cancers and around 90% of all HPV-related cancers in men) and types 6 and 11 (which cause 90% of genital warts).

Question 19

What are the causes of abnormal pap tests after vaccination?

Answer 19

• The vaccine was given after exposure to HPV had already occurred
• Caused byHPV type that the vaccine does not protect you against.