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Screening for cervical cancer

Image of scientistsThe Pap test has been the usual way to screen for cervical cancer for many years. The Pap test is used to find abnormal changes in the appearance of cervical cells. Abnormal changes are present in women with increased risk of cervical cancer.

Human Papilloma Virus (HPV) is necessary for the development of cervical cancer. Apart from the conventional Pap test, there are now two new methods of screening for cervical cancer. One is the ThinPrep method which, like the Pap test, looks for abnormal cells. The ThinPrep method reduces the number of unsatisfactory tests due to contamination by inflammatory cells, blood or mucous which can obscure the cervical cells. The other is the QIAGEN Digene HPV (Hybrid Capture® II) test which is a very sensitive method of testing for HPV in cervical cells. This test detects the DNA of the virus and does not rely on changes in cell appearance. These two new tests can be performed by your doctor at the same time as the cervical smear. Mater Pathology performs all three types of tests.

What is HPV (Human Papilloma Virus)?

HPV is detected in almost all cervical cancers. There are about 100 different types of HPV. Some types infect the skin (common warts) and others infect the anogenital area, including the cervix. Thirteen HPV types are called "high-risk" because these types are the ones which may lead to cancer. There are other types of HPV which infect the cervix but they are not associated with cancer (low-risk types). These low risk types can cause genital warts.

In most people the immune system combats the HPV infection, including the "high-risk" HPV types and removes the virus from the body. Usually this happens without any symptoms and so most people are not aware that they have ever been infected with HPV. Most women infected with HPV will not develop cervical cancer or the precancerous forms of the disease. However, if high-risk HPV infection remains over many years, there is a greater chance of developing cell changes which may lead to cervical cancer.

Who can get an HPV infection of the cervix?

HPV is a very common infection and is transmitted sexually. The majority of people who have ever been sexually active will have been exposed to the virus. However, very few women progress to cervical cancer.

What are the symptoms of HPV infection?

In most cases, HPV is harmless and does not cause symptoms. Usually, a woman only discovers that she has HPV on cervical screening, since cell changes due to HPV infection can be recognised on Pap smear. These cellular changes can occur weeks, months or many years after initial infection. However, two-thirds of young women with HPV infection do not have an abnormal Pap smear.

What is the difference between the ThinPrep test, the QIAGEN Digene HPV test and the Pap test?

All tests are designed to detect women who are at increased risk of cervical cancer. These women can then be treated before a cancer develops.

The Pap test and the ThinPrep test are similar and used to recognise abnormal cellular appearances, which may be due to HPV infection or due to pre-cancerous or cancerous changes in a cell. The ThinPrep Test has the advantage of removing contaminants which interfere with the interpretation of the cervical cells, reducing the number of unsatisfactory or uncertain results. Also, since the sample is placed directly in fluid, other tests can be performed on the single sample, as required by your doctor, including the QIAGEN Digene Hybrid Capture test.

The QIAGEN Digene HPV test detects high risk HPV in a cervical sample directly and does not rely on detecting abnormal cell appearances. The Digene HPV test directly identifies infection of any of the high risk HPV types.

How is the specimen collected for ThinPrep and QIAGEN Digene HPV test?

Both of these new tests are obtained from the cervix in the same manner as collecting a sample for a Pap smear and can be done at the same time or on a separate visit. Cells are brushed off the cervix and sent to the laboratory for analysis by a pathologist. The same sample collected for ThinPrep analysis may be used for the QIAGEN Digene HPV test, or a dedicated Digene sampler can be used. Neither ThinPrep nor the QIAGEN Digene HPV test can be done on the same sample as the Pap smear. A report will then be issued to your doctor.

The ThinPrep and QIAGEN Digene HPV test may reduce the uncertainty and anxiety caused by abnormal or inconclusive Pap test results. They are very useful ways to discover if you may be at increased risk of developing cervical precancer or rarely, cancer, enabling your doctor to monitor you more closely.

Both new tests may prevent delays in receiving further appropriate investigation and management if your Pap test is mildly abnormal.

What happens after I have been tested?

The results of your tests will be used by your doctor to decide whether you need:

  • further investigations by a gynaecologist. These investigations usually include colposcopy, in which the gynaecologist looks directly at the cervix and may take a tissue sample for histology.
  • repeat screening before two years
  • whether you do not need to have anything other than the usual screening.

Why should I have a Digene HPV test?

Currently in Australia, women are advised to be screened for cervical cancer by a Pap test every two years. If you have a Digene HPV test at the same time and both tests are negative, you have a very low risk of developing precancerous abnormalities or cancer of the cervix. This result can be very reassuring. In fact, combining the two tests for routine screening for cervical cancer is so accurate, that screening with both Pap and Digene HPV tests has been adopted in the USA for women over 30 years old.

Digene HPV test has also recently been recommended in Australia for routine use in patients who have been treated for precancerous or cancerous lesions of the cervix, to make sure the disease has been cured.

In some special circumstances, HPV testing may be useful if some abnormal cells are detected by the Pap screen or if the Pap screen is hard to interpret.

Digene HPV testing is less useful than a Pap smear in women younger than 30 years old, because the HPV test can detect recent infections which will be quickly cleared by the body (which is very common in women younger than 30 years) and will not lead to lasting infection.

Cervical screening by cytology has led to prevention of many cervical cancers. The Digene HPV test is a new, modern test for the virus which causes cervical cancer. Negative Pap and Digene HPV tests indicate that you are at very low risk of cervical cancer. The Digene HPV test can reduce the number of investigations needed to decide whether you should be treated for cervical changes. Combining the Digene HPV test and the Pap test is very accurate at detecting cervical precancer and cancer.

24-hour collection service

Mater Private Emergency Care Centre
301 Vulture Street
South Brisbane

Phone: 07 3163 8500


Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-410025
Last modified 15/8/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 27/8/2015
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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