NATIONAL CERVICAL SCREENING PROGRAM GUIDELINES
THE RENEWED NATIONAL CERVICAL SCREENING PROGRAM: Quick Reference Guide CHANGES TO THE CLINICAL MANAGEMENT OF PARTICIPANTS AT INTERMEDIATE RISK
HOW HAS THE INTERMEDIATE RISK PATHWAY CHANGED Under the renewed NCSP Clinical Guidelines published in 2016, screening participants who have had an intermediate risk cervical screening result (HPV not-16/18 positive with reflex LBC prediction negative, pLSIL or LSIL) were recommended to have a follow-up HPV test at 12 months and be managed as higher risk and referred to colposcopy if any HPV is detected in their follow-up test. In light of new evidence, it is now recommended that participants with a 12-month follow-up HPV test result of HPV (not-16/18) detected, with LBC prediction of negative, pLSIL or LSIL be regarded as still at intermediate risk and undertake a second HPV follow-up test in a further 12 months’ time. If any HPV is detected at the 2nd follow up HPV test these participants should be referred to colposcopy. This recommendation came into effect on 1st February 2021.
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WHY THIS CHANGE HAS OCCURRED In April 2020, an expert committee reviewed program data relating to biopsy outcomes in participants referred to colposcopy following persistent detection of oncogenic HPV (not 16/18) at their 12-month follow-up HPV test, where LBC was either negative, pLSIL or LSIL. This review found that the risk of CIN2/3 or cervical cancer among this cohort is very low. These data provide reassurance that if HPV (not 16/18) is detected at 12 months with reflex LBC prediction negative, pLSIL or LSIL, patients can safely be retested with an HPV test in a further 12 months. If HPV infection persists at that time these patients should be referred to colposcopy. This change will avoid many unnecessary colposcopies and associated harms (including biopsy, overtreatment, anxiety and financial costs) for screening participants with HPV-related cervical abnormalities that would resolve spontaneously without medical intervention. It will also enable colposcopy clinics to better manage demand and ensure timely access for participants who are at high risk.
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EXCLUSIONS TO THE NEW RECOMMENDATIONS The following groups may be at elevated risk of harbouring a high-grade abnormality and should be referred to colposcopy if HPV is detected at 12 months, regardless of the result of reflex cytology. These include: • participants two or more years overdue for screening at the time of the initial screen • participants who identify as Aboriginal or Torres Strait Islander • participants aged 50–69 years If your patient is in one of the above elevated risk groups, but has already been waiting more than 9 months for a colposcopy under the previous NCSP Clinical Guideline recommendations, a follow-up test should be considered in the first instance. Referral to colposcopy continues to be recommended for all participants with self-collected samples at intermediate risk who test positive for HPV (any type) at 12 months after an initial positive test.
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