Frequently asked questions about cervical cancer and screening

What are the symptoms of cervical cancer?

Symptoms of cervical cancer can include unusual vaginal bleeding discharge or pain during sex. At any age, if you experience any of these symptoms, see your healthcare provider as soon as possible.

Please note these symptoms do not mean that you have cervical cancer.

What is the Cervical Screening Test?

The Cervical Screening Test (CST) is more accurate compared to the Pap test because it detects the human papillomavirus (HPV). HPV is a common virus that can cause cervical cell changes that may lead to cervical cancer.

The CST is a simple procedure to check the health of your cervix that involves taking a small sample of cells from the cervix and sending it to a laboratory to be examined. The CST is done the same way as the Pap test.

Once you have had your first CST and if your results are normal, you’ll only need to have one every five years.

At what age does routine cervical screening start?

Your first CST is due from 25 years of age, and routine testing is every five years for people who have normal results. If you are not sure, talk to your healthcare provider about when your next test is due.

Who should have the test?

If you are 25 to 74 years old, have a cervix and have ever been sexually active, you should have a CST. This includes people vaccinated and unvaccinated for HPV as well as people who identify as lesbian or transgender. For most women your first CST will be two years after your last Pap test, starting at 25 years of age.

People with disabilities

Yes, if you have ever been sexually active you need to have a CST starting from the age of 25, and continue to have routine testing every five years to 74 years of age.

Can I have the test during pregnancy?

You can be safely screened at any time during or after pregnancy.

See I’m pregnant – what do I need to know? fact sheet for more information.

When to see your healthcare provider?

It is important to see your healthcare provider as soon as possible if you:

• Experience any symptoms at any age, such as unusual vaginal bleeding discharge or pain during sex.
• You are between 25 – 74 years of age, have been sexually active and it has been more than two years since your last test (including a Pap test).

Should I have the human papillomavirus (HPV) vaccine?

Yes, the human papillomavirus (HPV) vaccine works best if it is given before exposure to HPV, before you are sexually active. If you have already been exposed to HPV, the benefits of the vaccine may be reduced.

In Australia the HPV vaccine is given to adolescents through the school-based immunisation program and is approved for use in females aged 9 - 45 and in males aged 9 - 26. Talk to your healthcare provider about the individual benefits to you. The vaccine can be purchased outside of the funded school program; you might be charged extra consultation fees by your healthcare provider. Three doses of the vaccine are currently recommended for those aged over 15.

If you are under 25 and have never had a Pap test before, your first Cervical Screening Test (CST) should be when you turn 25. If you are 25 or over and:

• have never had a Pap test or CST before; or
• your last Pap test was two or more years ago, you should book a CST with your GP now.

Why has the screening age changed from 18 to 25 years?

Cervical cancer in people under the age of 25 is rare as most people have a strong immune system that can clear the HPV infection.

The CST is more accurate at detecting HPV. The Pap test used to look for cell changes in the cervix, whereas the new CST looks for the HPV which can lead to those cell changes. Cervical cancer generally takes at least 10 years of a persistent HPV infection to develop. Because of the improved accuracy of the test at finding this cause, there is a very low risk of an abnormality developing in your cervix within five years.

Why has screening changed from two to five years?

Due to the improved accuracy of the CST, the ability of the body to clear the virus, and the length of time it takes for cancer to develop (10 – 15 years) - it is safe to wait for five years between tests for women who do not have a HPV infection.

Do I need to start screening before 25 if I haven’t had the HPV vaccine?

No, it is safe to start routine cervical screening at the age of 25.

I’ve a family history of cervical cancer. Should I get tested before I turn 25?

If you have any concerns about your family history, speak to your healthcare provider.

Do I still need a CST if I’m no longer sexually active?

HPV can be dormant in your body for years after sexual activity. If you are between 25 to 74 years of age and have ever been sexually active, it is still important to talk to your healthcare provider about having a CST.

Can I choose to do the test before I turn 25?

It is recommended to have your first CST at 25 years of age. The CST is not covered by Medicare for people under 24 years and nine months.

Can I still have the Pap test until I’m 25?

No, the Pap test has been replaced by the CST.

When to see your healthcare provider?

It is important to see your healthcare provider as soon as possible if you:

• Experience any symptoms at any age, such as unusual vaginal bleeding discharge or pain during sex.

If you are turning 25 or are over 25 years of age, and have never had a Pap test or Cervical Screening Test (CST), or it’s been over two years since you had your last Pap test - you should make an appointment today with your healthcare provider to have a CST.

Can I still have the Pap test until I’m 25?

No, the Pap test has been replaced by the CST.

I’ve a family history of cervical cancer. Should I get tested before I turn 25?

If you have any concerns about your family history speak to your healthcare provider.

Why has screening changed from two to five years?

Due to the improved accuracy of the CST and the length of time it takes for cancer to develop, it is safe to wait for five years between tests for women who do not have a HPV infection.

Do I still need a CST if I’m no longer sexually active?

Yes, if you are not currently sexually active it is still important to have CSTs. You should have the test every five years, from 25 to 74 years of age.

How long does the test take?

The CST takes approximately five minutes. Your healthcare provider will then send the sample to a pathology laboratory. In 2 – 3 weeks the laboratory will have processed the test and sent the result back to your healthcare provider.

When to see your healthcare provider?

It is important to see your healthcare provider as soon as possible if you:

• At any age experience any symptoms such as unusual vaginal bleeding discharge or pain during sex.
• You are between 25 – 74 years of age, have been sexually active and it has been more than two years since your last test (including a Pap test).

What does my test result mean?

Possible Cervical Screening Test (CST) results include the following:

• Return to screen in five years
• Repeat the human papillomavirus (HPV) test in 12 months
• Refer to a specialist
• Unsatisfactory test result

Your healthcare provider will talk to you about your CST results.

Return to screen in five years

Your screening results indicate you do not have a HPV infection.

The National Cervical Screening Program will send you an invitation to have your next CST in five years. The latest medical and scientific evidence shows that you can safely return to screen in five years.

Repeat the HPV test in 12 months

Your screening results indicate you do not need further investigation but you should have a repeat test in 12 months.

This is because you have a HPV infection that is likely to be cleared by your body within the next 12 months. A repeat test in 12 months checks that the infection has gone, and you are safe to return to five yearly screening.

If the repeat test shows the HPV infection has not gone, you may need further investigation from a specialist. This does not mean that you have developed cancer. It takes about 10 to 15 years for cervical cancer to develop after a HPV infection and cervical cancer is a rare outcome.

Refer to a specialist

Your screening results indicated you have a type of HPV infection that requires further investigation from a specialist, or the test has indicated that you have abnormalities that might require treatment.

This does not mean you have developed cancer. It takes about 10 to 15 years for cervical cancer to develop after an HPV infection and cervical cancer is a rare outcome. You will be referred to a specialist for a follow-up test, known as a colposcopy test.

It is very important you follow the instructions of your healthcare provider if you received this test result.

An unsatisfactory test result

An unsatisfactory test result does not mean there is something wrong. An unsatisfactory result means your sample cannot be read properly.

It is important to repeat the test in six weeks.  There are many reasons why this happens, such as the number of cells collected was too small.

Abnormalities can usually be treated easily and successfully if detected early. If untreated there is a greater chance of developing cervical cancer.  Cervical Screening aims to prevent cervical cancer. Talk to your healthcare provider if you are anxious or worried about your result.

What does my test result mean?

Possible Cervical Screening Test (CST) results include the following:

• Return to screen in five years
• Repeat the human papillomavirus (HPV) test in 12 months
• Refer to a specialist
• Unsatisfactory test result

Your healthcare provider will talk to you about your CST results.

Return to screen in five years

Your screening results indicate you do not have a HPV infection.

The National Cervical Screening Program will send you an invitation to have your next CST in five years. The latest medical and scientific evidence shows that you can safely return to screen in five years.

Repeat the HPV test in 12 months

Your screening results indicate you do not need further investigation but you should have a repeat test in 12 months.

This is because you have a HPV infection that is likely to be cleared by your body within the next 12 months. A repeat test in 12 months checks that the infection has gone, and you are safe to return to five yearly screening.

If the repeat test shows the HPV infection has not gone, you may need further investigation from a specialist. This does not mean that you have developed cancer. It takes about 10 to 15 years for cervical cancer to develop after a HPV infection and cervical cancer is a rare outcome.

Refer to a specialist

Your screening results indicated you have a type of HPV infection that requires further investigation from a specialist, or the test has indicated that you have abnormalities that require treatment.

This does not mean you have developed cancer. It takes about 10 to 15 years for cervical cancer to develop after a HPV infection and cervical cancer is a rare outcome. You will be referred to a specialist for a follow-up test, known as a colposcopy test.

It is very important you follow the instructions of your healthcare provider if you received this test result.

An unsatisfactory test result

An unsatisfactory test result does not mean there is something wrong. An unsatisfactory result means your sample cannot be read properly.

It is important to repeat the test in six weeks.  There are many reasons why this happens, such as the number of cells collected was too small.

Abnormalities can usually be treated easily and successfully if detected early. If untreated there is a greater chance of developing cervical cancer. Cervical screening aims to prevent cervical cancer. Talk to your healthcare provider if you are anxious or worried about your result.

What to expect?

If your healthcare provider refers you to a specialist, some of the following procedures will be considered/discussed.

What is a colposcopy?

A colposcopy is an examination of your cervix. During this examination, the specialist will use a device called a colposcope, which looks like a pair of binoculars on a stand, which provides a magnified view of your cervix. The colposcope itself does not enter your body. A colposcopy is done by a specialist, usually a gynaecologist. Your healthcare provider can help you decide who to see for the colposcopy.

When you arrive for the appointment, it is fine to ask as many questions about the test as you like. Ask the specialist to explain what they are doing throughout the examination if that will help you.

To have a colposcopy test, you will be asked to lie on an examination bed with your legs supported, in a similar position to when you have a Cervical Screening Test (CST). Like the CST, the specialist will insert a speculum into your vagina. The specialist will then put a special liquid onto your cervix to highlight any abnormal areas.

The specialist will then look through the colposcope to carefully examine your cervix. The colposcope itself does not enter the body.

This examination usually takes 10 – 15 minutes and most people do not experience any pain. However, you may have some discomfort from having the speculum inside your vagina.

Ask your specialist to explain what it means if something is found during the examination.

What is a biopsy?

If areas of your cervix appear abnormal during the colposcopy, a small sample of tissue (a biopsy) may be taken from that area. This sample will be sent to a laboratory for testing.

It may take up to two weeks for the results of your biopsy to come back to your healthcare provider. You should make an appointment with your healthcare provider to discuss the results and talk about treatment (if needed).

If you have a biopsy, you may have some pain for a short time. Avoid rigorous exercise for 24 hours after a biopsy and it is best to avoid sexual intercourse for 1 - 2 days. You can shower, however avoid swimming, bathing and spas for 1 - 2 days.

These precautions reduce your risk of bleeding and/or infection. You may have some discharge and ‘spotting’ for a few hours afterwards, so it is a good idea to take a thin sanitary pad or panty liner to the appointment.

Treatment

Abnormalities can usually be treated easily and successfully if detected early. If untreated there is a greater chance of developing cervical cancer.

If an abnormality is found during your colposcopy, further treatment may be required. Your healthcare provider will talk to you about what treatment options are most appropriate for your personal circumstances.

Treatment options may include wire loop excision, laser or cone biopsy.

Wire loop excision

During this procedure, the abnormal cells are removed from your cervix with a wire loop. The procedure takes 15 – 30 minutes. Most women have the procedure with a local anaesthetic, however some need a general anaesthetic. If a general anaesthetic is advised or preferred, a one-day hospital stay may be necessary.

Laser

Laser treatment removes the abnormal cells using heat from a laser beam. The procedure takes 15 – 30 minutes. Most women have the procedure with a local anaesthetic, however some need a general anaesthetic. Like the wire loop procedure, if a general anaesthetic is advised or preferred, a one-day hospital stay may be necessary.

Cone Biopsy

In this minor operation, a cone-shaped section of the cervix which contains the abnormal cells is removed. A general anaesthetic is normally needed, and a day or overnight hospital stay for recovery may also be required.

This operation is recommended when the abnormal cells are higher in the cervical canal and/or affect the glandular cells. Glandular cells appear higher up in the cervical canal.

Note: After any form of treatment for abnormalities you should not swim, use tampons or have vaginal intercourse for three to four weeks until the cervix is healed. Strenuous exercise should be avoided for seven to ten days as this increases the risk of bleeding and infection.

When to see your healthcare provider?

It is important to see your healthcare provider as soon as possible if you:

• At any age experience any symptoms such as unusual vaginal bleeding discharge or pain during sex.
• Are between 25 – 74 years of age, have been sexually active and it has been more than two years since your last test (including a Pap test).

Is it safe to have a Cervical Screening Test?

The Cervical Screening Test (CST) is safe to have during pregnancy. If you have any concerns and questions, check with your healthcare provider.

Is it safe to have a self-collection sample?

It is not recommended to have a self-collection sample during pregnancy.

Is it safe to have the HPV vaccine?

The human papillomavirus (HPV) vaccines are not recommended for women who are pregnant.

Women who become pregnant after starting the HPV vaccination course are recommended to stop the vaccination course and receive the remaining doses after pregnancy.

Women who around the time of conception or during pregnancy were unintentionally given a dose of the HPV vaccine, should not be concerned as there is a lot of evidence suggesting that vaccination does not harm the mother or the foetus.

Breastfeeding

Women who are breastfeeding can receive the HPV vaccine.

I’ve given birth, when is it safe to have a Cervical Screening Test?

You should have your CST at your 6 - 12 week post-natal check-up.  There is no connection between having a CST and miscarriage. Talk to your doctor about the best time to have your CST.

Abnormal results when pregnant

Abnormal results do not mean you have cancer. Pregnant women with abnormalities should be referred to a specialist experienced in assessing the pregnant cervix.

When to see your healthcare provider?

It is important to see your healthcare provider as soon as possible if you:

• At any age experience any symptoms such as unusual vaginal bleeding discharge or pain during sex.
• You are between 25 – 74 years of age, have been sexually active and it has been more than two years since your last test (including a Pap test).

What is self-collection?

Self-collection is an alternative process for women who have never-screened or not screened regularly, to have a cervical screening test.

Self-collection of a cervical screening test sample must be performed under the supervision of your healthcare provider. You can collect the sample yourself in private.

Who is eligible for self-collection?

Self-collection of a cervical screening test is for women aged 30 years and over, and who:

• have never had a cervical screening test before; or
• are overdue for a cervical screening test by two years or more.

Talk to your doctor or healthcare provider to decide if you are eligible to do a self-collection test.

If at any time you have symptoms, such as pain, unusual vaginal discharge or bleeding or recent persistent unusual changes, you should see your doctor or healthcare provider straightaway.

For more information on self-collection visit the Australian Government Department of Health website and speak to your GP.

What is a Colposcopy?

A colposcopy is an examination of your cervix. During this examination, the specialist will use a device called a colposcope, which looks like a pair of binoculars on a stand, which provides a magnified view of your cervix. A colposcopy is done by a specialist, usually a gynaecologist. Your healthcare provider can help you decide who to see for the colposcopy.

How is a colposcopy test done?

When you arrive for the appointment, it is fine to ask as many questions about the test as you like. Ask the specialist to explain what they are doing throughout the examination if that will help you.

To have a colposcopy test, you will be asked to lie on an examination bed with your legs supported, in a similar position to when you have a Cervical Screening Test (CST). Like the CST, the specialist will insert a speculum into your vagina. The specialist will then put a special liquid onto your cervix to highlight any abnormal areas.

The specialist will then look through the colposcope to carefully examine your cervix. The colposcope itself does not enter the body.

This examination usually takes 10 – 15 minutes and most people do not experience any pain. However, you may have some discomfort from having the speculum inside your vagina.

Ask your specialist to explain what it means if something is found during the examination.

Abnormalities can usually be treated easily and successfully if detected early. If untreated there is a greater chance of developing cervical cancer.

Cervical screening aims to prevent cervical cancer. Talk to your healthcare provider if you are anxious or worried about your result.

If the colposcopist find an area of your cervix that appears abnormal, he/she might take a biopsy and send that to a laboratory for analysis. The laboratory may recommend that treatment be performed, or that you re-screening earlier than usual, so that your cervix can be monitored.

If the colposcopist doesn’t find any abnormal areas on your cervix, no further examinations are required, but you should discuss the results with your colposcopist or GP.

What is HPV?

HPV stands for the human papillomavirus, which is a common virus that is spread by genital skin-to-skin contact during sexual activity. It is so common that many people have it at some point in their lives and never know it as there are usually no symptoms.

How are HPV and cervical cancer related?

If your body does not clear a HPV infection, it can cause changes to cells in your cervix, which in rare cases can develop into cervical cancer. For most women the HPV infection will clear from the body in 1 – 2 years. It usually takes more than 10 years to develop cervical cancer from a persistent infection.

Should I have the HPV vaccine?

The HPV vaccine works best if it is given before exposure to HPV, before you are sexually active. If you have already been exposed to HPV, the benefits of the vaccine may be reduced.

The HPV vaccine is given to adolescents through the school-based immunisation program and is approved for use in females aged 9 – 45 and in males aged 9 – 26. Talk to your healthcare provider about the individual benefits to you. Three doses of the vaccine are currently recommended for those aged over 15.

How did I get HPV?

The HPV virus is spread by genital skin-to-skin contact during sexual activity. You can be exposed to HPV the first time you engage in sexual activity, and from only one sexual partner.

The virus is so common that it is considered a normal part of being sexually active.

Condoms and other barriers such as dental dams may provide some protection from HPV, but they do not cover all the genital skin.

How is HPV treated?

There is no treatment for HPV. In most cases the immune system will clear HPV from the body naturally over time. Most people with a HPV infection have no symptoms and will never know they have it.

Can I be reinfected with HPV?

It is unlikely that you will be infected again with the same strain of the virus, as the body develops immunity to that type.

Please note there are different types of HPV virus, and the virus may remain inactive in your body for many years before becoming active again. So even if you are no longer sexually active, or only have one sexual partner, you should continue screening.

Types of HPV

There are over 100 types of HPV, of which 14 types are known to be oncogenic and cause cancer. Types 16 and 18 cause 70% of cervical cancers in Australia.

Low-grade abnormalities  

Sometimes HPV infections can cause minor changes or abnormalities in the cells. For many women, their body will clear HPV infection but other times the infection may progress.

High-grade abnormalities  

If left undetected, HPV infection can progress and cause cells to mutate and divide. This is known as high-grade abnormalities, and may be pre-cancerous.

Genital warts

In a few people, HPV causes genital warts which are undesirable but harmless. The treatments available for genital warts,  but don’t treat HPV.

Do I still need to get tested for sexually transmitted infections (STI)?

Yes, you should still get tested for sexually transmitted infections (STI). STI testing does not check for HPV, while a CST only looks for HPV. Talk to your healthcare provider for more information.

How much does the HPV vaccine cost?

Vaccines are free for people who are eligible under the National Immunisation Program (NIP). Please check the NIP Schedule to find out which vaccines you or your family are eligible for.

Please note that eligible people get the vaccine for free, but your healthcare provider may charge a consultation fee for the visit. You need to check with them when you make your appointment.

If you are over 15 years old when you get your first dose of HPV vaccine, you will need three doses, not two doses, to provide the best protection. You will need to pay for one of these doses with your healthcare provider because only two doses are covered under the NIP and the school-funded programs.

If you are not eligible for a free vaccine, you may need to pay for it. Your healthcare provider can give you more information.

When to see your healthcare provider?

It is important to see your healthcare provider as soon as possible if you:

• At any age experience any symptoms such as unusual vaginal bleeding discharge or pain during sex.
• Are between 25 – 74 years of age, have been sexually active and it has been more than two years since your last test (including a Pap test).