Frequently asked questions
Why is the screening test changing?
The National Cervical Screening programme has saved thousands of lives in New Zealand with the help of the current cervical test (cytology or smear test) by identifying those at a higher risk of cervical cancer.
However, comprehensive evidence has shown that a new cervical screening test, called HPV Primary Screening, can identify those at a higher risk much earlier than the current test. So, New Zealand is moving to this new test from July 2023.
How is the test different?
Cervical screening’s primary aim is to identify people at higher risk of developing cervical cancer for further investigation. This is achieved by looking for early signs that can lead to these cancers. The current cervical screening test (cytology or smear test) requires a speculum examination every 3 years, where a sample is taken from the cervix and tested to determine if there are pre-cancerous cells changes in the cervix or vagina.
While the current test is effective, there is a viral infection that can be tested for that provides us a much earlier warning signal before cell changes have even occured. This viral infection is called human Papillomavirus (or HPV) and it is responsible for over 99 percent of cervical cancers and around 80 per cent of sexually active people will have had HPV infection at some stage. There are many types of HPV and only a few types of HPV will lead to abnormal, pre-cancerous cells that could progress to cancer. For most people, their body will clear the infection themselves, but persistent infection with HPV can lead to these abnormal cells developing in the cervix and some becoming cancerous.
So, the upcoming HPV test will instead identify if the HPV virus is present as the first test. This means that HPV primary screening can identify those who may need further testing at an earlier stage than the current test, making HPV primary screening a more effective test for identifying the risk of developing abnormal cell changes that may lead to cervical cancer in the first instance.
The new HPV screening test will also encourage more people with a cervix or vagina to take part in screening as it will include the option for self-testing. This will help reduce inequities for Māori and Pacific population groups/people.
Why does this mean you can extend the screening interval from 3 to 5 years?
Positive results from this new test will be fully investigated, as they are now, but for the majority the test will be negative. People 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 as the test is highly sensitive at picking up HPV infection, and cervical cancer usually takes many years to develop. So, any abnormal cells can be found and treated to stop them from becoming cancer. This means routine cervical screening will only be needed once every five years, not every three years as it is currently required by the current test.
Clinical modelling predicts the move to HPV screening will prevent about 400 additional cervical cancers over 17 years and will save around 138 additional lives. HPV testing, which is in place in Australia and several other European countries, has demonstrated the same increase in effectiveness and thus they have also adopted the 5-year screening interval.
What will people notice when HPV primary screening is introduced?
There will be some changes:
- The current cervical screening approach involves a clinician taking the sample using a speculum. In the new programme, the option of HPV self-testing with a vaginal swab will be available. This is expected to be more acceptable to participants. A clinician can also take the swab.
If the HPV test is positive, follow-up will be needed. This might include:
- a speculum exam to look at the cervix and check the cells
- a colposcopy, a procedure done in outpatients, where a specialist can inspect the cervix through magnification and may take a biopsy or remove an area of concern.
When the programme starts, people will need to see their health care provider for the HPV test, even when self-testing. The process will be that a doctor, nurse or other health care worker will explain how to do the test, and the person takes the test in a private area of the clinic. The health care provider may also arrange for the tests to be done off site, for example, at home, or in a non-clinical setting in the community. The clinic will be responsible for getting the sample to the laboratory.
In the future, the Ministry of Health will be looking at ways to make screening more accessible, which could include mailing-out self-testing kits if they are found to work safely and well.
Can people self-test now?
The change to new HPV primary screening programme will be implemented from July 2023.
The current cytology screening programme remains a high-quality programme by international standards and is effective at preventing many cases of cervical cancer.
During the transition to the new programme it is important that people continue with cervical cytology screening and not wait for the programme change in 2023.
Why is HPV immunisation important?
Persistent HPV infection is responsible for almost all cases of cervical cancer.
The vaccine is very effective in preventing infection from the nine types of HPV responsible for around 90 percent of the cancers caused by HPV.
Not all the HPV types that cause cervical cancer are in the vaccine, so people who have been vaccinated need to continue with regular cervical screening.
HPV immunisation is delivered through school-based immunisation programmes and is also available through your family doctor. HPV immunisation is free for everyone aged 9–26 years (inclusive), including boys and young men.
Please visit the Ministry’s HPV immunisation webpage for more information.
What if I’ve had the HPV vaccine, should I still be screened?
The HPV vaccine is highly effective, but not all the HPV types that cause cervical cancer are in the vaccine, which means it is still very important to have cervical screening to minimise the risk of cervical cancer.
Combining HPV immunisation with regular cervical screening is the most effective way you can protect yourself against cervical cancer.
What should I do if I am due for screening?
Regular cervical screening is the most effective way you can protect yourself against cervical cancer.
When the programme transitions to HPV primary screening from July 2023, participants will have an HPV test at their next scheduled screen. Regular screening at a 5-year interval will commence only after a negative HPV test is completed, so if you are due for your 3-yearly screen in August 2023, it will still be completed and if negative, 5-yearly from then on.
The current screening programme continues to be safe and effective, and it is important that people keep having their regular cervical screening tests, and not wait for the change to HPV primary screening in 2023.
People who are nervous or have concerns can talk to their health care provider. They will be able to help find ways to make screening more comfortable.
If you are concerned about symptoms that could be cervical cancer, see your doctor as soon as possible.
Symptoms to watch out for include unusual bleeding between periods, pain or bleeding during or after sex, a persistent discharge, and vaginal bleeding after menopause.
Visit Time to Screen for more information.
What about cervical cancers not caused by HPV?
Some kinds of cervical cancer are not caused by HPV, but these are very rare and are usually types of cancer that cervical screening tests cannot find early or prevent. They include cancer of the skin (melanoma) that has spread to the cervix and cancers of the muscles, nerves and connective tissues of the cervix.