Current Cervical Cancer Screening Guidelines in Australia
In Australia, the current cervical cancer screening program recommends 5-yearly primary HPV testing for women aged 25-74 years, replacing the previous 2-yearly Pap test program for women aged 18-69 years. 1, 2
Core Recommendations
- Screening begins at age 25 (regardless of sexual history or vaccination status) and continues until age 74 1, 2
- Primary HPV testing is performed every 5 years, with partial genotyping for HPV 16/18 3, 2
- Women who test positive for HPV 16/18 are directly referred for colposcopy due to higher risk 2
- Women who test positive for other high-risk HPV types undergo liquid-based cytology triage testing 3, 2
- Women with negative or low-grade cytology results and non-16/18 HPV are recommended for 12-month follow-up HPV testing 3, 2
- Women who have had a total hysterectomy with removal of the cervix and no history of high-grade lesions do not require screening 4
Management Pathways
- Women with HPV 16/18 positive results are referred directly to colposcopy regardless of cytology results 2
- Women with other high-risk HPV types and high-grade cytology are referred to colposcopy 3, 2
- Women with other high-risk HPV types and negative or low-grade cytology undergo a 12-month follow-up HPV test 3, 2
- If the 12-month follow-up test is positive for any high-risk HPV type, referral for colposcopy is recommended 2
Special Considerations
- HPV-vaccinated women follow the same screening recommendations as unvaccinated women 4, 5
- Self-collection is available as an option for under-screened women (those who are at least two years overdue for screening) 6
- Women who exit the program at age 74 should have had two negative HPV tests within the previous 10 years 5
Program Effectiveness
- The transition from 2-yearly cytology to 5-yearly HPV testing is predicted to reduce cervical cancer incidence and mortality by 24-36% 3
- Australia is projected to reach a cervical cancer incidence of fewer than 4 cases per 100,000 women by 2028, potentially eliminating cervical cancer as a public health problem 1
- The combination of high HPV vaccination coverage and the renewed screening program puts Australia on track to be one of the first countries to eliminate cervical cancer 1
Common Pitfalls to Avoid
- Continuing to screen women under age 25, which can lead to unnecessary interventions for lesions that would likely regress 4
- Screening more frequently than every 5 years, which provides minimal additional benefit while increasing harms from false positives 7
- Failing to offer self-collection to eligible under-screened women, which is an important strategy to increase participation 6
- Referring women with non-16/18 HPV and low-grade cytology directly to colposcopy, which is not cost-effective and leads to unnecessary procedures 3
The Australian program's evidence-based approach balances the benefits of early detection with minimizing harms from over-screening and unnecessary procedures, while leveraging the country's high HPV vaccination rates to move toward cervical cancer elimination.