Information for Health Professionals
Information on cervical screening for health professionals.
- Your role in screening
- Taking a Pap smear
- Communicating with the pathologist
- Benefits and limitations of cervical screening
Your role in screening
How can I help to increase the number of women who screen regularly?
Regular Pap smears can help prevent up to 90 per cent of the most common type of cervical cancer.The majority of Australian women consult a general practitioner at least once a year, which means general practitioners play a crucial role in encouraging women to screen regularly.
As general practitioners take around 80% of all Pap smears, they are also in a key position to help women understand that cervical cancer is preventable.
Even if a woman is embarrassed about having a Pap smear, research has shown that most will accept their general practitioner's advice about having one.
Why do some women not have regular Pap smears?
There are many reasons for why some women do not have regular Pap smears. Some of these reasons are outlined below along with suggestions for how to help women overcome their reluctance.Common reasons women give for not having a Pap smear include:
- forgetting when their next Pap smear is due
Talk to women about the Pap Test Register and/or your own practice's reminder system, if one is in place. - embarrassment, anxiety or fear about the procedure
Ask them what would make them feel more comfortable about having a Pap smear. - lack of knowledge about the benefits of regular Pap smears
Explain that Pap smears are not a test for cancer, they are a test to help prevent cervical cancer. Pap smears are the best way for a woman to reduce her risk of developing cervical cancer. - some women are reluctant to have a Pap smear taken by a general practitioner they know well
Suggest an alternative practitioner or provide information on a local health service, family planning or sexual health clinic or Aboriginal Medical Service. - expectation that the general practitioner will suggest a Pap smear if one is necessary, and that if he or she doesn't, then the test is not important.
Even if a woman is embarrassed about having a Pap smear, research has shown that most women will accept their general practitioner's advice about having one. Some women rely on their general practitioner to raise the issue.
Which groups of women are screening less often than recommended?
Older women
Cervical screening rates are still low in older women. About half of the new cases of cervical cancer diagnosed each year are in women over 50 years of age as women in this age group are less likely than younger women to have regular Pap smears. More women over 50 years of age die from cervical cancer because their cancer is diagnosed later when treatment is more difficult.Aboriginal and Torres Strait Islander women
Research shows that the rate of Aboriginal and Torres Strait Islander women who die from cervical cancer is much higher than that of non-Indigenous women. Some strategies to support Aboriginal and Torres Strait Islander women to participate in screening include:- being aware of language barriers and addressing these (for instance, using an interpreter);
- acknowledging specific cultural beliefs and the belief in privacy (women’s business);
- acknowledging shame, fear and embarrassment;
- ensuring the practice is culturally safe and culturally effective;
- seeking a female colleague to perform the Pap smear; and
- arranging for an Aboriginal health worker to accompany the woman if she would find this helpful.
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What is the Practice Incentive Program (PIP)?
The Practice Incentives Program (PIP) provides a range of incentives to support general practices improve the quality of care provided to patients. Practices must be accredited or registered for accreditation against the Royal Australian College of General Practitioners Standards for General Practices to participate in the Program.The PIP Cervical Screening Incentive offers financial incentives to encourage general practitioners to take cervical smears from unscreened and underscreened women aged between 20 and 69 years. Underscreened women are those who have not received a cervical smear for four years or more. The Initiative also rewards general practices that reach an overall practice screening target rate.
The incentive has three components: a Sign-on Payment, a Service Incentive Payment (SIP) and an Outcomes Payment.
Sign-on Payment
PIP practices receive a one-off sign-on payment when they join the incentive.Service Incentive Payment (SIP)
A SIP for cervical screening is paid when a GP screens a woman aged between 20 and 69 years who has not had a cervical smear in the last four years. The SIP is available in addition to a consultation fee.Outcomes Payment
The outcomes payment rewards practices that adopt a systematic approach to cervical screening. Practices participating in the Cervical Screening Incentive that reach the target screening rate will automatically receive an outcomes payment.Application forms and further information can be obtained from the PIP Information Line 1800 222 032
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What is the current participation rate?
Recent data (Cervical screening in Australia 2002-2003 - May 2006) shows that the participation rate in cervical screening for women in the target age group was 60.7%.What is the mortality rate from cervical cancer?
The lifetime probability to age 75 years of a woman in Australia developing cervical cancer is one in 183. In 2003, 238 women died from the disease.Top of Page
Taking a Pap smear
There are two important components in ensuring accurate Pap smear reports - good smear taking technique and rigorous cytological examination.An optimal Pap smear sample contains:
- sufficient mature and metaplastic squamous cells to indicate adequate sampling from the transformation zone; and
- sufficient endocervical cells to indicate that the upper limit of the transformation zone was sampled, and to provide a sample for screening for adenocarcinoma and its precursors.
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Communicating with the pathologist
Good communication with the pathologist is essential. Pap smears cannot be read in isolation, but must be read in the presence of details about the reason for the Pap smear and clinical history especially symptoms such as bleeding.Providing such details on the request form ensures the most accurate result possible is obtained.
Cytology items covering Pap and vaginal vault smears were revised in 1991 in conjunction with the development of the national policy. Smears need to be designated on the cytology form as one of the following:
- 73053 - a routine screening Pap smear taken at the usual two year interval on asymptomatic women;
- 73055 - a Pap smear taken as part of the investigation or management of women with symptoms or history of cervical pathology; or
- 73057 - a vaginal vault smear.
Benefits & limitations of cervical screening
There is convincing evidence that a systematic approach to screening provides better protection against cervical cancer than purely opportunistic screening.Although the Pap smear is not a perfect test there is currently no better way for preventing the development of cervical cancer.
Health professionals can increase women's confidence in cervical screening by helping them to understand:
- both the benefits and the limitations of the Pap smear;
- the importance of regular screening every two years, where no abnormality has been previously detected;
- the natural history of cervical cancer, HPV and abnormalities;
- all treatment options, if they have an abnormality;
- that any symptoms, such as bleeding, discharge or pain between Pap smears may require investigation even if the previous result was normal.
Page currency, Latest update: 01 September, 2006