What are the recommendations for cervical cancer screening in an 18-year-old asymptomatic individual with a family history of cervical cancer in Australia?

From the Guidelines

Cervical cancer screening is not recommended for an 18-year-old asymptomatic individual in Australia, even with a family history of cervical cancer. According to the most recent guidelines, cervical screening should begin at age 25, regardless of family history, and continue until age 74 1. The screening involves a human papillomavirus (HPV) test every five years. Family history of cervical cancer does not alter these recommendations because cervical cancer is primarily caused by persistent HPV infection rather than genetic factors. The age threshold of 25 was established because HPV infections are common in younger women but typically clear naturally, and screening before this age may lead to unnecessary interventions for transient infections. Additionally, cervical cancer is extremely rare in women under 25.

Instead, HPV vaccination is the recommended preventive measure for young people, ideally before sexual activity begins. The Australian National Immunisation Program offers free HPV vaccination to adolescents, which provides significant protection against the HPV types most commonly associated with cervical cancer. It is essential to note that while vaccination will provide protection against HPV16- and HPV18-associated invasive cervical cancer in the long-term, screening will still be necessary for the foreseeable future to protect women who will not get the vaccine and who are already infected pre-vaccination 1.

Key points to consider:

• Cervical cancer screening should begin at age 25, regardless of family history
• HPV vaccination is the recommended preventive measure for young people
• Screening before age 25 may lead to unnecessary interventions for transient infections
• Cervical cancer is extremely rare in women under 25
• The Australian National Immunisation Program offers free HPV vaccination to adolescents.

From the Research

Cervical Cancer Screening Recommendations

For an 18-year-old asymptomatic individual with a family history of cervical cancer in Australia, the recommendations for cervical cancer screening are as follows:

• The Australian National Cervical Screening Program has transitioned to primary HPV testing every 5 years for women aged 25-69 years 2.
• However, for women under 25, the guidelines do not recommend routine cervical screening 3, 4.
• A study examining the impact of the Australian National Cervical Screening Program found that the program had a substantial impact on squamous cell carcinoma and overall cervical cancer incidence in women aged 25 years and over, but its impact on the incidence of adenocarcinoma was limited 5.
• Another study found that inviting women for screening from age 20 years yields an additional number of screens, non-negative results, colposcopy referrals, and women treated, but prevents only a small number of frank invasive cancers 4.
• Young Australian women have expressed concerns about delaying the age of cervical screening until 25 years, but are willing to undertake primary screening with HPV testing 6.

Key Considerations

• The age of commencement for cervical screening in Australia is now 25 years, with primary HPV testing every 5 years 2.
• Women under 25 are not recommended for routine cervical screening, unless they have a history of abnormal results or other risk factors 3, 4.
• Family history of cervical cancer is a risk factor, but the guidelines do not provide specific recommendations for screening in this group 2, 5.

Screening Options

• Primary HPV testing every 5 years is the recommended screening method for women aged 25-69 years in Australia 2.
• For women under 25, alternative screening methods, such as cytology-based screening, may be considered on a case-by-case basis 3, 4.