Cervical Screening Test (CST) replaced Pap Smears
On the 1st of December 2017, Pap smears has been replaced by CST. There are a few differences between the two, mainly the interval screening period and the type of testing that it performed.
The procedure involved in the testing has not changed from Pap smears to CST. A speculum examination is still performed to assess the cervix and a brush is used to obtain a sample. The difference in the testing is that CST is more sensitive as it checked for the presence of human papillomavirus (HPV), instead of just abnormal cells. The traditional pap smears used to check for abnormal cells in the cervix through a smear. HPV is an infection that can cause abnormal cells in the cervix and there is more than 200 subtypes of HPV. CST checks for the presence of these viruses and highlights to the practitioner the subtype of virus, especially the high risk ones such as HPV 16 and HPV 18.
CST is recommended for all women from the ages of 25-74 years old who has been sexually active and this can be done through your GP or gynaecologist. Of note is, you may contract HPV even if you have only had one sexual partner. The difference in the time interval for testing, if your results are NORMAL/NEGATIVE, your next CST is 5 years (instead of the usual 2 years with pap smears).
If the results are ABNORMAL/POSITIVE, your doctor may also recommend a repeat testing in 12 months or a referral to a gynaecologist for a review. The reason for a repeat screen is because many people would be able to clear the infection naturally.
If a gynaecologist review is required, it might include a repeat test or a colposcopy examination. A colposcopy examination is similar to a CST screening procedure, where the cervix is being assessed. The examination does take longer than the CST and a colposcopy is used to magnify the view of the cervix so that the cervix could be assessed thoroughly. This examination takes about 5-10 minutes and your gynaecologist may place acetic acid (vinegar) and iodine on the cervix to aid the assessment. The application is not painful, and should not be any more uncomfortable than the routine CST screening.
If there appears to be abnormal cells, your gynaecologist may recommend a biopsy, which can feel like a pinch to some women. Some women might not feel anything then it’s done. The sample is then sent to the lab for further assessment. Some discomfort may be present and this can usually be managed with simple pain relief.
If the examination suggest, or the results show high grade changes, further treatment may be advised. Treatment options may include :
1. Large Loop Excision of Transformation Zone (LLETZ)
2. Laser treatment
3. Cone biopsy
Your gynaecologist will discuss the treatment options with you taking into account your results, and your personal circumstances.
If you are wondering about the safety of CST in pregnancy, it is a very safe procedure to perform in pregnancy. However, if treatment is required, this may sometimes be performed after the baby is born.
Sydney areas with the lowest cervical cancer screening rates
1. Campbelltown 44.2 per cent
2. Blacktown 46.1 per cent
3. Holroyd 47.1 per cent
4. Penrith 48.1 per cent
5. Auburn 48.1 per cent
6. Liverpool 48.3 per cent
7. Camden 48.7 per cent
8. Burwood 48.9 per cent
9. Strathfield 49.4 per cent
10. Parramatta 50.4 per cent
Sometimes, there is associated stigma with getting the test done in certain cultural areas, especially if they need to reach out to a male doctor within the community. You can always reach out to a female doctor. There is also the possibility for you to perform a self collection sample for CST screen however please discuss this with your healthcare provider to determine if this is a suitable option.
The aim of CST is to never develop cervical cancer. In Australia, about 800 cases of cervical cancer is diagnosed annually, and up to 80% of these cases occurred in women who have never had a pap smear/CST. Even if you have had the vaccination for cervical cancer, it is still important to get your CST done as the vaccines do not cover for all the HPV subtypes. The CST is one of the best cancer screening tools available.
The Department of Health has provided this informative video:
Dr Adeline Chan is a female gynaecologist in Sydney serving the North Western Sydney and Hill District region.