Australian Doctor 8th March issue | Page 22

8 MARCH 2024

Figure 3 . Cervical cancer mortality , ages 25-74 , 2016-2020 . Source : AIHW National Cervical Screening Program monitoring report 2022 5

Figure 4 . HPV immunisation rates by sex and Indigenous status 2022 . Source : Australian Immunisation Register 6

PAGE 20 and took some years to complete . During this time there was frustration with the inability to access patient information but functionality of the NCSR has now improved significantly .

The register can be accessed through the Provider Digital Access portal ( PRODA ). 8 It can also be integrated into practice software including Best Practice Premier , MedicalDirector Clinical and Communicare . The NCSR is working to broaden access to other proprietary software .

Such access helps clinicians to assess a patient ’ s frequency of screening and management options . Routine use may prevent out-of-phase testing .

The NCSR also offers a participant portal ; this may be of use to some program participants in the monitoring of their own screening history .

The register has a vital role in recruitment . It is a call-and-recall register that sends out invitation letters to women once they reach screening age ( 24 years and nine months ) and reminders when the five-yearly follow up is due .

It also operates a safety net by sending out follow-up queries to both patients and practitioners after abnormalities have been detected .

Another significant role for the NCSR is monitoring the screening program . Any public-funded screening program needs appropriate PAGE 24

Co-test ( HPV + LBC ) • Symptomatic ( provide details of symptoms ) Any age , no time restriction

HPV test

LBC test

• DES exposed

• Test of Cure , previous HSIL

• Follow-up , previous AIS

• Follow-up 12-month repeat test

• Immune-deficient

• Early sexual debut (< 14 years ) prior to vaccination

• Previous unsatisfactory HPV test

• Following HPV ( not 16 / 18 ) detection in a self-collected sample

• Previous unsatisfactory LBC test

Aged 20 – 24 years ( 1 test only )

VAGINAL TESTS Reason for test Medicare restrictions

Must have previous cervical MBS screening item

Must have previous cervical MBS screening item

Vaginal co-test ( HPV + LBC ) • Hysterectomy and previous HSIL Test of Cure not complete prior to hysterectomy

Vaginal HPV test • Previous hysterectomy without evidence of cervical pathology

• Previous hysterectomy screening history unknown

• Previous unsatisfactory vaginal HPV test Must have previous vaginal MBS screening item Vaginal LBC test • Previous unsatisfactory vaginal LBC test Must have previous vaginal MBS screening item

SELF-COLLECTED HPV TEST Reason for test Medicare restrictions

Self-collected HPV test ( vaginal )

• Asymptomatic screening

• Refused speculum examination

• Follow-up at 12 months following positive HPV ( not 16 / 18 ) and negative cytology

Aged 24 years and 9 months – 74 years ( 1 test in a 57-month period )

Figure 5 . MBS items when ordering a cervical screening test .