CSTs are the new Pap

CSTs are the new Pap

For more of our lives, we’ve known them as Pap Smears, the dreaded poke and prod with a metal contraption.

None of us like them, but we know they’re potentially lifesaving, so we make our semi-regular appoints. They might not be as regular as they should be, but that’s ok, right? Wrong.

Regular testing is critical to identifying cancer early enough to treat it. The good news? Testing for cervical cancer has changed, meaning doctors are able to spot issues even earlier, making the chances of survival even greater.

We spoke to Dr Angela Rassi, co-principal of Sydney Perinatal Doctors about how things have changed, and why what’s now known as Cervical Screen Tests, are just as important as ever.

SS: How have pap smears changed in recent years?

AR: Pap smears changed to the Cervical Screening Test (CST) on 1 December 2017. The CST detects the presence of human papilloma virus (HPV) which is a virus that can cause changes in the cells of the cervix. Sometimes, these changes can lead to the development of cervical cancer many years down the track. It is different to the Pap smears performed previously because the Pap smear was just used to detect the cell changes caused by HPV. So, with the CST we are now detecting women one step earlier in the long process that is the development of cervical cancer. It is thought that the change from Pap smear to CST will reduce cervical cancer rates and deaths by over 20 per cent. The other change is that the CST is generally performed every 5 years if a normal result is obtained, whereas the Pap smear was every 2 years.

SS: Has the process changed?

AR: The process of collection of a CST is much the same as a Pap smear. First, the doctor will ask some questions about your gynaecological and sexual health. Then the patient will disrobe from the waist down and lie down on the examination table. The doctor will examine the vulva, and then insert a speculum into the vagina to hold the vaginal walls open to allow the cervix to be visualised. Two brushes are used to gently collect a sample from the cervix.

There is now an option to self-collect your CST, where the patient inserts a cotton swab into the vagina to collect their own sample. Self-collection is not appropriate for everyone, so it is best to discuss with your GP if this is right for you. These samples are then sent to a laboratory to be analysed for the presence of HPV and results are available approximately 3-5 days later. 

SS: If HPV is detected, should you be alarmed?

AR: There is no need to be alarmed. Four out of five people will have HPV at some point in their lives. Most people will have no symptoms and will clear the virus on their own with no consequence. For some people with HPV, we simply repeat the CST in a year to check if the HPV has been cleared. For other people with HPV, they

may require further investigation with a colposcopy, which is similar to a CST but a little more involved.

SS: Are there many types of HPV?

AR: There are more than 100 strains of HPV, and the virus is extremely common. Not all strains of HPV cause cancer, some cause genital warts, which are treatable and do not develop into cancer. Occasionally, a person's immune system will not clear the HPV on its own. This is when cell changes can develop which can sometimes lead to cervical cancer.

SS: Does screening save lives?

AR: Absolutely! Cervical cancer is largely preventable with the HPV vaccination and a robust screening program like we have here in Australia. In fact, Australia is aiming to be the first country to eliminate cervical cancer as a public health issue.

Regular screening allows for the detection of cell changes within the cervix. These changed cells can be removed before they even have the chance to turn into cancer. So, CSTs can actively prevent people from developing cervical cancer. If cancer has already developed, early detection greatly improves treatment options and survival.

SS: What are the survival rates?

AR: According to data collected between 2014 and 2018 in Australia, the chance of surviving 5 years following cervical cancer diagnosis is 74 per cent.