New changes to cervical screening (smear test/Pap smear) 

In a nutshell. On 26th July 2023, smear testing is changing. 

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Smears have previously been taken by a nurse or Dr every three years from the age of 25 to 70. Some women* have them more frequently for many reasons. 

This has been done by coming in to see us in practice, lying down and having a speculum inserted into your vagina and a scratchy tissue sample taken of the cervix, which is the entrance to your uterus (womb). This test is called a liquid based cytology test (LBC). 

This can be a procedure which some women can find unnerving, invasive and uncomfortable. We understand that and we do everything we can to make it as comfortable as possible. This type of examination and test can be a huge barrier for women having the smear test, this will hopefully mean more people are able to participate in cervical screening and reduce their risk of cancer. 

From late July, 2023 the way we do smear tests will now be done by a simple swab for most women. This can be done by yourself or a nurse. The result will come back a week later indicating that: 

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• HPV is not detected. Your next HPV test will be in 5 years. 

• HPV 16 or 18 is detected. You will be referred to the colposcopy unit. The nurse will do this and you will receive a letter from the hospital. 

• HPV (other) is detected. You will need to come back to see the nurse for a speculum examination and we will take a tissue sample of your cervix (LBC) and send that to the lab again. Depending on the results, we will either refer you to the colposcopy unit, or ask you to come back in 12 months for a repeat LBC + HPV test. There is an additional small charge for this. Most infections from HPV (other) clear on their own within 2 years. 

• Test is unsuitable for testing.  This means that there are no skin cells on the swab. This is highly unlikely to occur if the swab is inserted even very superficially into the vagina. 

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The swab will test for the presence of the Human Papilloma Virus (HPV) which is the virus that causes the vast majority of cervical cancers in the world. This virus can be picked up by the laboratory on the sample you take and that means that we will see that virus and treat it before it has a chance to turn into cancer. 

Taking the test 

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When you are due for your smear, from 26th July, we will text you as we normally do.  The text will be different, and it will outline the new test and procedure.  Everyone will need to call us and book in. If coming in is not possible, please call the nurse to talk about it. We can, in some cases send the sample to you with instructions to do it at home and send it back to us for processing. 

The nurse will need to have a conversation with you about the new test and obtain your consent. Most of the time, you will be able to do the test by yourself in our toilet and hand the test to the nurse who will ensure it gets to the laboratory and is tested. This is a really simple test to do and takes about one minute. If you want any Sexually Transmitted Infection (STI) testing, let the nurse know and we will give you additional swabs to use. 

There are a couple of reasons why the swab test may not be suitable for you.

  

• If you have any abnormal vaginal bleeding or discharge, pain when you have sex, or pelvic pain we will need to ask you to come in and we will do the smear in the normal way using LBC.  Our nurses are all highly trained and very compassionate, especially when it comes to intimate examinations.  We all understand that it’s a hard thing to do with a very private area of your body.  If you would like to talk to us first about your options, we are more than happy to. 

• If you are on a ‘test of cure’ pathway following a colposcopy or high-grade cervical changes, you will need to have a LBC smear. 

Important points to consider: 

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• HPV testing is safe during pregnancy and from 6 weeks following birth. 

• If you have never been sexually active, please talk to the nurse. You will still probably need cervical screening for HPV as it can be transmitted not just through sexual intercourse.  Intimate touch and kissing can also result in infection. 

• You can do this test at any time during your monthly cycle, but it is best to avoid doing it on the heaviest day of your period. 

• If HPV is found, it does not mean that you have a Sexually Transmitted Infection (STI) and it doesn’t mean that you’ve got it from a recent partner. HPV can lay dormant (sort of sleeping) for many years in your body, and it can reactivate (awaken again) even after it has gone away which is why ongoing screening is very important. 

• Cervical screening with HPV testing is still very important even if you have had the HPV vaccinations because there are many different subtypes of HPV that aren’t covered by the vaccine. 

• HPV testing is still appropriate for people who do not identify as women but if you have a cervix, then you should have your cervical screening done. 

• If you have never had any intimate relations with a male-presenting person, and only had intimate relations with a person with a cervix, you still need cervical screening. There is a common misconception that lesbians or women who have sex with women do not need cervical screening, this is not true. Cervical screening should be undertaken by any person with a cervix. 

For the purposes of this document, the term ‘woman’ means any person who has a cervix or vagina, regardless of how they present or their identified gender 

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For more information, please speak to the nursing team at Hauora Health on 03 548 8663 or go online at https://www.timetoscreen.nz/ 

FAQ (taken from www.nsu.govt.nz) 

Why is the screening test changing? 

The National Cervical Screening programme has saved thousands of lives in New Zealand with the help of the current cervical test (cytology or smear test) by identifying those at a higher risk of cervical cancer. 

However, comprehensive evidence has shown that a new cervical screening test, called HPV Primary Screening, can identify those at a higher risk much earlier than the current test. So, New Zealand is moving to this new test from July 2023. 

How is the test different? 

Cervical screening’s primary aim is to identify people at higher risk of developing cervical cancer for further investigation. This is achieved by looking for early signs that can lead to these cancers. The current cervical screening test (cytology or smear test) requires a speculum examination every 3 years, where a sample is taken from the cervix and tested to determine if there are pre-cancerous cells changes in the cervix or vagina. 

While the current test is effective, there is a viral infection that can be tested for that provides us a much earlier warning signal before cell changes have even occured. This viral infection is called human Papillomavirus (or HPV) and it is responsible for over 99 percent of cervical cancers and around 80 per cent of sexually active people will have had HPV infection at some stage. There are many types of HPV and only a few types of HPV will lead to abnormal, pre-cancerous cells that could progress to cancer. For most people, their body will clear the infection themselves, but persistent infection with HPV can lead to these abnormal cells developing in the cervix and some becoming cancerous. 

So, the upcoming HPV test will instead identify if the HPV virus is present as the first test. This means that HPV primary screening can identify those who may need further testing at an earlier stage than the current test, making HPV primary screening a more effective test for identifying the risk of developing abnormal cell changes that may lead to cervical cancer in the first instance. 

The new HPV screening test will also encourage more people with a cervix or vagina to take part in screening as it will include the option for self-testing. This will help reduce inequities for Māori and Pacific population groups/people.  

Why does this mean you can extend the screening interval from 3 to 5 years? 

Positive results from this new test will be fully investigated, as they are now, but for the majority the test will be negative. People can be confident that a negative HPV test means they are at very low risk of developing abnormal cells that may lead to cervical cancer within the next five years as the test is highly sensitive at picking up HPV infection, and cervical cancer usually takes many years to develop. So, any abnormal cells can be found and treated to stop them from becoming cancer. This means routine cervical screening will only be needed once every five years, not every three years as it is currently required by the current test.  

Clinical modelling predicts the move to HPV screening will prevent about 400 additional cervical cancers over 17 years and will save around 138 additional lives. HPV testing, which is in place in Australia and several other European countries, has demonstrated the same increase in effectiveness and thus they have also adopted the 5-year screening interval. 

What will people notice when HPV primary screening is introduced? 

There will be some changes: 

• The current cervical screening approach involves a clinician taking the sample using a speculum. In the new programme, the option of HPV self-testing with a vaginal swab will be available. This is expected to be more acceptable to participants. A clinician can also take the swab. 

If the HPV test is positive, follow-up will be needed. This might include: 

• a speculum exam to look at the cervix and check the cells 

• a colposcopy, a procedure done in outpatients, where a specialist can inspect the cervix through magnification and may take a biopsy or remove an area of concern. 

When the programme starts, people will need to see their health care provider for the HPV test, even when self-testing. The process will be that a doctor, nurse or other health care worker will explain how to do the test, and the person takes the test in a private area of the clinic. The health care provider may also arrange for the tests to be done off site, for example, at home, or in a non-clinical setting in the community. The clinic will be responsible for getting the sample to the laboratory. 

In the future, the Ministry of Health will be looking at ways to make screening more accessible, which could include mailing-out self-testing kits if they are found to work safely and well. 

Can people self-test now? 

The change to new HPV primary screening programme will be implemented from July 2023. 

The current cytology screening programme remains a high-quality programme by international standards and is effective at preventing many cases of cervical cancer. 

During the transition to the new programme it is important that people continue with cervical cytology screening and not wait for the programme change in 2023. 

Why is HPV immunisation important? 

Persistent HPV infection is responsible for almost all cases of cervical cancer. 

The vaccine is very effective in preventing infection from the nine types of HPV responsible for around 90 percent of the cancers caused by HPV. 

Not all the HPV types that cause cervical cancer are in the vaccine, so people who have been vaccinated need to continue with regular cervical screening. 

HPV immunisation is delivered through school-based immunisation programmes and is also available through your family doctor. HPV immunisation is free for everyone aged 9–26 years (inclusive), including boys and young men. 

Please visit the Ministry’s HPV immunisation webpage for more information. 

What if I’ve had the HPV vaccine, should I still be screened? 

The HPV vaccine is highly effective, but not all the HPV types that cause cervical cancer are in the vaccine, which means it is still very important to have cervical screening to minimise the risk of cervical cancer. 

Combining HPV immunisation with regular cervical screening is the most effective way you can protect yourself against cervical cancer. 

What should I do if I am due for screening? 

Regular cervical screening is the most effective way you can protect yourself against cervical cancer. 

When the programme transitions to HPV primary screening from July 2023, participants will have an HPV test at their next scheduled screen. Regular screening at a 5-year interval will commence only after a negative HPV test is completed, so if you are due for your 3-yearly screen in August 2023, it will still be completed and if negative, 5-yearly from then on. 

The current screening programme continues to be safe and effective, and it is important that people keep having their regular cervical screening tests, and not wait for the change to HPV primary screening in 2023. 

People who are nervous or have concerns can talk to their health care provider. They will be able to help find ways to make screening more comfortable. 

If you are concerned about symptoms that could be cervical cancer, see your doctor as soon as possible. 

Symptoms to watch out for include unusual bleeding between periods, pain or bleeding during or after sex, a persistent discharge, and vaginal bleeding after menopause. 

Visit Time to Screen(link is external) for more information. 

What about cervical cancers not caused by HPV? 

Some kinds of cervical cancer are not caused by HPV, but these are very rare and are usually types of cancer that cervical screening tests cannot find early or prevent. They include cancer of the skin (melanoma) that has spread to the cervix and cancers of the muscles, nerves and connective tissues of the cervix.