National Cervical Screening Program monitoring report 2025

A new screening pathway was developed for the renewed NCSP, based on a participant’s risk of significant cervical abnormality. This risk is categorised as 'low risk', 'intermediate risk', or 'higher risk'.

The screening pathway starts with the first step – an HPV test with partial genotyping.

A positive HPV test means that one or more oncogenic types of HPV have been detected. There are 14 oncogenic HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68, with types 16 and 18 causing 70%–80% of cervical cancers in Australia (Brotherton 2008). The HPV test used in cervical screening incorporates partial genotyping of the HPV detected. This means it not only can detect oncogenic HPV, but also can determine whether the oncogenic HPV type detected is 16 or 18, or neither of these.

The 4 possible results of the HPV test are:

• oncogenic HPV not detected
• oncogenic HPV 16/18 detected
• oncogenic HPV (not 16/18) detected
• unsatisfactory HPV test.

The result of the HPV test determines whether cytology is also performed. This cytology test is called a ‘reflex LBC’, to reflect that it occurs automatically on the same cervical sample if an HPV test result indicates that it is required. Note that if the screening sample is a self-collected vaginal swab, then a second sample from the cervix is required if cytology will alter the risk category assigned.

This cytology test is used to provide further information to allow a risk to be allocated. This can be referred to as triage.

• 'Oncogenic HPV not detected' means that the participant is considered low risk, and reflex LBC is not required.
• 'Oncogenic HPV 16/18 detected' means that the participant is considered higher risk. Reflex LBC is performed on this sample, but the result does not affect the risk.
• 'Oncogenic HPV (not 16/18) detected' means that reflex LBC is required to determine the participant’s risk.
  • If the reflex LBC result indicates there is a high-grade abnormality present (including cervical cancer or a glandular abnormality), the participant is considered higher risk.
  • If the reflex LBC result indicates there is either no abnormality present or a low-grade abnormality present, the participant is considered intermediate risk and will need to have a follow-up HPV test in 12 months. At their follow-up HPV test:
    • If there is no oncogenic HPV detected, their risk changes to low risk.
    • If oncogenic HPV 16/18 is detected or oncogenic HPV not (16/18) is detected with a reflex LBC result of high-grade abnormality (including cervical cancer or a glandular abnormality), their risk changes to higher risk.
    • If oncogenic HPV (not 16/18) is detected and the reflex LBC result indicates there is either no abnormality present or a low-grade abnormality AND the participant is 2 or more years overdue for screening at the time of the initial screen, an Aboriginal and/or Torres Strait Islander participant, or aged 50 or over, their risk changes to higher risk.
    • If oncogenic HPV (not 16/18) is detected and the reflex LBC result indicates there is either no abnormality present or a low-grade abnormality, their risk remains as intermediate risk and they will need to have a further follow-up HPV test in another 12 months. At their second follow-up HPV test:
      • If there is no oncogenic HPV detected, their risk changes to low risk.
      • If any oncogenic HPV is detected (oncogenic HPV 16/18 or oncogenic HPV (not 16/18)), their risk changes to higher risk.
  • If the reflex LBC is unsatisfactory, a new sample will need to be collected and the LBC test repeated.
• 'Unsatisfactory HPV test' means that a new sample will need to be collected and tested. No risk is allocated.

The risk allocated to the participant then determines what recommendation they will receive at the conclusion of the screening episode.

At the completion of a primary screening episode, all participants are allocated a risk of low risk, intermediate risk, or higher risk:

• Participants considered low risk are recommended to rescreen in 5 years.
• Participants considered intermediate risk are recommended to have a follow-up HPV test in 12 months, after which their risk will be changed to:
  • low risk (recommended to rescreen in 5 years)
  • higher risk (referred for colposcopy),
  • or their risk will remain as intermediate risk (follow-up HPV test in 12 months), after which their risk will be changed to either low risk or higher risk.
• Participants considered higher risk are referred for colposcopy.

Self-collected samples in the screening pathway

There are some slight differences in the screening pathway for participants who self-collect a sample for their HPV test. Up until 30 June 2022, only those aged 30 or over who had never participated in cervical screening or were 2 or more years overdue for cervical screening, and who declined a practitioner-collected sample, were eligible to self-collect a vaginal sample that is tested for oncogenic HPV.

From 1 July 2022, everyone eligible to participate in cervical screening now have the choice to access self-collection as an alternative to practitioner-collection.

A self-collected vaginal sample is suitable for an HPV test but is not suitable for reflex LBC, because a self-collected vaginal sample contains vaginal cells, but an LBC requires cervical cells to assess for cervical cell abnormalities. This is not an issue if the HPV test result is ‘Oncogenic HPV not detected’ as the participant is considered low risk and recommended to rescreen in 5 years (no reflex LBC performed).

However, if the result is ‘Oncogenic HPV (not 16/18) detected’, the participant needs to have a separate sample collected by a practitioner for a reflex LBC test to be performed on cervical cells to determine their risk.

If the HPV test result is 'Oncogenic HPV 16/18 detected' the participant is considered higher risk and referred for colposcopy as per the standard screening pathway, with the reflex LBC then performed at colposcopy.

Screening pathway used in this report

This report uses the screening pathway in the National Cervical Screening Program Guidelines.

The National Cervical Screening Program screening pathway changed for participants at intermediate risk, effective from 1 February 2021 (Cancer Council Australia Cervical Cancer Screening Guidelines Working Party).

Prior to 1 February 2021, participants with a cervical screening result of intermediate risk were recommended to have a follow-up HPV test at 12 months and be managed as higher risk if any oncogenic HPV was detected in their follow-up HPV test and low risk if their follow-up HPV test did not detect oncogenic HPV.

From 1 February 2021, participants with a follow-up HPV test result of HPV (not 16/18) detected and an LBC prediction of negative, possible low-grade squamous epithelial lesion (LSIL), or LSIL instead remain at intermediate risk and undertake a second HPV follow-up test in a further 12 months. The exceptions to this are participants who are 2 or more years overdue for screening at the time of the initial screen, Aboriginal and/or Torres Strait Islander participants, and participants aged 50 years or over, who are instead considered higher risk.

As some data in this report pre-date the change to the screening pathway, this report uses the pre-2021 screening pathway for data from 1 January 2018 to 31 December 2020, and the post-2021 screening pathway for data from 1 January 2021 onwards.