Clarification of Cervical Cancer Symptoms
Some health care 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 the over-referral of participants for co-tests and unnecessary follow-up, where a cervical screening test would have been appropriate, if due.
To address this issue, a set of more specific symptoms suggestive of cervical cancer has been developed by the National Cervical Screening Program clinical advisers.
When filling out a Pathology Test Request Form, health care providers are required to describe the symptoms in more detail to help pathology laboratories understand why a co-test is needed.
The following signs or symptoms can be suggestive of cervical cancer and need 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.
Symptomatic participants need diagnostic testing, not cervical screening.
More information on the cervical cancer symptoms is available on the National Cervical Screening Program website.
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 further 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 their daughters (if requested); patients undergoing Test of Cure surveillance; and patients who have been treated for glandular abnormalities.
Health care 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.
National Cancer Screening Register Update
The implementation of Release 2 of the National Cancer Screening Register (NCSR) is on schedule to be completed by 29 June 2018.
This means that all pre 1 December 2017 results will have been migrated from the 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, health professionals (including GPs, health care 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.
Links for Further Information
Health care 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.
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 fact sheets on self-collection.
National Cervical Screening Program website
National Cancer Screening Register website
Visit the HealthPathway for Cervical Screening.
For a list of all localised pathways see:
Mid and North Coast Localised Pathways
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