Frequently asked questions
HPV is a common virus spread through sexual activity. There are many different types of HPV, some of which are high-risk for the possibility of developing cancer, and some which are low-risk. Almost all cervical cancer is caused by genital infection with HPV. High-risk types of HPV can cause cell changes in the cervix which, if not treated, can lead to cervical cancer.
It is important to remember that a cervical screening test is not a test for cancer
HPV infection is very common. About four out of five people have an HPV infection at some time in their lives. For most women who develop an HPV infection it will disappear on its own and not develop into cervical cancer.
HPV immunisation aims to protect young people from HPV infection and the risk of developing cervical cancer and a range of other HPV diseases later in life.
From 1 January 2017, HPV immunisation is free for everyone, male and female, aged 9 to 26, including non-residents under the age of 18.
HPV immunisation is available through participating schools or from family doctors, local health centres and some Family Planning clinics.
Please visit the Ministry’s HPV immunisation webpage for more information.
Since the National Cervical Screening Programme was set up in 1990, the number of new cases of cervical cancer detected has decreased by around 50 per cent and the number of women who die from cervical cancer has declined by about 60 per cent.
With HPV immunisation, up to 70% of cervical cancers can be prevented but cervical screening is needed to detect the types of HPV that are not prevented by the vaccine.
International research has found that HPV primary screening is accurate and detects more women at risk of developing abnormal cell changes than the current testing method using cytology. HPV primary screening means that a cervical screen sample is first tested for the presence of an HPV infection.
Women with a negative HPV test are less likely to develop abnormal cell changes in the next few years than women with a negative cytology test. This is because the HPV test is more sensitive than cytology. Women can be confident that a negative HPV test means they are at very low risk of developing abnormal cells that may lead to cervical cancer within the next five years. This means that a screening interval of five years is safe.
The International Agency for Research on Cancer and the World Health Organisation have endorsed HPV testing as the primary method for cervical screening. Pilot studies have been undertaken in other countries and findings show that primary HPV screening is more sensitive than cytology. Countries changing to HPV primary screening, include England, Australia, and the Netherlands.
When planning the move to HPV primary screening in New Zealand, the Ministry of Health (the Ministry) commissioned research using New Zealand and international data. That research shows that primary HPV screening will be more effective for women than the current cytology test. This is true both for women who have been immunised against HPV and those who have not. Compared to the current screening programme the model predicted:
- cervical cancer incidence will be reduced by a further 15% in unvaccinated women and 12% in vaccinated women
- cervical cancer mortality will be reduced by a further 16% in unvaccinated women and 12% in vaccinated women.
The best way to protect against the HPV infection is to get immunised. The best way to protect against cervical cancer is to have the HPV immunisation and to attend 5-yearly cervical screenings for early detection of abnormal cervical cells.
Women aged 25 to 69 years will receive primary HPV screening.
HPV infection and the cell changes associated with it are common in women under the age of 25, particularly those who have not been immunised against HPV. In younger women, these infections commonly disappear on their own without needing treatment. Screening women under the age of 25 could lead to over diagnosis and over treatment.
Cervical screening identifies abnormalities that if left untreated might develop into cancer. An abnormal screening test leads to further investigation. If an abnormality is identified on the cervix, then part of the cervix may be removed to treat the abnormal area. This treatment can increase the risk of premature births for women who become pregnant after their treatment.
Before making a final decision about whether the starting age will remain at 20 years or change to 25 years additional analysis will be undertaken to:
- look at the number of cases and patterning of cervical cancer in New Zealand women
- assess the impact of New Zealand’s HPV vaccination levels on the number of cases of cell abnormalities in the 20-24 year age group
- assess the impact of the New Zealand’s HPV vaccination levels on the accuracy of cytology testing.
The most noticeable change for women will be that cervical screening will only be needed once every five years as opposed to every three years.
Your smear taker will take a sample just as before. What will change is the way the sample is tested in the laboratory. The sample taken by your smear taker will first be tested for the presence of HPV.
Women who test positive for the high risk HPV types (called HPV types 16 and 18) will be referred to colposcopy services. The laboratory will automatically perform a cytology test to assist the colposcopist with their clinical decision making. This is known as an adjunct test.
Women with other types of high-risk HPV will automatically have cytology performed on their samples to determine whether they are high or moderate risk for abnormal cell changes to help doctors make the best assessment and treatment decisions. This is known as reflex testing.
The diagram below illustrates the cervical screening pathway.
The change to HPV primary screening is likely to occur in 2018. Until the change, women should continue to get their cervical cytology samples taken when they are due and they should continue to be immunised against HPV if they are eligible to do so.
A key priority for the Ministry of Health is to improve access to cervical screenings for women who have never been screened or who have less cervical screening tests than recommended. The Ministry would like to see all women screened.
Extra support for women who have trouble accessing services is available. For more information go to the Ministry of Health’s National Cervical Screening Programme webpage.
If a woman is concerned about symptoms she should see her doctor as soon as possible. The doctor may take a cervical smear and refer for further clinical assessment by a specialist gynaecologist.
Symptoms to watch for include unusual bleeding between periods, an unpleasant smelly vaginal discharge and/or discomfort, pain or bleeding during or after sex.
In the future it is possible that some women will be able to take their own sample for HPV testing. There are still questions to address regarding how self-sampling would work in New Zealand and how women would be supported for any follow up testing or treatment required.
The Ministry of Health is funding further research about the acceptability and feasibility of self-sampling in New Zealand and is also investigating the effectiveness of different self-sampling devices.
Any self-sample test needs to be as safe and effective as a sample collected by a smear taker.
It is very likely that the number of cytology tests undertaken in New Zealand will reduce over time. Skilled cytology staff will still be needed to analyse cytology samples as all women who have a positive HPV test will also have a cytology test (reflex test).
As the changes are implemented there may be some temporary increase in volumes for laboratory and gynaecology services.
More work is being done to understand the impact on the health workforce.
The most important consideration is the opportunity to reduce the number of women who get cervical cancer and who die from it. The decision to move to HPV primary screening is based on evidence that it reduces the number of women who get cervical cancer and those who die from it.