Cervical screening (HPV-based program)

Overview

Cervical cancer is the only gynaecological cancer with a population screening test that prevents it, because its cause — persistent oncogenic HPV infection — is detectable years before invasion. Australia's program began as 2-yearly cytology in 1991 and cut incidence dramatically; on 1 December 2017 the National Cervical Screening Program renewed to 5-yearly primary HPV testing with partial genotyping for ages 25–74.^[3][7]

The renewal logic is arithmetic: HPV testing detects CIN2+ far more sensitively than cytology (pooled sensitivity 89.9% vs 62.5% for conventional cytology in Cochrane's 40-study synthesis), so a negative HPV result protects for longer — justifying both the longer interval and starting at 25 rather than 18. The cost is more positive tests and more colposcopies per round; partial genotyping manages that burden by sending only the highest-risk group straight to colposcopy.^[5][4]

The first two Australian years validated the design: among 3.75 million primary HPV tests, colposcopy referral was 3.5%, and cervical cancer was found in about 1% of HPV 16/18-positive women at baseline — higher risk regardless of cytology result, which is exactly why that group bypasses triage.^[12]

References20ShowHide

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3. [3]Smith MA et al. Transitioning from cytology-based screening to HPV-based screening at longer intervals: implications for resource use. BMC Health Serv Res, 2016.PMID 27112193
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