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CERVICAL CANCER-IMPORTANT POINTS

■ A systematic approach to screening well women has contributed to a decline in incidence and
mortality from cervical cancer in Australia.
■ There is still room to improve participation in screening in Australia: older women and women
of low socioeconomic status are less likely to be adequately screened.
■ Indigenous women have not benefited from improvements in mortality through cervical cancer
screening.
■ Exposure to wart virus infection (HPV) is a normal part of sexual activity.
■ During the acute phase of infection, Pap smear show the changes of a low-grade squamous
cell abnormality.
■ Most women clear the HPV infection and the low-grade abnormality resolves.
■ Persistent infection with high-risk HPV subtypes carries
the possibility of developing high-grade squamous cell
abnormalities.
■ The new NHMRC guidelines on the Management of
Asymptomatic Women with Screen Detected
Abnormalities use evidence from the Pap smear
registries, new understandings of the epidemiology of
HPV and the revised terminology for cervical
cytology — the Australian Modified Bethesda
System 2004.
■ In women with a good screening history, only persisting
low-grade abnormalities require colposcopy.
■ Histologically confirmed low-grade lesions can be safely
monitored with repeat cytology at yearly intervals.
■ High-grade abnormalities continue to require colposcopic
assessment and treatment.
■ All glandular cell abnormalities require colposcopic
assessment and treatment.
■ For effective population screening, for any identified case,
the benefits of investigation and treatment need to outweigh
the risks of intervention and possible unnecessary treatment.
■ The safety of the new guidelines will be monitored using the
Pap test registries to detect any unexpected rise in the
incidence of cancer of the cervix.
■ GPs have a key role to play in recruiting women to screening