Cervical Cancer Screening Just Got a Whole Lot Better For Everyone

The new test is specifically about saving money and lives

We all love the expression “like a train wreck”, because it so accurately describes the feeling of helpless horror when something completely out of our control goes hurtling past. You reach out, willing your fingers to somehow slow or even stop the poor passengers hurtling to their doom. You watch the impact in a kind of stunned half-aware state, your mind unable to process exactly what is happening but still understanding that it’s not going to end well.

Why am I talking about trains in my article on cervical cancer, you ask?

Because it’s a bit of a train wreck.

Aren’t metaphors fun?

There is currently a petition trending with more than 75,000 signatures calling on the Australian government not to implement their planned changes to the cervical cancer screening program.

The only problem is that these changes are there to save women’s lives.

Pap Smears Galore

Australia has a brilliant screening program for detecting cervical cancer. It’s called the National Cervical Screening Program (NCSP), and is literally the envy of the world. For those who are not Australian women or public health workers, we offer free pap smears every 2 years to every woman in Australia, with the follow-up from an irregular test also covered under our universal health insurance (called Medicare).

The follow-up usually consists of further examination by a gynecologist, often including using a scope to take a biopsy of the cervix. If the results are positive, women usually have to have surgery to remove the suspicious cells and prevent future cancer.

The NCSP has been so successful that it has halved the rate of cervical cancer since 1991, with the vast majority of the remaining cancer occurring in women who do not attend their regular screenings.

If that’s not amazing enough to blow your mind; the NCSP has reduced the number of deaths caused by cervical cancer by almost 75% in the last 30 years.

Take a moment and marvel at the beauty of this graph

For that kind of massive benefit, you’d expect a hefty price-tag, but the NCSP comes in at the truly impressive yearly cost of $15 per woman in Australia.

It’s a bloody spectacular public health policy that has saved literally thousands of lives.

And it’s about to change drastically.

Fuck the patriarchy, am I right?

HPV Vaccination

When we talk about cervical cancer, we inevitably talk about the Human Papilloma Virus (HPV), because it causes >99% of all cervical cancers.

If you were a girl in school in Australia, you probably remember getting the cervical cancer vaccine. It’s a bit of a common misconception, because the vaccination actually guards against HPV, but really the thing we care most about is stopping the cancer (HPV is pretty benign otherwise).

I can’t stress how amazing the HPV vaccine is. We can literally prevent almost all cervical cancer with a 2-dose regimen.

With our world-class system we’ve reached vaccination rates for the HPV vaccine high enough to see herd immunity come into play, meaning that it’s becoming an extremely rare infection.

The vaccine has already reduced the number of pre-cancerous lesions in young women by >50%, and could almost eliminate the disease in our lifetimes.

Sometimes public health is pretty damn exciting.

Take a moment and jump for joy. I’ll wait.

What’s Actually Changing?

The Department of Health commissioned a report to see whether alternatives to the cervical screening program would be a good idea in this wonderful, vaccinated world. You can find the short, 126-page executive summary here.

It’s a gripping read

Keep in mind that this is just the summary. The actual report is hundreds of pages long, and an absolute nightmare to read.

Basically, they’ve really done their homework here.

The report found that there was very strong evidence from a number of studies that replacing the current pap smear with a test for HPV would have 3 main effects;

  1. Increase the sensitivity and specificity of the NCSP, basically meaning that women with abnormal results are more likely to be correctly identified by the test, and reducing the rate that women with normal results are incorrectly identified (fewer false positives and fewer false negatives)
  2. Because of the better accuracy of the test, it was safe to increase the length of time between tests from 2 years to 5 years, and the age that we recommend starting testing could increase from 18 to 25, and
  3. This would result in fewer women having unnecessary surgery to remove suspected cancer/lesions, meaning fewer women with painful and debilitating complications that all surgery occasionally causes

Essentially this means that the new test is better, so we don’t have to test as often or as invasively. Given that the pap smear is notoriously uncomfortable, it’s also probably going to increase the number of women attending for their regular screenings (sadly, it does still require a sample from the cervix, so a doctor is still going to have to scrape some cells off there).

In the words of the president of the AMA; “importantly, it will mean that thousands of women will avoid surgery historically performed (in good faith) to reduce the risk of progression to severe pre-cancerous changes or Cervix Cancer.”

In other words, the new screening regimen will save women’s lives.

Again, people; joy

It’s actually a very hopeful story; this new test heralds the day when cervical cancer is a thing of the past.

It’s a good day. Time to celebrate.

In a spectacular blunder, the Department of Health has just announced that the rollout of the new screening test will be delayed by 6 months, coming in December instead of May. A royal screwup, but at least the improvements are still happening; thanks @LRussellWolpe for the update!