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1. Which of the following groups are considered to be underscreened in the National Cervical Screening Program (NCSP)?

a. People aged 25-34 years
b. People who live in rural or remote areas
c. People in custody
d. People in the LGBTIQ+ communities
e. People aged 70-74 years

2. True or False: 
Self-collected HPV samples have not been proven to be a reliable method of cervical screening.

3. True or False:
Underscreened patients are likely to decline a self-collected HPV swab.

4. True or False: 
Patients with a positive HPV result on a self-collected sample are not likely to adhere to further recommended clinical management.

5. True or False:
General practice involvement in clinical audits can improve the uptake of cervical screening.

 

So, how did you go? Keep reading to find out the answers…


Australia’s NCSP has proven to be a successful program in reducing illness and deaths from cervical cancer1. However, participation in the program may not be as high you would expect, with only 46.5% of eligible patients undertaking cervical screening in 2018-20192.  Importantly. Over 80% of cervical cancer occurs in underscreened patients3, so, it is vital that we understand more about increasing screening uptake in these patients.

1. Which of the following groups are considered underscreened groups in the National Cervical Screening Program (NCSP)?

a. People aged 25-34 years
b. People who live in rural or remote areas
c. People in custody
d. People in the LGBTIQ+ communities
e. People aged 70-74 years

Answer: All of the above. Other groups who may be underscreened include Aboriginal and Torres Strait Islander people, some culturally and linguistically diverse communities, people who have undergone female genital mutilation/cutting, people from lower socioeconomic groups, people with disabilities, people with addictions, people who are homeless, people who are overweight, those who have had a previous negative experience with Pap smears, and those who have experienced sexual assault4.

2. True or False: Self-collected HPV samples have not been proven to be a reliable method of cervical screening.

Answer: FALSE! You are not alone if you answered this one incorrectly. Research shows that many practitioners believe that HPV self-collection is not a reliable test4 when in fact the opposite is true. When a PCR-based HPV assay is utilised, the test is as sensitive as a swab taken by a practitioner during a speculum examination for detecting pre-cancer (CIN2+/AIS)5.

3. True or False: Underscreened patients are likely to decline a self-collected HPV swab.

Answer: FALSE! A 2018 Victorian study found that over 86% of patients who were underscreened and had declined a speculum examination, agreed to perform a self-collected HPV swab if there was extensive health practitioner support and involvement in the process6.  In another study, 87% of screening participants reported that self‐collection provided greater control over one’s health7.

4. True or False: Patients with a positive HPV result on a self-collected sample are not likely to continue to adhere to further recommended management

Answer:  FALSE! Research has shown that over 90% of study participants who required further investigation based on the result of their self-collected HPV test undertook the recommended next steps5. Impressive, right? Some screening participants may need some extra support, time and information if they are worried about having a pelvic examination. Cervical screening providers and practice nurses can help these participants overcome barriers by sensitively exploring their questions and concerns and discussing ways to make the test as comfortable and gentle as possible.

5. True or False: General practice involvement in clinical audits can improve the uptake of cervical screening.

Answer: TRUE!! This is where you come in… as a GP or Nurse Cervical Screening Provider, you have a critical role in engaging with underscreened patients and increasing their involvement in the National Cervical Screening Program. We know that involvement in quality improvement processes, such as a clinical audit, can significantly improve engagement with underscreened patients. VCS Foundation offers a HPV self-collection clinical audit, which has been accredited by the RACGP, ACRRM, APNA and ACN for CPD points. Completing the clinical audit may also qualify your clinic for a PIP QI incentive.

This excellent online course will step you through the whole process, so you can join the fight against cervical cancer.
What’s not to love!

HPV Self-Collection Clinical Audit

 

References

  1. Australian Institute of Health and Welfare 2019, Cancer screening, Canberra: AIHW. https://www.aihw.gov.au/reports-data/health-welfare-services/cancer-screening/overview
  2.  Australian Institute of Health and Welfare 2019. Cervical screening in Australia 2019. Cancer series no. 123. Cat. no. CAN 124. Canberra: AIHW.
  3. Annual Statistical Report 2014, Victorian Cervical Cytology Register, VCS Foundation, https://www.vcs.org.au/wp-content/uploads/2019/07/VCCR_StatisticsReport_2014_Digital_FinalApproved.pdf
  4. Sultana F, Roeske L, Malloy MJ, McDermott TL, Saville M, Brotherton JML. Implementation of Australia’s renewed cervical screening program: Preparedness of general practitioners and nurses. PLoS One. 2020;15(1):e0228042. Published 2020 Jan 29. doi:10.1371/journal.pone.0228042
  5. Arbyn M, Smith SB, Temin S, Sultana F, Castle P; Collaboration on Self-Sampling and HPV Testing. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ. 2018 Dec 5;363:k4823. doi: 10.1136/bmj.k4823. PMID: 30518635; PMCID: PMC6278587.
  6. Saville M, Hawkes D, Mclachlan E, Anderson S, Arabena K. Self-collection for under-screened women in a National Cervical Screening Program: pilot study. Current Oncology 2018 25/2/2018.
  7. Creagh NS, Zammit C, Brotherton JML, Saville M, McDermott T, Nightingale C, Kelaher M. Self‐collection cervical screening in the renewed National Cervical Screening Program: a qualitative study. Published 28 June 2021. Med J Aust. doi: 10.5694/mja2.51137