Too many Pap tests
Most Australian women are currently having more Pap smears than their health requires, according to new research led by a University of New South Wales academic.
While the National Australian Cervical Screening Program recommends women between 18 and 70 years should have a Pap test every two years, the research found Australian women fared no better than those in comparable countries who were screened less often, in terms of the impact on incidence and deaths from cervical cancer.
The National Cervical Cancer Screening Program is undergoing a major review to assess the evidence on screening interval, age of screening and new technologies, as well as the impact of HPV vaccination.
The research is based on 20 years' worth of data from Australia, New Zealand and England. The paper, which has just been published in the journal Cancer Causes and Control, lends further support to a large body of international evidence that demonstrates screening only needs to be done every three years in women under 50, or every five years in older women.
"The screening program has been hugely successful since it was introduced in Australia in 1991, with cervical cancer mortality rates falling by 44 per cent between the mid-1990s and the mid-2000s," says an author of the paper, Associate Professor Karen Canfell, who is based at UNSW's Lowy Cancer Research Centre.
But the results for reductions in mortality are similar in New Zealand and England, where the recommended screening interval is less frequent. New Zealand encourages screening every three years in women of all ages and England has also predominantly recommended screening every three years, and in 2003 began recommending screening every five years for older women.
The current cervical screening program is estimated to cost the Australian Government $195 million each year. Currently 61 per cent of women are screened every two years.
Associate Professor Canfell says if new HPV screening technology is introduced, then women might only need to have a cervical screening test every five or six years.
There are three options being considered in the current national review of the screening program: using the current Pap test every three years in younger women and five years in older women; using newer technologies for taking and reading the Pap smear but also incorporating these longer screening intervals, and using an HPV test every five years.
While Associate Professor Canfell, who is also involved in the national review, emphasises that the landscape has changed for younger women who are being vaccinated against HPV, she says we will still need a screening program for the foreseeable future.
"Cervical screening remains very important because the vaccine doesn't protect against all cervical cancers, and also mid-adult and older women are not protected by vaccination," says Associate Professor Canfell, who acts as an advisor to Cancer Council Australia.
"But screening can potentially be better tailored to work together with vaccination; and that is the purpose of the current national review of the program.
"While the review is ongoing, women should be aware that the current recommendation stands; which is that sexually active women should be screened every two years from age 18-20 to 69 years. Women should be reassured that the current rigorous process of review is examining the worldwide evidence and its applicability to Australia before any change is made," she says.