RANZCOG - cervical screening

Question 1

When does cervical screening start in NZ?

Answer 1

Changed from 20 years to 25 years for anyone with a cervix or a vagina who has ever been sexually active

Question 2

For someone who is just having their first cytology test what would you tell them about frequency of testing?

Answer 2

If first ever cytology they will need a repeat in 1 year regardless of result
This is the same if their last smear was more than 5 years ago

Question 3

What about screening for over 70 y?

Answer 3

if aged 70 years or older and un-screened or under screened then should have 2 consecutive normal cytology samples (12 months apart) before ceasing cytology screening

Question 4

What happens after someone has completed treatment for high grade sqaumous disease?

Answer 4

• discharged to primary care
• test of cure
• hrHPV + cytology

Question 5

If a woman has had a total hysterectomy for benign disease what kind of cervical screening follow up is required?

Answer 5

• If has normal cervical screening history then no further follow up required
• if has been treated for confirmed HSIL + TOC completed then no further follow up required
• if unexpected LSIL or HSIL on cervical histology then follow up required annually with vaginal vault testing until 2 consecutive negative results

Question 6

If a woman has had previous treatment for AIS and goes on to have a hysterectomy, what should their cervical screening consist of?

Answer 6

• co test with HPV partial genotyping + vaginal vault cytology
• annually
• indefinitely

Question 7

If a woman has previously had high grade CIN (treated) and has a Total hysterectomy for benign Gynae reason, how frequently should testing occur?

Answer 7

• co test annually every 12 months until has had two consecutive years of both tests being negative

Question 8

If a woman has had HSIL treated but no test of cure and then undergoes total hysterectomy what monitoring is required?

Answer 8

• annual co test

- cease only when 2 consecutive co tests are negative

Question 9

If a women has never been screened before and then has a total hysterectomy what screening should she receive?

Answer 9

• if no cervical pathology at hysterectomy

- HPV test on vaginal vault annually until 2 consecutive negative results

Question 10

If a woman is undergoing co-testing after hysterectomy when should she be referred?

Answer 10

if she has either a positive HPV oncogene result or positive cytology

Question 11

If a woman is undergoing co-testing after hysterectomy when should she be referred?

Answer 11

if she has either a positive HPV oncogene result or positive cytology

Question 12

if a woman has vaginal bleeding following total hysterectomy what would you recommend?

Answer 12

• should be assessed by GP or gynaecologist regardless of their surveillance testing results

Question 13

If a woman has a total hysterectomy following genital tract cancer how should they be followed up?

Answer 13

• Gynae-oncologist should make this recommendation - outside of guidelines scope and case by case

Question 14

How should a woman who has had a subtotal hysterectomy be followed up?

Answer 14

5 yearly HPV testing in accordance with general population