Recommended Frequency for Cervical Smear Screening in New Zealand
In New Zealand, cervical smear screening is recommended every 3 years for women aged 25-69 years, with primary HPV testing as the preferred screening method.
Current Recommendations
The most recent evidence indicates that New Zealand has moved toward a 3-yearly screening interval with primary HPV testing as the optimal approach for cervical cancer screening. This represents a shift from earlier practices that involved more frequent screening.
Age to Begin and End Screening
- Starting age: 25 years
- Ending age: 69 years (women can discontinue screening at age 70 if they have had adequate prior screening)
This approach is supported by research specific to New Zealand that has evaluated the effectiveness of HPV-based screening in both vaccinated and unvaccinated populations 1, 2.
Screening Interval and Method
- Recommended interval: Every 3 years
- Preferred method: Primary HPV testing with partial genotyping for HPV 16/18
- Women positive for HPV 16/18 are referred directly to colposcopy
- Women positive for other oncogenic HPV types undergo cytological triage
This approach has been shown to be more effective and less costly than previous cytology-based screening programs 1.
Special Considerations
Previous Abnormal Results
Women with a history of cervical cancer, high-grade precancerous lesions (CIN II or III), or who are immunocompromised should receive more intensive surveillance and may require more frequent screening.
Post-Hysterectomy
- Women who have had a total hysterectomy for benign disease (with removal of the cervix) and no history of high-grade CIN do not require routine screening
- Women who have had a subtotal hysterectomy (cervix remains) should continue screening according to standard recommendations
Evidence Base
Research specific to New Zealand has demonstrated that 5-yearly HPV screening in women aged 25-69 years with partial genotyping would be more effective and less costly than more frequent cytology-based screening 1. This approach is predicted to reduce cervical cancer incidence and mortality by 12-16% while saving 4-13% in program costs.
The transition from cytology to HPV-based screening is predicted to reduce cervical cancer incidence by 17% in Māori women and 14% in European/Other women 2, addressing some of the disparities in cervical cancer rates between these populations.
Implementation Considerations
While New Zealand has historically had high screening coverage (82.5% in some regions) 3, there are disparities in screening participation between different population groups. Māori women have lower screening coverage (68%) compared to European/Other women (81%) 2, highlighting the importance of culturally appropriate screening approaches.
Common Pitfalls to Avoid
- Over-screening: Frequent screening (less than 3-yearly intervals) increases costs and potential harms without substantial additional benefits
- Under-screening of older women: Women aged 55+ years have historically been under-screened 3
- Inappropriate discontinuation: Women should only discontinue screening at age 70 if they have had adequate prior screening with normal results
By following the recommended 3-yearly screening interval starting at age 25, New Zealand's approach aligns with international evidence showing that more frequent screening does not substantially improve outcomes while increasing costs and potential harms from unnecessary procedures 4.