Cervical screening (HPV-based program) — KFP-style written assessment

KFP 1 (10 marks)

A 34-year-old woman attends for her first-ever cervical screening test, anxious about the examination. She is well with no bleeding or discharge. You offer her the choice of clinician-collected or self-collected HPV testing; she chooses self-collection and completes the swab in privacy. The laboratory reports oncogenic HPV detected, type not 16/18; reflex liquid-based cytology predicts low-grade changes. ^[5][3]

1. Why was she eligible for self-collection, and what does the swab test? (3) ^[5]
2. State the correct pathway for her result with its evidence-based rationale. (4) ^[3][4]
3. She asks whether the low-grade cytology means she has precancer. Answer precisely. (3) ^[3]

Model answers

1. Since July 2022 every person eligible for screening can choose self-collection — a low vaginal swabs run on the same PCR platforms as clinician samples. Meta-analysis shows PCR-based sensitivity about 90% on self-collected versus 93% on clinician-collected specimens, both surpassing cytology's pooled 87%. It tests for oncogenic HPV; it does not provide cytology directly nor diagnose cancer. ^[5]
2. Other oncogenic types (not 16/18) go to reflex LBC triage: high-grade prediction goes straight to colposcopy; low-grade or negative triage gets a repeat HPV test at 12 months, referring if any oncogenic type persists. The rationale is modelled cost-effectiveness: immediate colposcopy for this group needed over 650 extra colposcopies per additional cancer prevented versus 12-month surveillance, with 20-year cancer risk of about 1% either way. ^[3][4]
3. No — low-grade cytology predictions do not mean precancer. In Australia's first-round national data, women with non-16/18 types and negative/low-grade cytology had low risk of serious disease (3.4% CIN3+, 0.02% cancer), which is exactly why they are followed rather than scoped immediately. ^[3]