Clarification of cervical cancer symptoms

Some healthcare providers are using low thresholds to determine whether a participant shows symptoms indicative of cervical cancer. Pathology laboratories are getting requests for co-tests for participants with symptoms that are usually not indicative of cervical cancer. This has led to over-referral of participants for co-tests and unnecessary follow-up, where a cervical screening test would have been appropriate, if due. In order to address this issue, a set of more specific symptoms suggestive of cervical cancer has been developed by the National Cervical Screening Program clinical advisors.

When filling out a Pathology Test Request Form, healthcare providers are required to describe the symptoms in more detail to help pathology laboratories understand why a co-test is required. 

The following signs or symptoms can be suggestive of cervical cancer and require further investigation:

• Participants with abnormal vaginal bleeding (post-coital, unexplained inter-menstrual or any post-menopausal) should have a co-test, and usually will be referred for gynaecological assessment.
• Any participant with unexplained persistent unusual vaginal discharge (especially if offensive and/or blood stained) should be investigated with a co-test, and subsequent referral for gynaecological assessment.
• Any participant with unexplained persistent deep dyspareunia (pain during intercourse) should have a cervical screening test (if due), and subsequent referral for gynaecological assessment.

Participants with symptoms suggestive of cervical cancer are tested and managed on a different clinical pathway from those who are asymptomatic and require diagnostic testing  and not cervical screening. More information on the cervical cancer symptoms is available on the NCSP website (see ‘For healthcare providers’ page).

What is a co-test?

Co-testing involves the pathology laboratory performing both the human papillomavirus (HPV) test and liquid based cytology (LBC) test concurrently on the same specimen.  The LBC test is performed irrespective of the HPV test, without requiring an additional request.

When is a co-test required?

Co-testing is recommended for participants of any age with signs or symptoms suggestive of cervical cancer (see above); patients exposed to diethyl-stilboestrol (DES) in utero, and if requested their daughters; patients undergoing Test of Cure surveillance; and for patients who have been treated for glandular abnormalities. 

Healthcare providers should refer to the Pathology Test Guide for Cervical and Vaginal Testing for what to write on the Pathology Test Request Form when ordering a co-test.

state and territory registers into the NCSR to provide national cervical screening records for participants of the National Cervical Screening Program. Until Release 2 is complete, healthcare professionals (including GPs, healthcare workers, pathologists and specialists providing colposcopy services) should continue to contact their state and territory register for screening histories up to 1 December 2017. 

For cervical screening histories post 1 December 2017, please contact the NSCR. For more information please refer to the Transition Quick Start Guide for Healthcare Providers.

Cervical screening test does not screen for other cancers

The Cervical Screening Test detects the HPV, a common virus that can cause cervical cell abnormalities that, in rare cases, may develop into cervical cancer. The Cervical Screening Test does not screen for ovarian cancer, uterine cancer, or endometrial cancer. If your patients present with symptoms of these other cancers, please continue to follow normal clinical procedure.

Online training on the National Cervical Screening Program

Online training on the renewed National Cervical Screening Program is available at NPS MedicineWise Learning. This training developed by NPS Medicine Wise, is free and has been specifically designed for healthcare providers who conduct cervical screening tests and follow-up management for women aged 25-74. The topics covered by the six online modules are:

• Cervical cancer
• Changes to the National Cervical Screening Program
• Communicating the importance of cervical screening
• Screening in practice
• Understanding the cervical screening clinical pathway
• Communicating test results and patient management

Each of the modules attracts Continuing Professional Development (CPD) points.

Myth busting and facts

Links for further information 

• Healthcare providers are recommended to follow the National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding and the Pathology Test Guide for Cervical and Vaginal Testing
• Colposcopists must complete and submit the Colposcopy and treatment form and information about the mandatory notification of cervical screening information within 14 days of the colposcopy episode
• Toolkit for engaging Under-screened and Never-screened women in the National Cervical Screening Program
• A subset of the clinical pathways is included in the Understanding the National Cervical Screening Program Management Pathway: A Guide for Healthcare Providers
• Resources and education materials about the National Cervical Screening Program can be accessed on the website and ordered free of charge. This includes resources to help participants understand their cervical screening results, posters to promote the National Cervical Screening Program and factsheets on self-collection
• National Cervical Screening Program website
• National Cancer Screening Register website
• Factsheet on the new pathology Medicare items for tests under the National Cervical Screening Program