Frequently asked questions for providers
On this page:
- Why is the NCSP stopping screening for women aged under 25 years?
- When does screening commence in other countries?
- Should women aged 20 to 24 years old continue to have cervical screening prior to raising the age for screening?
- What should happen for women aged 20 to 24 years old who have had abnormal smears?
- If there is little benefit to screening women aged 20 to 24 years old, why can’t I stop screening them now?
- When the age is raised to 25, what should happen for women aged 20 to 24 years old who have already started screening?
- When the age is raised to 25, what should happen for women aged 20 to 24 years old who have had an abnormal smear?
- When the age is raised to 25, what should I tell women aged 20-24 who request a smear?
- Are there any exceptions to this guidance?
- Will the change in start age mean that there will be an increase in women between 25 and 30 years being diagnosed with cervical cancer?
- If screening of under-25s could pick up just one case early, wouldn’t this be worth it?
- What if a woman has symptoms?
- Does this decision save the Ministry of Health money?
- What impact does HPV vaccination have?
- Additional guidance
- Screening women who are aged 20 to 24 years has been shown to be ineffective at preventing cervical cancer. Screening younger women results in investigating and treating abnormalities that often resolve on their own in a high proportion of women. Further investigations and colposcopy can cause anxiety, and treatment can cause some harm. Increasing numbers of women in this age group are being vaccinated against HPV, and this provides much greater protection to 20 to 24 year old women than a screening programme can.
- Most organised screening programmes and the World Health Organization’s International Agency for Research on Cancer recommends starting screening at the age of 25 years or older. Australia, England, Wales, Scotland, Ireland, France, Belgium, Italy and Norway start screening at 25 years of age. Many other European countries, such as the Netherlands and Finland, start screening at age 30 years.
Before the screening age change
Should women aged 20 to 24 years old continue to have cervical screening prior to raising the age for screening?
- Until the age of screening is raised to 25 years of age, women aged between 20 and 24 years should continue to have cervical screening according to the current pathway. This includes commencing screening at 20 years old if ever sexually active. If this is normal continue with a repeat smear one year after the first and three yearly thereafter.
- Women with abnormal smear results should continue on the current investigation and management pathway.
If there is little benefit to screening women aged 20 to 24 years old, why can’t I stop screening them now?
- The clinical pathways that women aged 20 to 24 years should follow during this transition period are in development and will be provided as part of the communications before the change in 2019.
- The NCSP Register is set up to function well in the current NCSP screening programme. It is important to maintain the integrity of the current screening programme until specific changes are implemented, otherwise women are at risk of ‘falling through the cracks’.
At the point of changing the screening age
When the age is raised to 25 years, what should happen for women aged 20 to 24 years old who have already started screening?
- When the age of screening is raised to 25 years, women aged 20 to 24 years who have already started screening should continue on the current clinical management pathway.
When the age is raised to 25 years, what should happen for women aged 20 to 24 years old who have had an abnormal smear?
- If an abnormality has already been identified in a woman aged 20 to 24 years, the current clinical management pathway should be followed.
When the age is raised to 25 years, what should I tell women aged 20 to 24 years who request a smear?
- Evidence shows there is little benefit to cervical screening for women aged 20 to 24 years and there is a risk of harm. A copy of the evidence paper is available: Evidence supporting decision to stop cervical screening in women aged 20–24 years (Word, 2 MB)
- Women who have concerning symptoms, such as abnormal vaginal bleeding or bleeding that does not respond to appropriate treatment, persistent discharge or pelvic pain, should see their health care provider who will arrange appropriate tests.
- In some exceptional circumstances, screening may be appropriate for women younger than 25 years of age. Women who have experienced childhood sexual abuse or early sexual activity, and women who are immune-deficient may be in this category.
- Abnormal bleeding and symptoms.
Will the change in start age for cervical screening mean that there will be an increase in women between 25 and 30 years being diagnosed with cervical cancer?
- Research in the United Kingdom specifically looked at this issue. There is evidence that screening women aged 20 to 24 years has had little or no impact on rates of cervical cancer up to the age of 30 years.
- England changed its screening age in 2003, and since then, there has been no increase in cervical cancer mortality in women aged 20 to 24 years old or for 25 to 30 year old women.
- Promptly following up and treating young women with symptoms would have a greater impact on survival for 20 to 24 year old women who develop cervical cancer than screening the entire population. Cervical cancers in this age group are rare and not usually detected by screening because of rapid progression of the disease.
- If a woman has symptoms suspicious of cervical cancer, she requires prompt further investigation.
- If a woman is concerned about symptoms, such as abnormal bleeding or bleeding after sexual intercourse, persistent vaginal discharge or pelvic pain, she should see her doctor as soon as possible.
- The most important consideration in making the decision to cease cervical screening for women under 25 years is that screening is ineffective in this age group. Cancer in women under 25 years is rare and seldom detected as part of routine cervical screening. There is always pressure on health funding - we cannot afford to spend money on activities that don’t make a difference.
- HPV immunisation is the most effective way to reduce the incidence of cervical cancer at any age. Those women who commenced vaccination with Gardasil-4 in 2007 at 12 to 14 years old will be 24 to 26 years old when the transition is made in 2019. Vaccination with Gardasil-4 provides protection against HPV-16 and 18 as well as two other types of HPV that cause genital warts. Gardasil-9, which protects against seven high-risk HPV types, is now fully funded for both males and females up to and including 26 years old, providing even greater protection for a wider range of HPV types associated with cervical cancer. Those women who have not been immunised also achieve some protection because there is less HPV infection in the community as a result of the widespread immunisation of the population in this age group.
Intermenstrual bleeding (IMB) and other irregular bleeding patterns are common. Although most women investigated for abnormal vaginal bleeding do not have serious disease, abnormal vaginal bleeding can be associated with genital tract malignancy and premalignant conditions, as well as other conditions such as polyps, adenomyosis, leiomyomas, coagulopathies, ovulatory disorders, endometrial disorders and iatrogenic causes. Postcoital bleeding (PCB) in particular warrants investigation because it may be a symptom of cervical cancer.
Abnormal vaginal bleeding is relatively common in the 20 to 24 year age group.
Women under 25 years old should be properly evaluated for abnormal vaginal bleeding. This includes a thorough history (menstrual, contraceptive and sexual). If there is a suspected oral contraceptive problem, then it is appropriate to modify the oral contraceptive. If there is PCB, persistent bleeding or other signs and symptoms suggestive of malignancy, a speculum and pelvic examination must be performed.