Cervical Screening

What is cervical screening?

Screening of the cervix by the Papanicolaou smear, commonly known as the 'Pap smear', is the most common way to detect pre-cancerous changes in the cervix. Pap smears are taken by general practitioners, gynaecological specialists and, in some circumstances, nurse practitioners in doctors' surgeries, community health clinics and hospitals. During the test, a spatula or cytobrush is used to extract exfoliated cells from the cervix. These cells are transferred and fixed to a slide for staining and microscopic evaluation by a pathologist, cytologist or specially trained technician.

Cervical screening has been available for Australian women since the 1960s but it was largely opportunistic until it became a more structured program in 1991. In 1995 the program became known as the National Cervical Screening Program.

What are the symptoms of cervical cancer?

The main symptoms of invasive cervical cancer are unusual vaginal bleeding (inter-menstrual, post-coital or post-menopausal), and sometimes an unusual vaginal discharge. However, these symptoms are not always due to cervical cancer as other conditions can give rise to similar symptoms.

Why screen for cervical cancer?

Cervical cancer is one of the few cancers where screening can detect pre-cancerous lesions which rarely cause any symptoms.

Pre-cancerous changes, when detected, may be treated relatively easily and nearly all cases are cured. There is a range of treatments available for pre-cancerous changes, including cryosurgery (freezing), cauterisation (burning, also called diathermy), laser surgery, or loop or cone biopsies. In a small number of instances a hysterectomy may be necessary. However, the type of treatment depends on many factors such as the whether the change observed is low or high-grade, the woman's age and general health, whether she wants to have children, and her treatment preferences.

The result of detection by the Program of pre-cancerous changes, and treatment when required, has been large falls in incidence and mortality of cervical cancer in Australia since the commencement of the Program.

Who should be screened?

The current Australian recommendation is for all women who have been sexually active at any stage of their lives to have a Pap smear every 2 years until age 70 years. The target age group for the Program is age 20 to 69 years. Women over 70 years should be screened if they have never had a Pap smear. Women over 70 years may cease screening if they have had two normal Pap smears in the last five years. At present, there are Pap Test/cytology registries in each state and territory to provide the infrastructure necessary for regular screening. These registries encourage regular participation of women in screening and the follow-up of women with abnormal Pap smears.     

What is the role of the Australian Institute of Health and Welfare in cervical screening?

The Health Registers and Cancer Monitoring Unit monitors the performance of the National Cervical Screening Program and disseminates this information through annual statistical reports. The report Cervical screening in Australia 2003-2004 can be accessed through our Publications portal. A summary of the report is given below:

• In 2002 there were 689 new cases of cervical cancer detected, an age-standardised rate of 6.8 cases per 100,000 women. The peak year was in 1994 with 1,139 new cases, an age-standardised rate of 13.0 per 100,000 women.
• In 2003-2004, the National Cervical Screening Program screened a total of 3,842,410 women. Of these, 98% were in the target age group of 20-69 years.
• In 2004 there were 16,627 low-grade and 14,507 high-grade abnormalities of the cervix detected by the Program, representing 1.7% of all screens undertaken.
• The number of deaths from cervical cancer has been falling steadily. There were 329 deaths in 1991 when the screening program began; this had fallen to 212 in 2004, an age-standardised mortality rate of 1.8 per 100,000 women.

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